Suicide statistics repor t
Latest statistics for the UK and Republic of Ireland
September 2019
Contents
2
Suicide statistics report 2019
Samaritans – working together to reduce suicide 4
Samaritans’ response to recent trends in suicide 5
What are the recent trends? 5 What do the trends tell us? 6
Focus on young people 7
Trends in suicide among young people in the UK and ROI 7 Why do young people take their own life? 8 Young people and self-harm 8 Why do young people self-harm? 9 Why is the increase in self-harm concerning? 9 What do we want to see? 9
Samaritans’ response to suicide trends 10
What are Samaritans calling for? 10 What will Samaritans do? 10 What do we want to see? 11
Understanding suicide statistics 12
Suicide rates in the UK & Republic of Ireland 13
Suicides in the UK 14 Suicides in England 15 Suicides in Wales 16 Suicides in Scotland 17 Suicides in Northern Ireland in 2017* 18 Suicides in the Republic of Ireland 19
Journey to suicide statistics 20
Cause of Death 21 Registration 22 Coding 23 Calculating suicide numbers and rates 24 Reporting 25
Data sources used in this report 26 Other nationally available statistics 27
Additional notes on the statistics 28
The reliability and validity of suicide statistics 29 Further notes on narrative verdicts 31 Further notes on changes to coding rules 31 The availability of suicide statistics 32
References 33 Appendix: Data tables UK and Republic of Ireland 34
Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12:
UK suicide rates for all persons, males
and females and by age group, 2016–2018 35
UK suicide numbers for all persons, males
and females and by age group, 2016–2018 36
England suicide rates for all persons, males
and females and by age group, 2016–2018 37
England suicide numbers for all persons, males
and females and by age group, 2016–2018 38
Wales suicide rates for all persons, males
and females and by age group, 2016–2018 39
Wales suicide numbers for all persons, males
and females and by age group, 2016–2018 40
Scotland suicide rates for all persons, males
and females and by age group, 2016–2018 41
Scotland suicide numbers for all persons, males
and females and by age group, 2016–2018 42
Northern Ireland suicide rates for all persons,
males and females and by age group, 2015–2017 43
Northern Ireland suicide numbers for all persons,
males and females and by age group, 2015–2017 44
Republic of Ireland suicide rates for all persons,
males and females and by age group, 2016–2018 45
Republic of Ireland suicide numbers for all persons,
males and females and by age group, 2016–2018 46
There were 6,859 suicides in the UK and Republic of Ireland in 2018
3
Suicide statistics report 2019
Suicide statistics for the UK as a whole, England, Wales, Scotland, Northern Ireland and the Republic of Ireland are not routinely published together by any other organisation
Suicide statistics report
Authors: Charlotte Simms, Elizabeth Scowcroft, Mette Isaksen, Joe Potter and Jacqui Morrissey
iStock.com/tbradford
Samaritans – working together to reduce suicide
We can choose to stand together in the face of a society which may often feel like a lonely and disconnected place, and we can choose to make a difference by making lives more liveable for those who struggle to cope. We believe we can do this because we know that people and organisations are stronger together. Samaritans: Working together to reduce suicide 1
4
Suicide statistics report 2019
Samaritans’ vision is that fewer people die by suicide.
Suicide is not inevitable; it is preventable.
The causes of suicide are complex, but we know it is both a gender and an inequality issue. Behind every statistic is an individual with a family, and a community, devastated by their loss.
Samaritans’ strategy, Working together to reduce suicide 2015-21, outlines our commitment to reducing the number of people who die by suicide. To reduce suicide, we need to reach more people who may be at risk of taking their own lives. This can only be achieved by understanding which groups of individuals are more at risk of suicidal thoughts and behaviours.
This report pulls together data from national statistical agencies to provide an overview of the latest suicide rates and trends for the UK and Republic of Ireland.
Self-harm and suicide are increasing among young people and in this report we explore this issue in more detail. Reversing this worrying trend should
be a priority for governments and is a key area of work for Samaritans.
The report also presents some of the key challenges with suicide statistics, which can be unreliable and slow to be released. Timely access to accurate statistics is vital so that we can fully understand who is at risk of suicide.
In this report we take you on a journey to suicide statistics, from how the cause of death is established, through to what reported figures mean. Along the way we highlight key differences in the way countries produce suicide statistics, which influence how they are used and understood.
Recent trends in suicide
What are the recent trends?
Key facts from 2018:
• There were 6,859 suicides in the UK and Republic of Ireland.
• 6,507 suicides were registered in the UK and 352
occurred in the Republic of Ireland.
• The suicide rate in Scotland is the highest in the UK – where men aged 35-44 have the highest suicide rate.
• The highest suicide rate in the UK, and England, is among men aged 45-49.
• The highest suicide rate in Wales is among men aged 40-44.
• The highest suicide rate in the Republic of Ireland is among men aged 55-64. Key trends from 2018:
• There has been a significant increase in suicide in the UK, the first time since 2013 – this appears to be driven by an increase in the male suicide rate.
• In the UK, suicide rates among young people have been increasing in recent years. The suicide rate for young
• females is now at its highest rate on record.
In the UK men remain three times more likely to take their own lives
than women, and in the Republic of Ireland four times more likely.
• Suicide has continued to fall in both males and females in the Republic of Ireland.
Highest rate in the
ROI
19.5
Men
55-64 years
Highest rate in the
UK
27.1
Men
45-49 years
6,507
people died by suicide in the UK
5
Suicide statistics report 2019
352
people died by suicide in the ROI
What do the trends tell us?
It is worrying to see a significant increase in suicide in the UK, for both men and women. Although, the overall increase seems to be driven by the rise in male suicide.
The continued decline in suicide rates in the Republic of Ireland is encouraging.
Men remain around three times more likely to take their own lives than women in the UK, and four times in the Republic of Ireland. Middle aged- men are still at greatest risk of suicide overall. Our previous research has shown that there are unique factors affecting middle-aged men. Now this knowledge needs to translate into actionable ways to target this group.
In the UK, suicide rates increased in women aged 45-49 years. Over the past 2 years, the female suicide rates also appear to be increasing in Wales. This also shows that more evidence is needed to understand why women take their own life, and why rates are increasing.
It is also particularly concerning that suicide in young people is increasing in the UK. Suicide is complex and it is rarely caused by one thing. However, we know that some risk factors – such as self-harm and academic pressures – are particularly common among young people.
Suicide is not inevitable – it is preventable. Monitoring trends and changing suicide rates is key to understanding who is most at risk and what we can do to prevent suicide.
Impact of changes to coroners practices in England and Wales on 2018 data – In July 2018 the standard of proof used by coroners to determine whether a death was caused by suicide were lowered. The lowering of the standard of proof may mean that more deaths are registered as suicides (for further information see p.32).
6
Suicide statistics report 2019
Suicide is the biggest killer of young people2. In 2018, 759 young people took their own life in the UK and Republic of Ireland. Every single one of these deaths is a tragedy that devastates families, friends and communities.
Three quarters of deaths among young people are male, and rates are highest in men aged 20-24.
Suicide rates per 100,000, for young people in 2018
Trends in suicide among young people in the UK and ROI
In the UK, suicide rates increased for all groups of young people in 2018. Suicide rates among men aged 20-24 had been decreasing, but this year there was a significant increase of 30%.
In the Republic of Ireland, suicide rates have been decreasing
UK
ROI
9.7
5.1
Focus on young people
among young people since 2011.
Suicide rate per 100,000 for young people in the UK 2004-2018
20 18
16 14 12 10 8 6 4 2 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Male 15–19 years Female 15–19 years Male 20-24 years Female 20–24 years
7
Suicide statistics report 2019
9.0
4.4
15–19 years
16.9
5.1
20–24 years
Men
15–24 Women years
* ‘Young people’ refers to those aged 15-24 years. Data and evidence provided within this section are aligned to this age range as closely as possible. However, data is collated from multiple sources where age brackets and definitions may differ, and therefore will not necessarily always match the age range exactly.
Notes about data: Data source – Office for National Statistics (ONS) and Central Statistics Office (CSO). Data for the Republic of Ireland for 2017 and 2018 is provisional.
Rate per 100,000
Focus on young people…
Why do young people take their own life?
Suicide is complex and is rarely caused by one thing. It usually follows
a combination of adverse childhood experiences, stressors in early
life and recent events3. Research shows that bereavement, abuse, neglect, self-harm, mental or physical ill health, and experiencing academic pressures are just some of the common risk factors for suicide among young people.3 Of course, though, most young people will experience these stresses and not go on to take their own lives.
‘self-harm’ as any deliberate act of self-poisoning or self-injury without suicidal intent. This excludes accidents, substance misuse and eating disorders.
Self-harm is more common among young people than other age groups6. Self-harm increased across all age groups between 2000 and 2014, but it increased the most among young women7.
