The paper by Mok et al ^{Reference Mok, Kapur, Windfuhr, Leyland, Appleby and Platt1} makes for interesting reading but is something of a blunt instrument in the presentation of the figures.

By combining figures for England and Wales it overlooks the fact that the suicide rate for men in Wales is significantly higher than in England, with a peak between 20 and 39 years of age. For women in Wales the rate is a little higher than the English average. Within Wales the rate varies considerably, with higher rates in areas of high social deprivation. ²

The figures for Wales are not as high as those for Scotland and Northern Ireland but have been of sufficient concern for the Welsh Government to launch its suicide prevention campaign ‘Talk to Me’ ³ in 2008, which is full of good intentions but lacks some detail as to real-life implementation. The impact of this is yet to be evaluated but it is not likely to have been helped by recent economic problems. The association between social adversity and suicide is easy to identify but harder to change.

Also of interest is the high incidence of drowning in Scotland. Of note is the fact that Scotland accounts for 90% of the standing freshwater of Great Britain and water makes up around 2% of the land area of Scotland compared with 0.5% in England. ⁴ Similarly in Ireland, drowning accounts for approximately a fifth of male suicides. ^{Reference Connelly5} Although it may be simplistic to equate methods of suicide with geographical proximity, it is interesting to speculate on an individual’s relationship with their culture, landscape and history which may have a bearing on attitudes to suicide and methods chosen. Drowning, for example, could be more easily explained away as accidental in cultures where everyday use of water for recreation or work is more commonplace, thereby avoiding a pronouncement of suicide and its associated stigma.

Although there are some common, well-replicated associations with completed suicide as discussed in Mok et al, broad statistics tend to hide subtle variations within regions and it is examination of these differences that can inform suicide prevention strategies that are relevant, practical, acceptable and beneficial for a given community.