The impact of place on suicidal behaviour

This chapter provides a rapid evidence review of empirical studies, from the UK and Republic of Ireland, that have examined associations between suicidal behaviour (suicide and non-fatal self harm) and area-level deprivation. Five electronic databases (Medline, Embase, PsycINFO, Social Sciences Citation Index and EconLit) were searched from 2005 to 2015. Eighteen studies were included; one was a cohort study, eight were repeat cross-sectional studies and nine were cross sectional studies. Overall, these studies found a strong association between area-level deprivation and suicidal behaviour: as area-level deprivation increased, so did suicidal behaviour. The chapter contextualises these results by applying insights from the wider geographical literature about health and place, leading to the identification of potential mechanisms (‘suicidogenic’ pathways) underpinning the association between area-level deprivation and suicidal behaviour. These mechanisms include compositional factors (the characteristics of people living in deprived areas, such as marital status) and contextual factors (the nature of the places themselves, such as the social environment). It concludes by reflecting on the implications for policy, practice and research, suggesting that, as there is a socio-spatial gradient in suicidal behaviours, every local area should have a suicide prevention strategy and action plan and that deprived areas should have additional support via a proportionate universalism approach to reducing geographical inequalities in suicide

Defying the odds: A mixed-methods study of health resilience in deprived areas of England

Previous studies have identified an area-level association between socio-economic deprivation and poorer population health. However, some recent studies have suggested that some areas exhibit better health outcomes than would be expected given their level of deprivation. This has been conceptualised in terms of 'health resilience'. This study is the first to explore area-level 'health resilience' at different geographical scales and by using mixed-methods. Regression Tree Classification was used to identify local areas (Local Authority Districts and Census Area Statistical Wards) in England that performed relatively well in terms of mortality (premature mortality 1998-2003) or morbidity (2001 Census measures of self-reported general and limiting long-term illness) despite experiencing long term deprivation (Townsend scores 1971-2001). Five Local Authority Districts (LADs) and 90 Census Area Statistical Wards (CASWARDS) exhibited 'health resilience' in terms of self-reported health, three LADs and 88 CASWARDS for limiting long-term illness, and three LADs and 62 CASWARDS for premature mortality. Potential mechanisms underpinning this resilience were explored using focus groups and in-depth interviews in one case study area in the North East of England. This suggested that for this case study area, place attachment, the natural environment and social capital may have played a role in mediating the detrimental health effects of long term deprivation. The study concludes by exploring the implications of these findings within the context of the study limitations and by outlining future avenues for research and policy

Real world reviews: A beginner’s guide to undertaking systematic reviews of public health policy interventions

Background The systematic review is becoming an increasingly popular and established research method in public health. Obtaining systematic review skills are therefore becoming a common requirement for most public health researchers and practitioners. However, most researchers still remain apprehensive about conducting their first systematic review. This is often because an ‘ideal’ type of systematic review is promoted in the methods literature. Methods This brief guide is intended to help dispel these concerns by providing an accessible overview of a ‘real’ approach to conducting systematic reviews. The guide draws upon an extensive practical experience of conducting various types of systematic reviews of complex social interventions. Results The paper discusses what a systematic review is and how definitions vary. It describes the stages of a review in simple terms. It then draws on case study reviews to reflect on five key practical aspects of the conduct of the method, outlining debates and potential ways to make the method shorter and smarter—enhancing the speed of production of systematic reviews and reducing labour intensity while still maintaining high methodological standards. Conclusion There are clear advantages in conducting the high quality pragmatic reviews that this guide has described: (1) time and labour resources are saved; (2) it enables reviewers to inform or respond to developments in policy and practice in a timelier manner; and (3) it encourages researchers to conduct systematic reviews before embarking on primary research. Well-conducted systematic reviews remain a valuable part of the public health methodological tool box

The worlds of welfare: Illusory and gender-blind?

The nature of welfare state regimes has been an ongoing debate within the comparative social policy literature since the publication of Esping-Andersen's The Three Worlds of Welfare Capitalism (1990). This paper engages with two aspects of this debate; the gender critique of Esping-Andersen's thesis, and Kasza's (2002) assertions about the ‘illusory nature’ of welfare state regimes. It presents a gender-focused defamilisation index and contrasts it with Esping-Andersen's decommodification index to illustrate that, whilst individual welfare states have been shown to exhibit internal variety across different policy areas, they are both consistent and coherent in terms of their policy variation by gender. It concludes, in contrast to both the gender critique of Esping-Andersen, and Kasza's rejection of the regimes concept, that the ‘worlds of welfare’ approach is therefore neither gender blind or illusory, and can, if limited to the analysis of specific areas such as labour market decommodification or defamilisation, be resurrected as a useful means of organising and classifying welfare states

Has the disability discrimination act closed the employment gap?

Study objective. To investigate whether the disparity in employment rates between people with a limiting long-term illness or disability and those without has decreased since the implementation of the Disability Discrimination Act in the UK. Design. National cross-sectional data on employment rates for people with and without a limiting long-term illness or disability were obtained from the General Household Survey for a twelve-year period (1990 - 2002; 10 surveys). Representative population samples were analysed. The sample size for the GHS over the study period ranged from 19193 to 24657 and the average response rate ranged from 72% to 82%. Main outcome measure. The relative employment rates of men and women of working age (18 - 60/65 years). Compares people with a limiting long-term illness or disability ('disabled') with people with no limiting long-term illness or disability ('not disabled'). Results. Age standardised employment rates remained relatively stable from 1990 to 2001 for people defined as 'not disabled'. However, the employment rates of people defined as 'disabled' have decreased since 1990, and were at their lowest following the implementation of the employment aspects of the DDA in 1996 (1998 - 2002). In addition the gap between the employment rates of people defined as 'disabled' and 'not disabled' was most marked after the DDA between 1998 - 2002 (p < 0.05). Conclusions. This appraisal of routine population data pre- and post- the Disability Discrimination Act indicates that the legislation may not have been effective in closing the employment gap that exists in the UK between people with a limiting long-term illness or disability and those without

Area-level socioeconomic disadvantage and suicidal behaviour in Europe: a systematic review

The relationship between adverse individual socio-economic circumstances and suicidal behaviour is well established. However, the impact of adverse collective circumstances - such as the socio-economic context where people live - is less well understood. This systematic review explores the extent to which area-level socioeconomic disadvantage is associated with inequalities in suicidal behaviour and self-harm in Europe. We performed a systematic review (in MEDLINE, Embase, PsycINFO, EconLit and Social Sciences Citation Index) from 2005 to 2015. Observational studies were included if they were based in Europe and had a primary suicidal behaviour and self-harm outcome, compared at least two areas, included an area-level measure of socio-economic disadvantage and were published in the English language. The review followed The Joanna Briggs Institute guidelines for quality appraisal. We identified 27 studies (30 papers) from 14 different European countries. There was a significant association (in 25/27 studies, all of which were rated as of medium or high quality) between socioeconomic disadvantage and suicidal behaviour (and self-harm), particularly for men, and this was a consistent finding across a variety of European countries. Socio-economic disadvantage was found to have an independent effect in several studies whilst others found evidence of mediating contextual and compositional factors. There is strong evidence of an association between suicidal behaviours (and self-harm) and area-level socio-economic disadvantage in Europe, particularly for men. Suicide prevention strategies should take this into account.