Percentage of adults in England reporting that they have self-harmed at some point in their lives
30 25 20 15 10 5 0
25.7
9.7
16-24
13.2
10.9
Female
Male
0.60.0 75+
9.2
6.6 5.0 5.0
25-34 35-44
3.3 3.3
45-54 55-64
1.8 2.0 65-74
Data source: Adult Psychiatric Morbidity Survey 20145
Young people and self-harm
A major concern is the increase in self-harm among young people over the last 15 years. Self-harm is a sign of serious emotional distress and, while most people who self-harm will not go on to take their own life, it is a strong risk factor for future suicide4,5.
There are many definitions of self-harm. Researchers, clinicians, charities and media all often use the term to mean different things. Samaritans defines
Academic pressures and bullying were found to be more common before suicide in young people under 203
Workplace, housing and financial problems were more common for 20-24 year-olds3
Suicide-related internet use was found in 26% of deaths in under 20s and 13% of deaths in 20-24 year-olds3
8
Suicide statistics report 2019
Findings taken from the The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Suicide by children and young people in England.
Percentage
• Stigma around self-harm is reduced leading to more young people who self-harm seeking help.
• Support is in place for every young person who needs it, with services available and being accessed.
• Everyone who self-harms is entered into a care pathway that meets their needs; social prescribing is offered where appropriate; and GPs have
the skills and resource to respond effectively to every person they see.
• Research is undertaken to better understand the link between self harm and suicide and which interventions are most effective in supporting those who self harm
In the coming months, Samaritans will work to secure policy and attitudinal change to help reduce rates of self-harm among young people. We will place the voices and experiences of young people at the heart of this work, using evidence to drive change, as well as adding to the existing evidence base through our research work.
9
Suicide statistics report 2019
Focus on young people…
Why do young people self-harm?
Self-harm is often used as a way of trying to obtain relief from emotional distress8 or expressing feelings that are difficult to communicate9. Evidence shows that people who self-harm may feel distress more intensely10 and
be more likely to try and avoid negative thoughts and feelings, even when doing so may lead to more harm in the long run11. In this way self-harm can become a repeated behaviour12, used as a response to emotional distress9.
However, research shows that longer term self-harm is ineffective at managing emotional distress12. And longer term self-harm
is associated with developing thoughts about suicide4.
Why is the increase in self-harm concerning?
We still don’t know enough about why self-harm is increasing among young people. The increase is concerning because it might lead to:
• self-harm becoming further normalised as a way to cope with emotional distress
• self-harm becoming a long-term response to emotional distress • an increase in future suicides
What do we want to see?
Self-harm needs to be prioritised by governments with ambitious, comprehensive plans put in place to achieve a reduction in the rates of self-harm. These need to include actions to ensure:
• Young people are aware of and equipped to use effective, healthy coping mechanisms when they are struggling.
Samaritans’ response to suicide trends
10
Suicide statistics report 2019
What are Samaritans calling for?
• We need improved data and further research into risk factors and high-risk groups. In particular, we need to understand more about ‘what works’ for high-risk groups, such as middle-aged men. We need to understand more about the transition from thinking about suicide to attempting suicide and which risk factors are most influential for at-risk groups.
• We need to know more about why rates of suicide are increasing among young people. This will help ensure appropriate support and interventions are available and targeted for those most at risk of suicide.
• The views of people with lived experience, including young people, should be at the heart of suicide prevention policy. National and local government should support a safe, supported network to enable on-going engagement with a representative group of people with lived experience.
• Governments should have in place comprehensive, ambitious, cross-government workplans that include clear actions on how to reach the two-thirds of people who die by suicide who are not in touch with mental health services.
• There should be improved, timely national data collection, minimising delays in registering and reporting suicide, to allow local areas to respond quickly to suicide and offer bereavement support.
• Local areas need more support and resources with sharing
of suicide prevention best practice, to reduce duplication and enhance effectiveness. Robust evaluation of activity that is rooted in public health and focused on impact and delivery is key.
What will Samaritans do?
We will continue to focus on the groups who are most at risk of suicide and who are hardest to reach. We will carry out new analysis to understand more about our callers. We’ll also undertake research to understand
more about the support available for people who self-harm, putting
the voice of people with lived experience at the centre of this work.
Middle-aged men continue to experience the highest rates of suicide of any demographic. We will undertake research to gain insight into ‘what works’ to prevent suicide among this group. We will also work to understand more about how inequality impacts on suicide risk among middle-aged men.
We will work to ensure the online environment is as safe as possible for young and vulnerable people. This will include working with online providers in the development of best practice standards, helping companies monitor and remove harmful content while promoting content that will help keep people safe.
Samaritans is currently developing new services to help people access emotional support in the ways that suit them. We are developing a new Online Chat service, which will provide one-on-one real-time written word emotional support 24/7 from a trained Samaritan; an Online Self-help tool, which will provide approved self-help resources for self-care; and a peer support tool, which will help people identify and support others in emotional distress. These new services will increase Samaritans’ capacity to support people who are struggling to cope and also offer effective alternative channels for those who prefer to access support digitally.
What do we want to see?
Improvements to the accuracy and availability of suicide data.
To improve the reliability and availability of data we need more accurate and timely statistics across the UK and Republic of Ireland, and are calling for the following:
• More timely reporting of suicide from the Northern Ireland Statistics and Research Agency (NISRA) to align with
the publication of statistics from other agencies
• National database of inquest and procurator fiscal findings In England, Wales, Northern Ireland and the Republic of
Ireland, coroners conduct detailed inquests when someone
dies unexpectedly, speaking to family members and friends to understand the life experiences affecting the person who died. But this information is kept locally in coroner records or within
the Procurator Fiscal Service and only basic demographics such as sex, age and location are reported nationally. This makes it difficult to research risk factors systematically and hugely restricts our knowledge of suicide. A centralised electronic database would overcome this issue and dramatically improve our understanding of the risk factors associated with people who die by suicide.
•
Revision of the statistical definition of suicide in the Republic of Ireland to align with the UK and other countries
In the UK, the statistical definition of suicide includes deaths and events of undetermined intent. This improves the accuracy of suicide statistics, as it accounts for the known underreporting
of suicides due to the misclassification of deaths. However, in the Republic of Ireland deaths of undetermined intent are not included in the national definition, which means that suicide is potentially underreported (see page 24 for further information).
• Review of the death registration process in England,
Wales, Northern Ireland and the Republic of Ireland
In Scotland the maximum time between a death and registration is eight days. In other countries, deaths are registered after an inquest, which means there can be delays of a year or more before a death is recorded and appears in suicide data. This makes it harder to pick up changes to suicide rates and respond quickly. We would like to see a process in line with Scotland (see page 22 for further information).
Measuring the success, or lack thereof, of efforts to reduce suicides, suicide attempts or the impact of suicide on society at large requires access to reliable and valid data.
World Health Organisation, 2014; Preventing suicide: A global imperative3
11
Suicide statistics report 2019
Understanding suicide statistics
Understanding suicide statistics can be tricky. Figures are not always as straightforward as they might appear. Below are some important things to consider when using suicide statistics:
• It’s all about rates per 100,000 The number of suicides in a group (e.g. in a country or a specific age group) can give a misleading picture of the incidence of suicide when considered alone. Rates per 100,000 people are calculated in order to adjust for the underlying population size. An area or group with a larger population may have a higher number of suicides than an area or group with a smaller population, but the rate per 100,000 may be lower.
• Age-standardised vs. crude rates “Age-standardised” rates have been standardised to the European population so that comparisons between countries can be made with greater confidence. “Crude rates” have not been standardised in this way and are a basic calculation of the number of deaths divided by the population (x100,000). The two types of rate are not necessarily comparable.
• Be careful of small groups/populations The size of populations should be considered when looking at suicide rates. Smaller populations often produce rates that are less reliable as the rates per 100,000 are based on small numbers. Therefore, differences in the number of suicides
may have a bigger impact on the rate than in a larger population. An example of this might be suicide in older people (e.g. over 80 years), as the population size is lower than in younger age groups.
• Rates for a whole country can mask regional variations It is important to note that within countries there are significant regional and local differences in suicide rates.
• Year-on-year fluctuations can be misleading It is important to look at suicide trends over a relatively long period of time. Increases and decreases year-on-year should not necessarily be viewed as ‘true’ changes to the trend that are attributable to any specific psycho-social factors (e.g. an increase in unemployment).
• Sensitive and responsible use of suicide statistics When talking about suicide publicly, including in the media, it is crucial to do so sensitively and responsibly, to minimise the risk of contagion (suicidal behaviour that seems to occur as a result of previous suicides or attempts by others). Also, when talking to particularly vulnerable groups, e.g. children and young people, caution should be taken with the use of statistics which although may be shocking, may have the effect of normalising suicide. Samaritans’ Media Guidelines provide advice for how to talk about suicide responsibly and sensitively.
