The Social Context of Suicide in England and Wales: a multilevel analysis

Student thesis: Phd


Suicide is a major public health concern in the UK, with recent published rates for England at 11.8 per 100,000 population for the year 2011. There has been extensive research into individual-level risk factors for suicide, though some suggest that ecological and social factors may also have an influence on suicide. The majority of the UK literature investigating this has examined suicide rates in relation to area-level deprivation or social fragmentation scores. Most of the research has not accounted for ecological fallacy (in this instance the erroneous assumption that factors associated with suicide at the group-level would be associated with suicide at the individual-level and vice versa).This thesis uses multilevel modelling to investigate differences in suicide by area, in order to account for both individual and area-level factors. Data from the 2001 UK Census, and the Office for National Statistics (ONS) were combined to create a complete case-control sample of suicide vs. non-suicide for the year 2001. This represents an alternative methodology for examining suicide incidence in England and Wales. Analysing this data by NHS Primary Care Organisation (PCO) for England, and Local Health Board (LHB) for Wales could influence how NHS services are allocated.UK Census data was then linked with patient data from The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), to examine suicide amongst both the general population and people in contact with mental health services. Analysing this data by PCO and LHB highlights specific risk factors for certain types of suicide in different areas in England and Wales. Again, this could influence the allocation of NHS services within particular areas.This study found that including information about individual-level characteristics explained the majority of variance in suicide types between areas. Social fragmentation was associated with certain types of suicide after controlling for individual-level factors, and was associated with suicide risk in the initial case-control sample. This suggests that social cohesion at a local level is important for suicide prevention, and for improving the mental health of the nation. This supports the goals of the National Suicide Prevention Strategy for England.
Date of Award1 Aug 2014
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorMark Tranmer (Supervisor) & Isabelle Hunt (Supervisor)


  • Suicide
  • England and Wales
  • Mental Illness
  • Multilevel modelling

Cite this