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Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations.
BJPsych Open. 2020 Jun 01; 6(4):e57.BO

Abstract

BACKGROUND

Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie.

AIMS

To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum.

METHOD

National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined.

RESULTS

Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004).

CONCLUSIONS

Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context.

Authors+Show Affiliations

Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK.Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK.Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK.Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, UK.Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester; and Greater Manchester Mental Health NHS Foundation Trust, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32475363

Citation

Steeg, Sarah, et al. "Suicide Rates and Voting Choice in the UK's 2016 National Brexit Referendum On European Union Membership: Cross-sectional Ecological Investigation Across England's Local Authority Populations." BJPsych Open, vol. 6, no. 4, 2020, pp. e57.
Steeg S, Webb RT, Ibrahim S, et al. Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations. BJPsych Open. 2020;6(4):e57.
Steeg, S., Webb, R. T., Ibrahim, S., Appleby, L., & Kapur, N. (2020). Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations. BJPsych Open, 6(4), e57. https://doi.org/10.1192/bjo.2020.32
Steeg S, et al. Suicide Rates and Voting Choice in the UK's 2016 National Brexit Referendum On European Union Membership: Cross-sectional Ecological Investigation Across England's Local Authority Populations. BJPsych Open. 2020 Jun 1;6(4):e57. PubMed PMID: 32475363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suicide rates and voting choice in the UK's 2016 national Brexit referendum on European Union membership: cross-sectional ecological investigation across England's local authority populations. AU - Steeg,Sarah, AU - Webb,Roger T, AU - Ibrahim,Saied, AU - Appleby,Louis, AU - Kapur,Nav, Y1 - 2020/06/01/ PY - 2020/6/2/entrez PY - 2020/6/2/pubmed PY - 2020/6/2/medline KW - Epidemiology KW - mortality KW - suicide SP - e57 EP - e57 JF - BJPsych open JO - BJPsych Open VL - 6 IS - 4 N2 - BACKGROUND: Individual- and area-level risk factors for suicide are relatively well-understood but the role of macro social factors such as alienation, social fragmentation or 'anomie' is relatively underresearched. Voting choice in the 2016 referendum on the UK's membership of the European Union (EU) provides a potential measure of anomie. AIMS: To examine associations between percentage 'Leave' votes in the EU referendum and suicide rates in 2015-2017, the period just prior to, and following, the referendum. METHOD: National cross-sectional ecological study of 315 English local authority populations. Associations between voting choice in the EU referendum and age-standardised suicide rates, averaged for the years 2015, 2016 and 2017, were examined. RESULTS: Overall there was a weak, but statistically significant, positive correlation between the local authority-level percentage 'Leave' vote in 2016 and the suicide rate 2015-2017: Pearson's correlation coefficient, r = 0.17; P = 0.003. This relationship was explained by populations having an older age distribution, being more deprived and lacking ethnic diversity. However, there was divergence (likelihood ratio test for interaction, χ2 = 7.2, P = 0.007) in the observed associations between London and the provincial regions with Greater London having a moderately strong negative association (r = -0.40; P = 0.02) and the rest of England a weak positive association (r = 0.17; P = 0.004). CONCLUSIONS: Deprivation, older age distribution and a lack of ethnic diversity seems to explain raised suicide risk in Brexit-voting communities. A greater sense of alienation among people feeling 'left behind'/'left out' may have had some influence too, although multilevel modelling of individual- versus area-level data are needed to examine these complex relationships. The incongruent ecological relationship observed for London likely reflect its distinct social, economic and health context. SN - 2056-4724 UR - https://www.unboundmedicine.com/medline/citation/32475363/Suicide_rates_and_voting_choice_in_the_UK's_2016_national_Brexit_referendum_on_European_Union_membership:_cross-sectional_ecological_investigation_across_England's_local_authority_populations L2 - https://www.cambridge.org/core/product/identifier/S2056472420000320/type/journal_article DB - PRIME DP - Unbound Medicine ER -
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