12
Suicide statistics report 2019
Suicide rates in the UK & Republic of Ireland
6,859
people died by suicide in the UK and ROI+
Men Women 21.9 7.3
per 100,000
per 100,000
Women
Men
29.1* per 100,000
Women
8.5* per 100,000
Scotland
Men
15.9 4.9
per 100,000
per 100,000
1,674
women
+ Please note the total number of deaths does not equal the sum of the UK constituent nations and the Republic of Ireland. This is due to ONS including the deaths of non- residents in the UK total figure but not in regional breakdown of deaths in England and Wales. NRS and NISRA include deaths of non-residents as standard.
Rates for the UK are age standardised; rates for ROI are crude.
Please note not all nations collect data on suicide in the same way and therefore rates are not necessarily comparable.
Data sources: Office for National Statistics (ONS), Northern Ireland Statistics and Research Agency (NISRA) and Central Statistics Office (CSO).
*2018 data for Northern Ireland not yet available at time of publication.
This report will be updated when data becomes available before the end of 2019.
Northern Ireland
Republic of Ireland
Women
5,185
men
Wales
England
13 Suicide statistics report 2019
Men
11.7 2.9
per 100,000
per 100,000
Men
Women
19.1 6.9 per 100,000 per 100,000
6,507
people took their own life in 2018
Suicides in the UK
Middle aged men are still at greatest risk
Age groups with highest rate per 100,000
27.1
9.2
Men Women
Women
45–49 years
Scotland 14.1%
Suicide rates increased for people aged 20-24 and 45-49 in 2018.
The suicide rate
14
Suicide statistics report 2019
4,903 Wales men 3%
75% 17.2 per 100,000
1,604 women
25%
Suicide rate has risen by 10.9% The male suicide rate has increased 11% between 2017
and 2018.
The female suicide rate has increased by 10.2% between 2017 and 2018
England 12%
Northern Ireland 1.9%
5.4 per 100,000
20 15 10 5
0 2004 2006 2008 2010
Male
Overall
Female
increased among women aged 45–49 by 39.4%.
45–49 45-49 years years
Suicide rate per 100,000
in the UK 2004–2018
2012 2014
2016 2018
Notes about data: Data sources – Office for National Statistics (ONS), National Records of Scotland (NRS), Northern Ireland Statistics and Research Agency (NISRA). Suicide refers to deaths where the underlying cause is intentional self-harm and events of undetermined intent. Increases/decreases are based on one year of data and may not reflect longer term trends. Overall rates for women, men and all persons are age standardised. Rates broken down by age group are crude.
Rate per 100,000
2017 2018
Age g
England 12%
45–49 years
20 15 10 5
0 2004
45–49 years
increased significantly. The increase was 39.1%.
Suicide rate per 100,000 in England 2004–2018
2006 2008 2010 2012
2014 2016 2018
Male
Overall
Female
Notes about data: Data source – Office for National Statistics (ONS). Suicide refers to deaths where the underlying cause is intentional self-harm and events of undetermined intent. Increases/ decreases are based on one year of data and may not reflect longer term trends. Overall rates for women, men and all persons are age standardised. Rates broken down by age group are crude.
5,021
Suicides in England
Men aged 45-49 have highest suicide rate
roups with highest rate per 100,000
Men
20-24 years
people took 26.1 their own life in
Suicide rates increased
for people aged 20-24 8.2 and 45-49.
15
Suicide statistics report 2019
2018
3,800 men 76% 15.9
per 100,000
1,221 women
24%
Suicide rate has risen by 12% The male suicide rate has increased by 13.6% between
2017 and 2018.
The female suicide rate increased by 6.5% between 2017 and 2018.
Men Women
For the first time, the suicide rate for men aged 20-24
4.9 per 100,000
Rate per 100,000
2017 2018
349
people took their own life in 2018
252 men
Suicides in Wales
Men aged 40-44 have highest suicide rate
Age groups with highest rate per 100,000
33.6
Men
The female age group with the highest rate is not
shown because the Office for National Statistics x3 (ONS) considers data to be unreliable when there
are fewer than 20 deaths in an age group.
16
Suicide statistics report 2019
72%
97 women
28%
Suicide rate has decreased by 3%
Wales 3%
19.1 per 100,000
6.9 per 100,000
40–44 The male suicide rate is almost three times higher years than the female rate.
Suicide rate per 100,000 in Wales 2004–2018
25 20 15 10 5
0 2004 2006 2008 2010
Male
Overall
Female
2012 2014 2016 2018
Notes about data: Data source – Office for National Statistics (ONS). Suicide refers to deaths where the underlying cause is intentional self-harm and events of undetermined intent. Increases/decreases
are based on one year of data and may not reflect longer term trends. Smaller populations often produce rates that are less reliable, therefore, differences in the number of suicides may have a bigger impact on the rate than in a larger population. Overall rates for women, men and all persons are age standardised. Rates broken down by age group are crude.
The male suicide rate decreased by 8.6% between 2017 and 2018. The female suicide rate increased by 19% between 2017 and 2018.
Note about fluctuations shown in graph – the male and female suicide rates for Wales show a volatile pattern due to the relatively smaller number of deaths. Sharper increases and decreases between 2013 and 2015 may be due to registration delays and coroner processes; see ONS for further details.
Rate per 100,000
Suicides in Scotland
Men aged 35–44 have highest suicide rate
Age groups with highest rate per 100,000
784
people took their own life in 2018
581 men
74%
203 women
26%
Suicide rate has increased by 14.1% The male suicide rate has increased by 10.3%.
The female suicide rate has increased by 27.5%, following a decrease of 24.3% in 2017.
36.5
Men
The suicide rate among young 12.4 people aged 15-24 increased by
Scotland 14.1%
The rate for this age group is the years years highest it has been since 2007.
Suicide rate per 100,000
in Scotland 2004–2018
35–44 45–54
30 25 20 15 10 5
0 2004
Male
Overall
Female
2006 2008 2010 2012
2014 2016 2018
Notes about data: Data source – National Records of Scotland (NRS). Suicide refers to deaths where the underlying cause is intentional self-harm and events of undetermined intent. Increases/decreases are based on one year of data and may not indicate longer term trends. Overall rates for women, men and all persons are age standardised. Rates broken down by age group are crude. Data in the graph only includes deaths coded using ‘old-rules’. This is because data using ‘new-rules’ for 2011 to 2018 are not directly comparable to the previous years’ data.
17
Suicide statistics report 2019
21.9 per 100,000
7.3 per 100,000
Women
52.7% between 2017 and 2018.
Rate per 100,000
305
people took their own life in 2018
234 men
77%
71 women
23%
Suicides in Northern Ireland in 2017* Men aged 35-39 have highest suicide rate
Age groups with highest rate per 100,000
56.1
Men
Please note the suicide rate for
women aged 30–34 should be
22.1 used with caution as it is based x3
Women
on fewer than 20 deaths. The male suicide rate is three
18
Suicide statistics report 2019
29.1 per 100,000
8.5 per 100,000
Suicide rate has increased by 1.9% The male suicide rate increased by 6.1% between 2016 and 2017.
The female suicide rate increased by 8.1% between 2016 and 2017.
Although the data shows a fall in the overall suicide rate, Northern Ireland continues to have the highest rate in the UK. However, comparisons between nations should be made with caution, since rates are not directly comparable.
Northern Ireland 1.9%
35–39 30–34 times higher than the female years years rate.
Suicide rate per 100,000 in Northern Ireland 2003–2017
35 30 25 20
15 10 5
0 2002
2004 2006 2008 2010 2012 2014 2016
Male
Overall
Female
Notes about data: Data source – Northern Ireland Statistics and Research Agency (NISRA). *Data not yet available for 2018 at time of publication. This report will be updated when data becomes available before the end of 2019. Suicide refers to deaths where the underlying cause is intentional self-harm and events of undetermined intent. Increases/decreases are based on one year of data and may not reflect longer term trends. Smaller populations often produce rates that are less reliable, therefore, differences in the number of suicides may have a bigger impact on the rate than in a larger population. Overall rates for women, men and all persons are age standardised. Rates broken down by age group are crude.
Rate per 100,000
352
people took their own life in 2018
282 men
80% 11.7 per 100,000
70 women
20%
Suicides in the Republic of Ireland Men aged 55-64 have highest suicide rate
Age groups with highest rate per 100,000
55–64 15–24 used with caution as it is based years years on fewer than 20 deaths.
Suicide rate per 100,000 in the Republic of Ireland 2004–2018
25 20 15 10 5
0 2004
Male
Overall
Female
2006 2008 2010 2012
2014 2016
2018
Notes about data: Data source – Central Statistics Office (CSO). Suicide refers to deaths where the underlying cause is intentional self-harm, but does not include events of undetermined intent, meaning it is not directly comparable to UK data. Increases/decreases are based on one year of data and may not reflect longer term trends. Data for 2017 and 2018 is provisional.
