Suicide in the Highlands of Scotland.

OBJECTIVE: The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average. DESIGN: Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis. SETTING: Highland and Scotland 1978-98. RESULTS: The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths. CONCLUSION: Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.