The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average.
Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis.
Highland and Scotland 1978-98.
The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths.
Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.
"Highland Region has one of the highest rates of suicide in Scotland [4,5]. Deaths by drowning, firearms and by others gases and vapours (mainly due to car exhausts) are overrepresented in the Highlands in comparison with the rest of Scotland. "
[Show abstract][Hide abstract] ABSTRACT: As part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative, the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff. In this study of the dissemination and implementation of STORM (Skills-based Training On Risk Management), we set out to explore not only the outcomes of training, but key factors involved in the processes of diffusion, dissemination and implementation of the educational intervention.
Participants attending STORM training in Highland Region provided by 12 trained facilitators during the period March 2004 to February 2005 were recruited. Quantitative data collection from participants took place at three time points; immediately before training, immediately post-training and six months after training. Semi-structured telephone interviews were carried out with the training facilitators and with a sample of course participants 6 months after they had been trained. We have utilized the conceptual model described by Greenhalgh and colleagues in a Framework analysis of the data, for considering the determinants of diffusion, dissemination and implementation of interventions in health service delivery and organization.
Some 203 individuals completed a series of questionnaire measures immediately pre (time 1) and immediately post (time 2) training and there were significant improvements in attitudes and confidence of participants. Key factors in the diffusion, dissemination and implementation process were the presence of a champion or local opinion leader who supported and directed the intervention, local adaptation of the materials, commissioning of a group of facilitators who were provided with financial and administrative support, dedicated time to provide the training and regular peer-support.
Features that contributed to the success of STORM were related to both the context (the multi-dimensional support provided from the host organisation and the favourable policy environment) and the intervention (openness to local adaptation, clinical relevance and utility), and the dynamic interaction between context and the intervention.
BMC Health Services Research 01/2009; 8(1):246. DOI:10.1186/1472-6963-8-246 · 1.71 Impact Factor
"Crombie  found that some areas had higher rates of male suicide than the Scottish average, mainly in rural areas. Access to particular methods of suicide may contribute to this . Gender, age, suicide method and geographical area therefore appear to be important considerations in the epidemiology of suicide in Scotland. "
[Show abstract][Hide abstract] ABSTRACT: Male suicide rates continued to increase in Scotland when rates in England and Wales declined. Female rates decreased, but at a slower rate than in England and Wales. Previous work has suggested higher than average rates in some rural areas of Scotland. This paper describes trends in suicide and undetermined death in Scotland by age, gender, geographical area and method for 1981 - 1999.
Deaths from suicide and undetermined cause in Scotland from 1981 - 1999 were identified using the records of the General Registrar Office. The deaths of people not resident in Scotland were excluded from the analysis. Death rates were calculated by area of residence, age group, gender, and method. Standardised Mortality Ratios (SMRs) and 95% confidence intervals were calculated for rates by geographical area.
Male rates of death by suicide and undetermined death increased by 35% between 1981 - 1985 and 1996 - 1999. The largest increases were in the youngest age groups. All age female rates decreased by 7% in the same period, although there were increases in younger female age groups. The commonest methods of suicide in men were hanging, self-poisoning and car exhaust fumes. Hanging in males increased by 96.8% from 45 per million to 89 per million, compared to a 30.7% increase for self-poisoning deaths. In females, the commonest method of suicide was self-poisoning. Female hanging death rates increased in the time period. Male SMRs for 1981 - 1999 were significantly elevated in Western Isles (SMR 138, 95% CI 112 - 171), Highland (135, CI 125 - 147), and Greater Glasgow (120, CI 115 - 125). The female SMR was significantly high only in Greater Glasgow (120, CI 112 - 128).
All age suicide rates increased in men and decreased in women in Scotland in 1981 - 1999. Previous findings of higher than expected male rates in some rural areas were supported. Rates were also high in Greater Glasgow, one of the most deprived areas of Scotland. There were changes in the methods used, with an increase in hanging deaths in men, and a smaller increase in hanging in women. Altered choice of method may have contributed to the increased male deaths.
BMC Public Health 11/2004; 4(1):49. DOI:10.1186/1471-2458-4-49 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Suicide rates among men have increased in Scotland while falling in neighbouring countries. A national suicide prevention strategy has been produced. Previous work found that some rural areas of Scotland had higher than average rates of male suicide and undetermined deaths. This article describes the association between population density and suicide and undetermined death rates in Scotland.
Anonymised information on deaths from suicide and undetermined cause in Scotland were obtained from the General Registrar Office for 1981-1999, including information on postcode sector. Each postcode sector was assigned a deprivation and population density score. Loglinear models were used to examine the effects of time period (grouped into four periods), deprivation quintiles, population density (grouped into four categories) and their interactions in each sex in three age groups. A significance level of 5% was used throughout. Adjusted rate ratios and 95% confidence intervals were based on models that included only significant factors and interactions.
In men, there were higher rate ratios in the most densely populated and least densely populated quartiles, with intermediate rate ratios in other areas. There was no association with population density in women aged less than 25 years, a similar pattern to men in 25-44 year old women, and lower rates in rural areas in older women. Higher levels of deprivation were associated with higher rate ratios of suicide in both sexes and all age groups. Rate ratios over time increased in younger men and women, remained stable in older men, and declined in older women.
Deprivation is associated with higher rates of suicide and undetermined deaths at all levels of population density and in all age groups. The highest rates of suicide among men are in the most and least densely populated areas, after adjusting for deprivation. The effect is different among women, with no effect among younger women, and lower rates among older women in areas with lower population density.
Rural and remote health 7(3):672. · 0.88 Impact Factor
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