19.5
Men
5.1
Women
The male suicide rate is four times higher than the female rate.
Please note the suicide rate for women aged 15–24 should be
x4
19
Suicide rate has fallen by 11.7%
The male suicide rate decreased by 11.2% between 2017 and 2018.
The female suicide rate has decreased by 13.6% between 2017 and 2018. Suicide statistics report 2019
2.9 per 100,000
Republic of Ireland 11.7%
Rate per 100,000
20
Suicide statistics report 2019
Journey to suicide statistics
To prevent suicide, we need to know how many people die by suicide, when, and where, so we know who is at risk. Understanding suicide statistics can help us to better target action and prevent suicides.
This section takes you on the journey to suicide statistics; from how a cause of death is established through to what reported figures mean. This helps us to understand how suicide data is generated so that we can use it effectively to inform our suicide prevention work.
Cause of Death
CAUSE OF DEATH
CAUSE OF DEATH
CAUSE OF DEATH
SUICIDE
OPEN VERDICT
NARRATIVE VERDICT
ACCIDENTAL
MISCLASSIFIED
CAUSE OF DEATH
21
Suicide statistics report 2019
When someone dies suddenly, the circumstances are investigated to establish the cause of death. In England, Wales, Northern Ireland and Republic of Ireland this is done by
a coroner, through an inquest. And in Scotland,
it is investigated by the Procurator Fiscal.
OR
However, sometimes it can be difficult to establish whether the cause of death was suicide, which can result
in deaths being misclassified.
A narrative verdict
gives a brief description about the circumstances surrounding the death
and is given instead of a short form verdict (such as ‘suicide’ or ‘accidental death’).
• In certain circumstances, a suicide might seem to be
an accident, rather than intentional – and so it might be recorded as an accidental death. For example, this
can occur in situations where the death involved a road traffic accident. It can also be difficult to determine whether there was intent
to die in situations of self- harm leading to suicide.
• Or there may not be enough evidence to say whether a death was either accidental or a suicide. When there is not enough evidence an ‘open verdict’ or ‘narrative verdict’ can be given.
Each of these factors can lead to the misclassification of suicides, which can lead to underreporting.
• Social or cultural factors may also influence verdicts. While suicide is no longer a criminal offence, ongoing stigma means suicide verdicts are sometimes less likely
to be given – particularly if there are cultural or religious taboos around suicide, and for the death of a child.
The difference in methods of suicide between males and females has been discussed by researchers for many years: males seem to choose more ‘final’ and ‘obvious’ methods than females. It may be that in methods more commonly
used by females, the intent cannot be determined (or assumed) as easily as in methods more common to males. This may, in part, explain some of the variation in rates between the genders, as there may be more under-reporting of suicidal deaths in females13.
22
Suicide statistics report 2019
In each country, all deaths are officially registered.
In Scotland deaths are registered within 8 days. In the rest of the UK and Republic of Ireland, deaths are registered after an inquest. This means that there can sometimes be registration delays of a year or more.
Delays in registration mean that some deaths may not appear in official statistics
for over a year. This means it takes longer for us to understand how many people, and which groups of people, are dying by suicide, which can prevent us from being able to respond to increases in suicide rates quickly.
CSO ONS
Once registered, information is collated by the national statistical agencies in different nations. You can find out more about the statistical agencies on page 26 of this report.
Coding Registration
After an inquest
Within 8 days
NISRA NRS
OPEN VERDICT
HARD TO CODE NARRATIVE VERDICTS
DEATH CERTIFICATE
DEATH CERTIFICATE
DEATH CERTIFICATE
DEATH CERTIFICATE
SHORT FORM VERDICTS
DEATH CERTIFICATE
SUICIDE
ACCIDENTAL
NARRATIVE
23
Suicide statistics report 2019
Once registered, the statistical agencies code deaths based on ICD coding rules provided by the World Health Organisation (WHO). Short form verdicts (such as suicide, accidental, and open verdicts) are easily coded in this way, however some narrative verdicts can be more problematic.
Narrative verdicts – Statistical agencies can code narrative verdicts as suicides
if the description clearly shows that the individual intended to take their own life. When this isn’t clear they are referred to as ‘hard to code’ narrative verdicts, which are coded as accidental deaths.
The use of hard-to-code
narrative verdicts has been
shown to have a real impact
on our understanding of
suicide. Increases in the use
of narrative verdicts and a
decrease in the use of suicide
verdicts may make it look like
In 2011, ONS, NRS and NISRA adopted a change in the classification of deaths in line with the new coding rules of
suicide rates are going down
14 more deaths could be coded with
when they might not be .
an underlying cause of ‘event of decreases undetermined intent’, which is included
increases
in the national definition of suicide (see box 1 on page 24). This change does not affect the Republic of Ireland statistics since their definition does not include deaths of undetermined intent (further information on changes to coding rules on page 31).
*Explanation taken from ScotPHO website, updated July 2018; scotpho.org.uk/health-wellbeing-and-disease/suicide/key-points
NISRA NRS
the WHO. The change resulted in some deaths previously coded under ‘mental and behavioural disorders’ now being classified as ‘self-poisoning of undetermined intent’ and therefore included in the suicide figures*. Theoretically, this could mean that
ONS
24
Suicide statistics report 2019
NISRA
CSO
After coding, each statistical agency calculates the total number of suicides. To do this they add together deaths that resulted from a range of different causes that describe what actually happened. The causes of death included
as suicides are determined by each country’s definition of suicide. However some countries use different definitions.
The UK’s definition includes deaths where the underlying cause is ‘intentional self-harm’ and ‘events of undetermined intent’. Including both helps to account for the problem
of under-reporting, mentioned on page 21.
Box 1: UK definition of suicide
NRS
ONS
Agencies also calculate suicide rates based on population data. This shows how many suicides there are per 100,000 people. This allows us to compare suicides between groups, as numbers can be misleading. For example, two places might have the same number of suicides but if one has a smaller population, their suicide rate will be higher.
Because of differences in processes and definitions, figures don’t always mean exactly the same thing in different countries (see previous steps in the journey). So, the ‘suicide rate’ in one country might mean something different to the rate in another. This means
that it can be unhelpful to compare them. Instead we can compare suicide trends between countries, considering increases or decreases over time.
Reporting
Calculating suicide
ICD-10 code
X60–X84 Y10–Y341
Y87.0/Y87.22
Table notes:
Description
Intentional self-harm
Injury/poisoning of undetermined intent Sequelae of intentional self-harm/injury/ poisoning of undetermined intent
adding up different things to get the total number
of suicides, so statistics about suicide in the UK and Republic of Ireland are not necessarily comparable.
The Republic
of Ireland’s definition is different from the UK. It does not include deaths of undetermined intent, only deaths of intentional self-harm.
1. Excluding Y33.9 where the coroner’s verdict was pending in England and Wales, up to 2006. From 2007, deaths which were previously coded to Y33.9 are coded to U50.9.
2. Y87.0 and Y87.2 are not included in England and Wales.
This means the Republic of Ireland and the UK are
After calculating the number and rates of suicides, each agency makes them available by publishing them or providing them on request, just like they do for births and
other deaths.
All agencies provide annual suicide statistics.
Agencies provide data for males, females and by age groups.
The national statistical agencies also report on the data by age groupings differently and this also impacts
on the comparability of data.
ONS provide data that includes suicides and self-inflicted deaths with undetermined intent for persons aged 10 and over.
ScotPHO does not present annual numbers or crude rates for ages 0-14 and 85+ in Scotland. NRS does however provide rates for all age groups and rates for all persons, males and females are based on all ages.
NISRA provide data that includes suicides and self-inflicted deaths with undetermined intent for persons aged 10 and over.
CSO does not present annual data by age groups. However, data will be provided on request and includes crude rates for ages 0-14 and 75+.
Other organisations also use
the statistics and publish further detail. For example, Public Health England and the Scottish Public Health Observatory provide statistics by local authority
area (see page 27 for further information and links to access). This is useful for understanding more about who dies by
suicide and where they are.
The journey to suicide statistics is complex and there
are also some key challenges that still need to be addressed to improve the accuracy and consistency of data.
However, suicide data is an important public health surveillance tool and gives us a powerful starting point to help us target our work to prevent future suicides.
Registration delays
In the UK, routine data reflect the date of death registration. However, because of registration delays some deaths may not have happened in that
25
Suicide statistics report 2019
year. In Scotland, deaths are registered within 8 days, so data will mostly include deaths that happened in that year.
In the Republic of Ireland, data represent when the death occurred, not when it was registered.
