• Nicos Middleton, Jonathan A C Sterne, and David J Gunnell.
• Department of Environmental Health, Harvard School of Public Health, Landmark Center, 401 Park Drive, Boston, MA, USA. nmitlett@hsph.harvard.edu
• Health Place. 2008 Sep 1; 14 (3): 492-506.

AbstractThe incidence of suicide exhibits marked geographic variability; however, documentation of features in its spatial distribution, or the magnitude of differences, is limited. Standardised mortality ratios, commonly presented in maps, are calculated in each area independently and incorporate no information about heterogeneity or clustering. Bayesian hierarchical models with random effects for between-area and local variability in neighbouring areas were used to map age- and sex-specific estimates of rate ratios of suicide across wards in England and Wales. Differences were greater than expected due to random variation alone. Although the geography of suicide differed across age/sex groups, some common patterns emerged e.g. high rates in (a) central parts of cities and (b) remote and coastal areas. Some features were common to all, while others appeared male specific or specific to the younger age group. Suicide prevention strategies can be informed by an understanding and addressing the geography of suicide.

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