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

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.

Voting with your feet or voting for Brexit: The tale of those stuck behind

“…Sometimes this human/cultural factor in voting has been referred to as a second level (where the first level are economic considerations) in the analysis of voting in the USA and France (see Mulroy & Ogorzalek, 2019; Ogorzalek, 2019). While there are many extensions of this broader cultural/human category, such as ecology strategies, trade unionization and even psychological health and suicide (see Coderre‐LaPalme & Greer, 2018; Kiewiet, 2013; Steeg, Webb, Ibrahim, Appleby, & Kapur, 2020), these are derived aspects, endogenous to and related to the inequality between human demographic strata in a Polanyi tradition of opposition (Hopkin, 2017). There is even evidence that poverty obscures the concerns about the natural environment (Dasgupta, Laplante, Wang, & Wheeler, 2002; Hollander, 2003), and thus cultural attitudes are endogenous to economics.…”

An examination of tweets posted before and after enactment of Twitter’s Suicide and Self-Harm Policy: a content analysis study.

“…While the impact of calling social issues acts of self-harm has not been assessed, tweets that draw comparisons to self-harm may perpetuate mental health stigma [31]. It is critical for future work to determine if reporting Brexit in this manner may have contributed, at least to some degree, to the raised suicide risk in Brexit-voting communities [32] and increased anxiety and compromised mental health in migrants residing in the United Kingdom [33]. It certainly raises the intriguing linguistic nding of this study, where the term selfharm extended beyond traditional de nitions of the behavior.…”