Data sources used in this report
Data sources – UK
The map shows the sources for the data shown in this report for the UK and Republic of Ireland in 2018 (published or obtained in 2019).
Rates provided by the ONS for the UK, England, and Wales, by ScotPHO for Scotland, and by NISRA for Northern Ireland are age-standardised to the 2013 European Standard Population for overall male, female and person rates. Rates broken down by age group are crude
(age specific) rates. Rates provided by CSO for the Republic of Ireland are all crude. Data provided for suicides in 2018 is provisional and subject to future revision.
*ONS also reproduce suicide rates for Scotland and Northern Ireland, however the rates produced by the respective national agencies are used within this report.
National Statistical Agencies
NISRA
Northern Ireland Statistics and Research Agency (NISRA)18. Source for Northern Ireland.
CSO
Central Statistics Office for Ireland (CSO)19. Source for Republic of Ireland.
NRS
The National Records of Scotland (NRS)16. Source for Scotland with data compiled by the Scottish Public Health Observatory (ScotPHO)17
ONS
Office for National Statistics (ONS)15. Source for combined UK data* and for England, and Wales.
26
Suicide statistics report 2019
Other nationally available statistics
ONS provides the number of suicides by Local Authority for England and Wales from 2002 to 2018, and age-standardised three-year aggregate suicide rates where the latest period is 2016-2018. These data can be downloaded from their website.
Public Health England (PHE) has created an online Suicide Prevention Profile which brings together a range of publicly available data. In the tool you can filter data by local authority area and regions of England to see which have higher, similar or lower than the national average suicide rates among different groups. It also includes local data for suicide risk factors, such as depression, mental health and unemployment, and service related local data such as emergency hospital admissions for intentional self-harm.
ScotPHO provides the number, crude rates and age-standardised rates of suicide in aggregate five-year periods from 1983–2018
for NHS Boards and Local Authorities in Scotland, which can be downloaded from their website. Data broken down by deprivation, which shows that the most deprived areas of Scotland have the highest suicide rates, are also available on the ScotPHO website.
NISRA provides the number of suicide deaths per year in Northern Ireland, from 1997–2017, by Local Government District, Health and Social Care
Trust, Parliamentary Constituency, Assembly Area, and by Urban Rural Classification. They also provide the number of suicide deaths by deprivation, from 2001–2017. No rates per 100,000 are available for this local or deprivation data. These data can be downloaded from their website.
CSO provide the number and crude rates of suicide, for the years 2018, 2017 and 2013 by county, which can be downloaded from their website.
27
Suicide statistics report 2019
Additional notes on the statistics
Measuring the success, or lack thereof, of efforts to reduce suicides, suicide attempts or the impact of suicide on society at large requires access to reliable and valid data.
World Health Organisation, 2014; Preventing suicide: A global imperative3
28
Suicide statistics report 2019
The reliability and validity of suicide statistics
Suicide statistics should be and are commonly used to directly influence decisions about public policy and public health strategies (including suicide prevention). It is therefore important that we understand the validity (are we measuring what we think we’re measuring) and reliability (do we measure in the same way, over time) of them to ensure we are basing decisions on good information.
Valid and reliable data about suicide is essential for understanding the scale of suicide, to identify those most at risk and to evaluate the effectiveness of interventions to prevent suicide.
Validity of suicide data
Validity refers to ‘how good’ the data is, and whether it is a measure of what we intend it to be. We need to understand whether suicide data actually tells us about suicide, and not another behaviour. The validity of suicide data is important since we need to be sure that data is an accurate representation of who is at risk so that we can target our work and prevent suicide. If suicide data does not give us a good understanding of who takes their own lives, interventions may not be targeted most effectively.
Reliability of suicide data
Reliability refers to whether data demonstrates consistency in measurement. We need to understand whether, if we counted the number of suicides
in a group twice, we would come to the same number. Having reliable
data about suicide is clearly important for being able to monitor and prevent suicides. In order to understand when, and for who, suicide
rates are increasing we must have a reliable measure of suicide.
Challenges with the validity and reliability of suicide data
In order to use suicide data effectively, and draw the right conclusions from
it, we need to understand and recognise the limitations in relation to the validity and reliably. This report details some of the complexities in the process for recoding and reporting suicides across the UK and Republic of Ireland. These different processes and definitions inevitably affect the validity and reliability of suicide data within and between countries; more detail about how this can impact on our understanding of suicide is provided over page.
29
Suicide statistics report 2019
Misclassification and the under-reporting of suicide
As mentioned earlier suicides are sometimes misclassified, which can lead to under-reporting since deaths are being recorded as something other than a suicide (see page 21). There are several factors that can lead to the misclassification of deaths, such as:
• Suicides appear to be accidental – in certain circumstances, a suicide might seem to be an accident, rather than intentional – and so it might be recorded as an accidental death.
• Social and cultural factors – while suicide is no longer a criminal offence, ongoing stigma means suicide verdicts are sometimes less likely to be given – particularly if there are cultural or religious taboos around suicide, and for the death of a child.
• Hard-to-code narrative verdicts – ‘hard to code’ verdicts are coded by statistical agencies as accidental deaths. This has been shown to have a real impact on our understanding of suicide (see page 21 for further information).
Each of these factors means that suicide data may not be capturing all suicides. And this may add to some systematic inaccuracies in suicide data; for example, it is suggested that female suicides are more likely to be coded as accidental or undetermined intent due to the methods chosen (see page 21), but there may also be other group characteristics which are more subtle and missed for other reasons.
Variation within countries
As discussed in the journey to suicide statistics, each country has their own process for recording, registering and reporting on suicides. Although there
are standard processes within a country, for the reasons mentioned above, data still may not be completely accurate, and suicide might for example be under-reported. In addition to this, the process for reaching a verdict about the cause of death is subjective, so suicide may not be consistently under- reported because one coroner might take a different approach to another.
Variation between countries
As well as the death registration processes being subject to interpretation and inconsistencies within a country, there are also inconsistencies between countries. There are some differences in the way countries register deaths and therefore how deaths are classified as suicides. This potentially undermines confidence in the value of comparing suicide statistics across countries. Lower or higher rates may be an artefact of lower or higher quality (or just different) registration procedures between countries,
rather than a reflection of true differences in suicide risk. For example, in the UK, deaths of undetermined intent are included in the definition of suicide, however in the Republic of Ireland these deaths are not included in the definition and are not represented in the data (see page 24).
For these reasons, some suggest that cross-country comparison should
not be made or assumed to provide any reliable information about
20
which populations may be at more risk of suicide . Others suggest that
the differences in coding and registration of suicides pose problems that make comparisons difficult, but not impossible, and that the rates should be compared with caution21. In this view, the differences are not enough to stop comparisons between countries and to do so would prove unhelpful in understanding the epidemiology of suicide.
30
Suicide statistics report 2019
Defining suicide
Silverman22 suggested over a decade ago, that there were more than 27 definitions of suicide used in the research literature. Today, the problem of defining and classifying suicide and suicidal behaviours in research is still a problem which hinders our understanding of the subject23. This adds another dimension to the problem of reliability, as suicide is defined differently by different researchers and research disciplines, and in different contexts
and professions. The recent high court ruling to lower the standard of proof required for a suicide verdict from criminal to civil (see page 32) means that the legal definition of suicide in England and Wales is more closely aligned with the definition of other professions and disciplines. This ruling is positive and is likely to improve the validity of suicide data as more deaths may be classified as suicides in future. However, the ruling will impact on the reliability of data and analyses will need to be taken to establish the effect on long term trends to inform how statistics are compared before and after the ruling.
There is a lack of research into the reliability of suicide statistics and there is a tendency in international data to under-report suicide24. Researchers have different views about the reliability of suicide statistics and how,
or even if, they can be used effectively. Some reject the use of official suicide statistics on the grounds of poor reliability; others argue that the statistics are still reliable enough to be used to establish trends over time.
What does this mean?
It can be argued that suicide statistics have poor validity (they might
not measure exactly what we think they measure) but reasonable reliability (they measure the same thing over time). This would mean
that, even if we accept the limitations to the statistics, the data is
still likely to have some temporal stability and any limiting factor
(such as those associated with misclassification) would be reasonably constant over time. Changes in rates and fluctuations may be valid if under-reporting remains stable over time20. The addition of deaths of ‘undetermined intent’ is a solution to the known under-reporting of suicide. In this way, suicide statistics will still give us valuable information about suicide over time and about different groups who may be at risk.
It is worth noting that, due to the subjective nature of registration and reporting and the complexity of suicidal behaviour and actions, it is inevitable that suicide statistics will never be completely accurate. It can be argued
that this will always be the case20 – the subjective nature of recording
deaths and the differences between countries’ registration processes
will forever pose a problem for any official statistics and their wider use. However, we still must address these issues and continue to do everything possible to limit these confounding factors, so that suicide statistics are as reliable as possible. Also, fluctuations and trends should not be ignored because of the issues of under-reporting, misclassification and limited reliability. All mortality figures will be subject to some degree of error,
but they do still provide valuable insights and predictive information25.
