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Death by Suicide: a Report Based on the Northern Ireland Coroner's

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Death by Suicide: a Report Based on the Northern Ireland Coroner's Death by Suicide: A Report Based on the Northern Ireland Coroner’s Database Report prepared by Brendan Bunting (PI), Colette Corry, Siobhan O’Neill, Adrian Moore, Tony Benson, and Danielle McFeeters Funded by HSC Research and Development Division, Public Health Agency Contents Preface and Acknowledgements ....................................................................................................... 1 Executive Summary ............................................................................................................................. 4 Recommendations following from the current analysis .................................................................. 4 Recommendations based on current knowledge .......................................................................... 13 Part 1. Individual Characteristics .................................................................................................... 19 1.1. Suicide statistics in Northern Ireland ................................................................................... 19 1.2. The Bamford Review and ‘Protect Life-A Shared Vision’ ................................................. 20 1.3. Mental Health .......................................................................................................................... 21 1.4. Primary Care ........................................................................................................................... 23 1.5. Risk Factors and Services .................................................................................................... 24 1.6. Prior suicidal behaviour and completed suicide ................................................................ 25 1.7. Employment status and Occupation .................................................................................... 26 Methods ............................................................................................................................................... 29 2.1. Report Aims ............................................................................................................................. 29 2.2. The database .......................................................................................................................... 30 2.3. Data Structure ......................................................................................................................... 31 2.4. Data Items ............................................................................................................................... 32 2.5. Analyses................................................................................................................................... 33 3. Classification and socio-demographic pre-disposing risk factors ........................................... 35 3.1. Age and gender ...................................................................................................................... 35 3.2. Marital Status .......................................................................................................................... 36 3.3. Living arrangements ............................................................................................................... 37 3.4. Means of death ....................................................................................................................... 37 3.5. Characteristics and prior suicidal behaviour ...................................................................... 38 i 3.6. Alcohol intoxication at time of death .................................................................................... 40 3.7. Prescription medications at time of death ........................................................................... 41 3.8. Adverse events prior to death ............................................................................................... 45 3.9. Employment status and Occupation .................................................................................... 46 4. Use of Health Services and Diagnosis Prior to Death ............................................................. 49 4.1. Gender and service use ........................................................................................................ 49 4.2. Age and Service Use ............................................................................................................. 50 4.3. Diagnosis prior to suicide ...................................................................................................... 52 4.4. Risk factors associated with types of diagnosis in the deceased ................................... 54 4.5. Conclusions based on individual characteristics ............................................................... 57 References (part 1) ............................................................................................................................ 61 Part 2. Geographical Characteristics .............................................................................................. 66 Empirical Bayes Standardised Mortality Ratios for Geographically Aggregated Deaths by Suicide ............................................................................................................................................. 66 5. Deaths by suicide from 1971 – 2011 .......................................................................................... 67 6. Administrative areas ( LGDs), gender and recorded deaths from suicide ............................ 70 .......................................................................................................................................................... 70 Deaths by LGDs (adjusted for population size) ......................................................................... 70 Deaths by gender and LGD (adjusted for population size) ...................................................... 73 Neighbourhood effect on Suicide ................................................................................................. 74 LGD and Deprivation ..................................................................................................................... 76 7. Administrative areas (Wards and LGDs), deprivation and recorded deaths from suicide .. 77 .......................................................................................................................................................... 77 Deaths by Wards (unadjusted for population size) ................................................................... 77 Empirical Bayes Standardized Mortality Ratios (adjusted for population size) .................... 79 ii Pictorial representation of Ward Standardized Mortality Ratios (adjusted for population size) .................................................................................................................................................. 84 Wards within Local Government Districts (LGDs) ..................................................................... 86 Ward deaths controlling for deprivation ...................................................................................... 88 8. Administrative areas ( Wards), adjusted for LGDs, Wards and Age ..................................... 93 .......................................................................................................................................................... 93 Age, Gender, and Ward (descriptive statistics) ......................................................................... 93 Adjusted and unadjusted figures when making group comparisons ...................................... 95 9. Deaths within age categories (0-15, 16-39, 40-64 and 65+) controlling for size of respective populations and the clustering effects of Wards and LGDs ..................................... 97 .......................................................................................................................................................... 97 Random intercepts (4-levels) ....................................................................................................... 97 Deaths by age group, ranked by area deprivation .................................................................. 101 Random intercept model with covariates for age and deprivation ........................................ 103 Conclusions based on geo-demographic characteristics ...................................................... 105 Appendix ............................................................................................................................................ 108 Appendix 1. Publication ............................................................................................................... 108 Abstract ...................................................................................................................................... 108 References (part 2) .......................................................................................................................... 109 iii Preface and Acknowledgements The common perception is that deaths from suicide are largely preventable. The silent ‘but how?’ in the sentence is more problematic. This report sets out to address the issue of suicide by a search for those things that are associated with deaths by suicide. Few adults in society will have been fortunate enough not to have known someone who has taken his or her own life. On an individual level a wide variety of explanations are
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