Sociodemographic characteristics

Single and divorced people were over-represented among suicide attempters in the WHO/EURO study. (l!> In Leiden, a region in the western part of The Netherlands, the rates of attempted suicide were highest among divorced women (248 per 100 000) and divorced men (191) and lowest for the widowed (39 for women, 16 for men)/21 Compared with the general population those with low levels of education, the unemployed, and the disabled are significantly overrepresented among suicide attempters. About 22 per cent of the male and 15 per cent of the female suicide attempters in the Dutch region areas were unemployed versus 3 per cent and 2 per cent for the male and for the female corresponding general population (15-64 years). About 57 per cent had a low level of formal education, the majority had no vocational training. When expressed in rates per 100 000 for the Dutch part of the study it appeared that the unemployed (322 for males, 455 for females) and the disabled (113 for males, 205 for females) had much higher rates than the employed (27 for males, 31 for females). Those who completed primary education only had rates of 160 per 100 000 compared to 27 per 100 000 for those with higher vocational training or university education. (21) These findings support data from the United Kingdom, where socio-economic deprivation (low social class and unemployment) repeatedly appear as characteristics of the parasuicide populations. (22)

These findings indicate that suicide attempters disproportionately have had low education, and have high levels of unemployment, poverty, and divorce. The findings may be partly related to underlying common causes, such as the presence of psychiatric disorders, but they also suggest the influence of sociological factors impacting on a relatively economically deprived group in society with a greater share of adversity. (!5,> Socio-economic deprivation is a well-established determinant of psychiatric morbidity and attempted suicide.(2324) In contrast with completed suicide, where the presence of psychiatric disorders is well documented (up to 95 per cent of suicides may have suffered from a psychiatric disorder), psychiatric disorders are much less frequent among those who attempt suicide or deliberately harm themselves. Among those who engage in suicidal behaviour for the first time in their lives, the prevalence of psychiatric disorders may be rather low; among repeaters, psychiatric morbidity is considerable. k,5

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