It has been suggested that over the last 50 years, the field of suicide research has failed to generate new and novel risk factors that can lead
to major advancements in the understanding and therefore prevention of suicide26. Perhaps improving the official data in this area is a place to start in moving the field forwards and ensuring we are measuring this phenomenon accurately in a valid and reliable way to understand it enough to advance.
Further notes on narrative verdicts
When there is not enough evidence to say whether a death was either accidental or a suicide an ‘open verdict’ or ‘narrative verdict’ can be given. Statistical agencies can code narrative verdicts as suicides if the description clearly shows that the individual intended to take their own life. When this isn’t clear they are referred to as ‘hard to code’ narrative verdicts, which are coded as accidental deaths. The use of hard-to-code narrative verdicts has been shown to have a real impact on our understanding of suicide. As the use of these narrative verdicts increases, the use of suicide verdicts decreases, which can make it look like suicide rates are going down when they might not be.
ONS have carried out analyses on the use of narrative verdicts, which suggest that for the 2015 data, the use of narrative verdicts does not seem to have a significant impact on suicide rates. However, they note that the increased use of such verdicts in Wales in particular, in previous years accounted for a sharp decline (and now a subsequent sharp increase) in the suicide rate (adding further support to the note of caution around over interpreting year-on-year fluctuations)14.
Further notes on changes to coding rules
As noted earlier in this report (see page 23) ONS, NRS and NISRA adopted a change in the classification of deaths in 2011, to align with new coding rules introduced by the World Health Organisation (WHO). The table below outlines what statistical agencies provide since they adopted this change, and the impact of the change on the comparability of statistics*.
Statistical agency
Data provided after coding change
Effect of coding change on comparability of statistical data
ONS
Only produce data using new coding rules.
Caution should be used when comparing data with old and new coding as they are not directly comparable. Preliminary analyses of the data suggest no significant change as a result of the coding changes; however, this finding should still be treated with caution.
NRS
Produce two sets of suicide data each year to reflect what figures would show using both the old and new coding rules.
When examining trends over time (older than 2011), data using the old coding rules should be used; 2011 onwards
data, based on the new rules, is not directly comparable to old data.
NISRA
Only produce data using new coding rules.
Preliminary checks have indicated only minimal differences to the coding change, and NISRA therefore does not expect that there will be a significant impact on the figures reported.
31
Suicide statistics report 2019
*The Central Statistics Office (Republic of Ireland) did not adopt the coding change introduced by the WHO and is not included in the table.
32
Suicide statistics report 2019
The availability of suicide statistics
Routine data on the epidemiology of suicide published by official
national statistical bodies are limited to age and gender, and age bands differ between countries. Data on socio-economic status are collected
by some statistical agencies but not routinely published, while other socio-demographic information (such as ethnicity) is typically not included in the recording of a suicide. ONS provide details about suicide methods/ cause of death, but these details are not included in this document.
Further notes on changes to coroners practice in England and Wales.
When someone dies suddenly, the circumstances are investigated to establish the cause of death. In England and Wales this is done by a coroner, through an inquest. In July 2018 the standard of proof used by coroners to determine whether a death was caused by suicide was lowered in England and Wales. Before this, for a death to be recorded as a suicide, the burden of proof was on a par with that of a crime. Coroners and jurors needed to be satisfied
that a person took their own life ‘beyond reasonable doubt’. The lowering
of the standard of proof, from criminal to civil, means that coroners and jurors may return a verdict of suicide on ‘the balance of probabilities’. This is likely to mean that more deaths will be classified as suicides in future. This is something that Samaritans and others have been calling for, for several years because we believe it will help get a more accurate picture of the number of people who take their own lives and help to reduce the stigma around suicide. The ONS will monitor the impact that this change has on suicide data.
References
1. Samaritans. Working together to reduce suicide: Samaritans strategy 2015 – 2021. http://www.samaritans.org/about-us/our-organisation/our-strategy. Updated 2015.
2. ONS. (2019). Deaths registered in England and Wales (series DR): 2018. United Kingdom: Office for National Statistics.
3. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) (2017) Suicide by children and young people in England. Manchester: University of Manchester, 2017.
4. Klonsky, E.D., May, A.M., & Glenn, C.R. (2013). The relationship between non-suicidal self-injury and attempted suicide: Converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231.
5. Mars, B., Heron, J., Klonsky, D.E., Moran, P., O’Connor, R, C., Tilling, K., Gunnell, D. (2019) Predictors of future suicide attempt among adolescents with suicidal thoughts or nonsuicidal self-harm: a population-based birth cohort study, The Lancet Psychiatry, 6, 327-337.
6. McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/ uploads/attachment_data/file/556596/apms-2014-full-rpt.pdf
7. McManus, S., Gunnell, D., Cooper, C., Bebbington, P.E., Howard, L.M., Brugha, T., Appleby, L. (2019). Prevalence of non-suicidal self-harm and service contact in England, 2000–14: Repeated cross-sectional surveys of the general population. The Lancet Psychiatry, 6(7), 573–581.
8. Wadman, R., Vostanis, P., Sayal, K., Majumder, P., Harroe, C., Clarke, D., Armstrong, M., Townsend, E. (2018). An interpretative phenomenological analysis of young people’s self-harm in the context of interpersonal stressors and supports:
Parents, peers, and clinical services. Social science & medicine, 212, 120-128.
9. Stänicke, L.I., Haavind, H., Gullestad, S.E. (2018). How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm. Adolescent Research Review, 3, 173-191.
10. Slabbert, A., Hasking, P., Boyes, M. (2018). Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury. Psychiatry Research, 269, 309-315.
11. Hayes, S.C., Strosahl, K.D., Wilson, K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press, New York, NY, US.
12. Chapman, A.L., Gratz, K.L., Brown, M.Z. (2006). Solving the puzzle of deliberate selfharm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371-394.
13. Cantor CH, Leenaars Aa, Lester D. Under-reporting of suicide in Ireland 1960–1989. Arch Suicide Res. 1997;3(1): 5-12.
14. Office for National Statistics. Suicides in the United Kingdom, 2015 registrations. Office for National Statistics. 2016.
15. Office for National Statistics. Suicides in the UK: 2017 registrations. http://www.ons. gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/ datasets/suicidesintheunitedkingdomreferencetables. Updated 2018.
16. NRS. Probable suicides: Deaths which are the result of intentional self-harm or events of undetermined intent. http://www.nrscotland.gov.uk/statistics-and-data/ statistics/statistics-by-theme/vital-events/deaths/suicides. Updated 2016.
17. ScotPHO. Suicide: Key points. https://www.scotpho.org.uk/health- wellbeing-and-disease/suicide/key-points. Updated 2017.
18. NISRA. Suicide deaths. http://www.nisra.gov.uk/publications/suicide-statistics. Updated 2017.
19. Central Statistics Office. Vital statistics yearly summary. http://www.cso.ie/en/ releasesandpublications/ep/p-vsys/vitalstatisticsyearlysummary2017/. Updated 2018.
20. Sainsbury P., Jenkins J. The accuracy of officially reported suicide statistics for purposes of epidemiological research. Journal of Epidemiology and Community Health. 1982;36(1): 43-48.
21. Gjertsen F. Head on into the mountainside–accident or suicide? about the reliability of suicide statistics. Suicidologi. 2000;5: 18-21.
22. Silverman M.M.. The language of suicidology. Suicide and LifeThreatening Behavior. 2006;36(5): 519-532.
23. Silverman M.M.. Challenges to defining and classifying suicide and suicidal behaviors. The International Handbook of Suicide Prevention. 2016:11.
24. Tøllefsen I.M., Hem E., Ekeberg Ø.. The reliability of suicide statistics: A systematic review. BMC Psychiatry. 2012;12(1): 1.
25. Goldney R.D.. A note on the reliability and validity of suicide statistics. Psychiatry, Psychology and Law. 2010;17(1): 52-56.
26. Franklin J.C., Ribeiro J.D., Fox K.R., et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin Journal. 2017;143(2): 187.
33
Suicide statistics report 2019
Appendix:
Data tables UK and Republic of Ireland
Appendices
Rate per 100,000 for persons aged 10+
Overall 10.4
Male 16
Female 5.0
Overall 10.1
Male 15.5
Female 4.9
Overall 11.2
Male 17.2
Female 5.4
UK suicide* rates for all persons, males and females and by age group, 2016-2018
Table 1
Rate per 100,000 by age group (years)
UK 2016
2017
Male Female
0.4† 0.4†
7.6 3.5
12.9 4.3
17.0 4.2
17.7 5.7
19.0 5.6
22.7 6.3
24.8 6.6
21.6 6.8
18.8 5.3
14.2 5.2
11.6 4.6
9.8 4.0
11.4 4.9
9.1 3.8
17.1 4.2
17.4 5.2
† Potentially unreliable rates due to low number of deaths in this age group.
