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Different Approaches Required For Monitoring Suicide Trends (p 961)

September 17, 2003

UK authors of a research letter in this week's issue of THE LANCET suggest that conventional methods for assessing trends in suicide rates-which show an overall reduction in suicide in England and Wales over the past two decades-have masked an important increase in suicide rates among younger men.

Health programmes in many countries include targets for reducing suicide. The conventional method for measuring population suicide trends involves analysis of suicides across all age-ranges combining male and female suicides. David Gunnell and Nicos Middleton from the University of Bristol, UK, propose that suicide assessment focusing on the potential years of life lost (PYLL) provides a different perspective on suicide trends. They report how analysis of routine mortality and census data for England and Wales shows that although age-standardised suicide rates fell by 18% between 1981 and 1998, the PYLL before age 65 years increased by 5%.

David Gunnell comments: "In England and Wales, favourable trends in overall suicide rates have masked an increase in PYLL from this cause. This masking has occurred because the standardised suicide rate is created by pooling different age-specific and sex-specific rates into a single summary measure, thereby ignoring the differing trends within specific population groups. This finding suggests that nations with similar patterns of suicide to those seen in England and Wales such as Australia and the USA, might also have reductions in overall suicide rates yet deteriorating rates in young people. Such deteriorations are especially important if they signify a decline in young people's mental health."

Lancet