Epidemiology of suicide and parasuicide.

The epidemiology of suicide (1970-1990) and parasuicide (1970-1989) in Great Britain is reviewed. A wide variation in suicide rates exists across Europe, and the rates in England and Wales fall considerably below the median. Although suicide accounted for only 0.7% of all deaths in 1990 in people aged over 15, it was the second most common cause of death among males aged 15-34 years. In 1990, the suicide rate for males was 19% above that in 1970, while in females the rate in 1990 was much lower than it had been during the 1970s. Male suicide rates exceed female rates in all 10-year age groups. The lowest rates of suicide in both sexes and in all age groups occur among married people, and the rates among semi-skilled (class IV) and unskilled (class V) manual workers are higher than those in the other four social classes. The leading methods of suicide are poisoning, hanging and domestic gas, though deaths by domestic gas poisoning had disappeared completely by 1990 with the detoxification of gas. Men use violent methods to a greater extent than women. Only two British centres, in Oxford and Edinburgh, have monitored episodes of hospital-treated parasuicide during the period of review. Both British cities have parasuicide rates greatly in excess of the European median. Between 1970 and 1989, annual parasuicide rates were higher for females than for males. Self- poisoning has been the predominant method used in parasuicide. Parasuicide is a behaviour mainly encountered during adolescence and young adulthood, and parasuicide rates decline with advancing age. The lowest rates of parasuicide are found among the married, and the highest among the divorced. A direct relationship exists between parasuicide and social class; the lower the social class, the higher the rate of parasuicide. The rates of parasuicide are considerably higher among the unemployed, with females at greater risk than males.