10-14 0.1† 0.2†
15-19 5.3 7.5
20-24 10.4 14.8
25-29 10.9 17.5
30-34 12.0 19.1
35-39 11.8 19.0
40-44 15.3 24.1
45-49 14.9 23.1
0.4† 0.5† 0.3†
6.7 9.0 4.4
11.2 16.9 5.1
12.0 18.3 5.5
13.3 21.0 5.6
13.1 19.9 6.3
15.2 23.6 6.9
18.1 27.1 9.2
15.2 23.5 7.2
12.1 18.4 5.9
10.9 16.2 5.9
8.6 12.5 5.0
7.0 10.8 3.5
8.0 13.0 3.7
9.1 17.2 2.8
10.5 19.4 4.8
Overall Male
Female Overall
– 0.4†
2.9 5.6
5.7 8.7
4.2 10.6
5.0 11.6
4.7 12.2
6.7 14.4
6.9 15.6
2018
Overall Male
Female
50-54 15.1 22.0 8.3 14.1
55-59 13.2 19.9 6.6 11.9
60-64 9.9 14.4 5.5 9.6
65-69 8.0 12.0 4.2 8.0
70-74 6.8 10.1 3.9 6.8
75-79 6.3 10.4 2.7 7.9
80-84 8.2 14.7 3.2 6.1
85-89 8.2 15.0 3.9 9.2
90+ 10.7 22.1 5.8 9.0 *Suicide as defined by the Office for National Statistics – for coding and definition see box 1, page 22
9.9 20.7 5.0
35
Suicide statistics report 2019
Appendices
Number of deaths for persons aged 10+
Overall 5,965
Male 4,508
Female 1,457
Overall 5,821
Male 4,382
Female 1,439
Overall 6,507
Male 4,903
Female 1,604
UK suicide numbers for all persons, males and females and by age group, 2016-2018
Table 2
Number of deaths by age group (years)
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
85-89 90+
UK
2016 2017 2018
Overall Male Female Overall Male Female Overall
Male Female
5 3 2 16 8 8 16 10 6
199 145
441 323
491 397
530 419
494 395
640 498
688 526
699 503
535 400
350 250
290 212
195 137
135 103
131 102
81 57 61 38
54 207
118 367
94 483
111 515
99 523
142 586
162 713
196 658
135 500
100 347
78 278
58 211
32 172
29 100
144 63
279 88
389 94
389 126
403 120
458 128
559 154
496 162
388 112
251 96
195 83
146 65
114 58
65 35
247 169 78
467 363 104
544 420 124
592 466 126
572 432 140
607 468 139
814 603 211
711 541 170
519 390 129
401 291 110
293 206 87
228 168 60
178 134 44
152 126 26
249367 26
23 52 31 21 58 38 20
108 78 30
36
Suicide statistics report 2019
Appendices
Rate per 100,000 for persons aged 10+
Overall 9.5
Male 14.7
Female 4.5
Overall 9.2
Male 14.0
Female 4.6
Overall 10.3
Male 15.9
Female 4.9
England suicide rates for all persons, males and females and by age group, 2016-2018
Table 3
Rate per 100,000 by age group (years)
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-90 90+
England
2016
Male Female Overall
– – 0.3†
6.3 2.6 5.0
2017 2018
Male Female Overall Male Female
0.3† 0.3† 0.3† 0.4† 0.3†
6.5 3.4 5.7 7.6 3.8
11.0 3.6 10.2 15.3 4.7
14.1 4.0 10.2 15.2 5.2
15.6 5.0 11.7 18.6 4.8
16.8 4.8 11.3 17.3 5.4
19.8 5.8 13.4 20.9 6.0
22.4 6.3 17.1 26.1 8.2
19.7 6.2 14.2 22.0 6.6
17.2 5.2 11.1 17.0 5.5
13.3 4.4 10.3 15.2 5.5
11.7 4.4 8.1 11.6 4.7
9.7 4.0 6.8 10.8 3.2
10.5 5.0 8.2 13.8 3.4
9.9 4.0 9.8 18.6 2.8
18.2 4.2 11.0 20.5 4.8
15.0 5.8 10.4 21.5 5.3†
† Potentially unreliable rates due to low number of deaths in this age group.
Overall
–
4.5
9.0 13.5
9.4 14.9
10.6 16.6
10.6 17.1
14.0 21.9
13.9 21.7
14.0 20.2
12.3 19.0
8.9 13.0
7.3 11.0
6.2 9.2
6.3 10.4
8.2 14.5
8.8 16.7
11.3 21.7
4.4 7.4
3.7 9.1
4.6 10.3
4.2 10.8
6.2 12.8
6.3 14.3
8.0 12.8
5.8 11.2
5.0 8.7
3.8 7.9
3.5 6.7
2.8 7.6
3.3 6.6
3.9 9.7
6.8 8.7
37
Suicide statistics report 2019
Appendices
Number of deaths for persons aged 10+
Overall 4,575
Male 3,464
Female 1,111
Overall 4,451
Male 3,328
Female 1,123
Overall 5,021
Male 3,800
Female 1,221
England suicide numbers for all persons, males and females and by age group, 2016-2018
Table 4
Number of deaths by age group (years)
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
85-89
90+
England
2016 2017 2018
Overall Male Female Overall Male Female Overall Male Female
2 1 1 10 5 5 10 6 4
143 102 41
322 246 76
357 287 70
398 311 87
378 303 75
495 384 111
539 416 123
542 386 156
416 317 99
261 187 74
222 162 60
148 105 43
113 86 27
110 85 25
745420
55 32 23
155 104
261 199
349 273
387 293
392 304
440 339
549 426
502 380
388 296
261 194
229 163
51 178 121 57
62 358 277 81
76 391 294 97
94 443 351 92
88 420 319 101
101
123
122
92
67
66
456 353 103
648 491 157
555 424 131
398 299 99
313 227 86
228 159 69
186 141 45
153 119 34
175 121 54
137 88 49
90 59 31 137 115 22
836122 95 70 25
43 23 20 52 34 18
38
Suicide statistics report 2019
Appendices
Rate per 100,000 for persons aged 15+
Overall 11.8
Male 20.0
Female 4.0
Overall 13.2
Male 20.9
Female 5.8
Overall 12.8
Male 19.1
Female 6.9
Wales suicide rates for all persons, males and females and by age group, 2016-2018
Table 5
Rate per 100,000 by age group (years)
Wales 2016 2017 2018
Overall Male Female Overall Male Female Overall
Male Female
10-14 ———
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
8.8† 13.8† 3.4† 11.2
14.2 15.5† 12.8† 11.5
12.9 24.3 – 18.6
16.4 28.5 4.4† 16.7
15.4 27.6 3.4† 12.8
16.0 29.3 3.3† 20.7
11.7 23.1 – 21.9
14.0 19.4 8.8† 15.8
17.8 25.2 10.6† 14.0
10.8 18.9† 3.2† 15.5
16.3†
15.6†
32.7
24.9
19.2†
37.4
36.0
24.0
26.6
18.7†
10.8†
7.4†
18.1†
5.8† 6.9† 12.2† –
7.1† 12.2 18.5 5.1†
4.0† 15.5 24.8 5.9†
8.6† 12.7 21.2 4.2†
6.6† 19.6 27.5 11.9†
4.5† 20.1 33.6 7.0†
8.4† 17.5 20.9 14.2†
7.9† 18.5 30.6 7.0†
1.9† 13.2 18.4† 8.3†
12.5† 13.7 21.6 6.2†
6.2† 6.5† 5.6† 7.4†
3.5† 8.6† 7.1† 9.9†
4.7† 6.6† – 9.2†
11.6 19.7† 4.0†
8.4† 16.1† –
2.6† 5.6† –
9.4† 21.5† –
— –
10.1† 34.3† –
8.5
5.4
11.0
–
2.6† – 9.1† 20.7† –
13.5† 19.7†
10.1† 22.3†
9.5† 11.4† 14.4† 9.4†
– 16.8† 43.4† –
† Potentially unreliable rates due to low number of deaths in this age group.
39
Suicide statistics report 2019
Appendices
Number of deaths for persons aged 10+
Overall 322
Male 265
Female 57
Overall 360
Male 278
Female 82
Overall 349
Male 252
Female 97
Wales suicide numbers for all persons, males and females and by age group, 2016-2018
Table 6
Number of deaths by age group (years)
Wales 2016 2017 2018
Overall Male Female Overall Male Female Overall Male Female
10-14 00000011-
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
85-89
16 13 3 20 15 5 12 11 1
30 17 13 24 17 7 25 20 5
26 25 1 38 34 4 32 26 6
30 26 4 31 23 8 24 20 4
27 24 3 23 17 6 36 25 11
29 26 3 36 32 4 34 28 6
25 24 1 46 37 9 36 21 15
31 21 10 35 26 9 41 33 8
36 25 11 29 27 2 28 19 9
20 17 3 29 17 12 26 20 6
23 19 4 16 10 6 12 5 7
13 12 1 9 6 3 15 6 9
3 3 0 13 10 3 8 2 6
880110880
220743633
90+ 3 3 0 3 2 1 5 4 1
40
Suicide statistics report 2019
Appendices
Rate per 100,000 for all persons
All 13.6
Male 19.7
Female 7.6
All 12.8
Male 19.9
Female 5.7
All 14.6
Male 21.9
Female 7.3
Scotland suicide rates for all persons, males and females and by age group, 2016-2018
Table 7
Scotland 2016 2017 2018
Rate per 100,000 by
age group (years) All Male Female All Male Female All Male Female
0-14 ———
15-24 10.9 14.4 7.3
25-34 17.9 27.9 8.2
35-44 22.2 33.7 11.2
45-54 22.3 33.3 11.9
55-64 15.6 21.4 10.1
65-74 10.4 13.9 7.2
75-84 7.1 11.5 3.8
9.9 16.2 3.4 15.1
15.6 27.1 4.3 19.1
20.6 31.3 10.3 23.7
21.7 35.0 9.3 23.1
22.3 7.7
29.3 9.1
36.5 11.5
34.5 12.4
23.9 8.9
17.2 4.0
9.8 3.2
14.4 21.5
8.3 11.9
8.6 12.8
7.7 16.2
5.1 10.3
5.4 6.0
85+ – – – – – – – – –
Source: ScotPHO. New coding rules for all years, see page 30.
41
Suicide statistics report 2019
Appendices
Number of deaths for persons aged 10+
All 728
Male 517
Female 211
All 680
Male 522
Female 158
All 784
Male 581
Female 203
Scotland suicide numbers for all persons, males and females and by age group, 2016-2018
Table 8
Scotland 2016 2017 2018
Number of deaths by
age group (years) All Male Female All Male Female All Male Female
0-14 ———
15-24 25-34 35-44 45-54 55-64 65-74 75-84
72
130
148
178
108
48 24
100 30
110 38
129 49
72 36
64 53 11 96 72 24
115 99 16
137 102 35
172 134 38
102 74 28
142 108 34
158 119 39
180 130 50
117 84 33
59 47 12
20 14 6
58 37 21 47 32 15
23 16 7 28 18 10
85+ – – – – – – – – –
Source: ScotPHO. New coding rules for all years, see page 30.
42
Suicide statistics report 2019
Appendices
Rate per 100,000 for all persons
Overall 19.3
Male 30.3
Female 8.8
Overall 18.1
Male 27.3
Female 9.2
Overall 18.5
Male 29.1
Female 8.5
Northern Ireland suicide rates for all persons, males and females and by age group, 2015–2017*
Table 9
Northern Ireland
Rate per 100,000 by age group (years)
10-14* 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
2015 2016 2017
Overall Male Female Overall Male Female Overall
—0.30.5-1.7*
14.1 19.3 8.6 11.0 27.4 42.3 11.9 31.2 35.4 61.6 9.6 25.8 30.7 47.9 14.3 31.5 22.2 33.5 11.6 18.4 23.5 39.9 7.9 22.5 28.9 42.0 16.4 21.4 23.2 34.5 12.2 27.5 23.1 41.4 5.3 19.9 11.6 14.8 8.4 14.4 18.0 21.0 15.3 11.2 6.8 11.5 2.6 9.1
Male Female
3.4* – 11.7 5.4 38.2 17.7
48.7 12.9 40.7 22.1 56.1 11.2 50.6 9.9 39.6 10.6 37.0 11.9
25.7 1.7 20.2 6.0 6.9 6.6 10.7 2.4
18.0
41.0
37.2
57.6 6.3 31.3
3.5 8.6 20.8 28.3 14.5 30.7
31.1 6.5 32.9 35.8 9.8 29.7 31.4 12.0 24.7 38.8 16.6 24.3 28.1 11.9 13.5 18.6 10.3 13.0 16.1 6.5 6.7 11.0 7.4 6.3 19.9 6.6 3.5
5.5 12.2 – 12.6
2.6 6.2 – 2.5 6.1 – – – –
7.7 –
2.8 8.6 – – – – 5.4 15.9
–
Source: NISRA
43
Suicide statistics report 2019
*NISRA only include deaths for persons aged 10 and over in their suicide data. In 2017 *2018 data for Northern Ireland not available at time of publication. This report the rate calculation changed and is now based on the population of 10-14 year olds. It will be updated when data becomes available later in 2019.
was previously calculated using the population of under 15’s. Rates for this age group
may not necessarily be comparable with previous years.
Appendices
Number of deaths for all persons
Overall 318
Male 245
Female 73
Overall 297
Male 221
Female 76
Overall 305
Male 234
Female 71
Northern Ireland suicide numbers for all persons, males and females and by age group, 2015–2017
Table 10
Northern Ireland 2015 2016 2017
Number of deaths by age group (years)
Overall Male Female Overall Male Female Overall Male Female
10-14 —11-22-
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
90+ – – – – – – – – –
Source: NISRA
17 12 5 13 11 2 10 7 3
33 26 7 37 25 12 33 23 10
443863223938308
3829939354392514
261972218440337
292452721635296
3827112820832257
3022836251132248
262332316716151
11 7 4 14 9 5 13 10 3
16 9 7 10 7 3 6 3 3
541743541
33-75222-
11-11—- 85+ 1 1 – – – – 2 2 –
44
Suicide statistics report 2019
Appendices
Rate per 100,000 for persons aged 15+
Overall 9.2
Male 14.9
Female 3.6
Overall 8.2
Male 13.2
Female 3.3
Overall 7.2
Male 11.7
Female 2.9
Republic of Ireland suicide rates for all persons, males and females and by age group, 2016-2018
Table 11
Republic of Ireland 2016
2017 2018*
Overall Male Female Overall Male
Rate per 100,00 by age group (years)
Overall Male Female
Female
0-14 0.5 0.6 0.4
15-24 11.3 15.7 6.7
25-34 11.6 20.5 3.2
35-44 13.6 22.0 5.3
45-54 14.1 22.6 5.7
55-64 13.3 23.5 3.2
65-74 6.3 10.5 2.1
75+ 4.6 6.3 3.3
0.4 0.4 0.4 0.2 0.2 0.2
10.3 14.1 6.3 7.4 9.7 5.1
11.4 19.3 3.9 11.2 18.9 3.7
11.1 19.0 3.4 9.1 15.1 3.3
12.6 19.3 5.9 11.4 18.3 4.6
10.5 17.9 3.1 11.6 19.5 3.8
6.6 10.1 3.1 5.3 9.8 1.0
4.5 9.5 0.7 3.2 5.8 1.3
45
Suicide statistics report 2019
*Provisional data that will be finalised in subsequent years; provisional data reflects the suicides registered in that year, final data will reflect the suicides that occur in that year.
Appendices
Number of deaths for all persons
Overall 437
Male 350
Female 87
Number of deaths for all persons
Overall 392
Male 312
Female 80
Number of deaths for all persons
Overall 352
Male 282
Female 70
Republic of Ireland suicide numbers for all persons, males and females and by age group, 2016-2018
Table 12
Republic of Ireland
Number of deaths by age group (years)
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+
2016
Overall Male
Female
Number of deaths by age group (years)
0-24
Overall
64
2017*^
Male Female
44 20
Number of deaths by age group (years)
0-14
2018*^
Overall Male Female
2 1 1
45 30 15
70 58 12
70 57 13
74 59 15
61 51 10
21 19 2
9 7 2
5 3 2
65 46 19 25-34 73
76 65 11 35-44 84
101 81 20 45-54 80
88 70 18 55-64 54
67 59 8 65+ 37
23 19 4
12 7 5
60 13 15-24
71 13
61 19
46 8
30 7
25-34 35-44 45-54 55-64 65-74 75+
46
Suicide statistics report 2019
*Provisional data reflects the suicides registered in that year, final data will reflect the suicides that occur in that year.
^Data have been provided in different age ranges for confidentiality reasons.
Samaritans Registered Office
The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF T 020 8394 8300 F 020 8394 8301
samaritans.org
Founded in 1953 by Prebendary Dr Chad Varah CH CBE.A company limited by guarantee registered in England & Wales (757372) and a charity registered in England & Wales (219432) and in Scotland (SC040604).
Persona Insight 