No abstract

Further research is necessary, including a case-control study to disentangle the confounding effects of poverty, ethnicity, and age at the individual level. In addition, recent developments in DNA analysis of Mycobacterium tuberculosis 20 could be used to study patterns of transmission within and between ethnic groups. In the meantime, as national notification rates are 25 times higher in Asians than white people (and this inequality is widening), 3 prevention of new infection in Asians by education, 21 immunisation, 22 and prompt diagnosis and treatment of infectious cases 23 must remain a priority.We thank Dr John Innes and the staff at Birmingham chest clinic for their work in maintaining the Birmingham tuberculosis register.Contributors: JIH contributed to the formulation of the primary study hypothesis and led the design of the study, interpretation of the results, and writing of the paper. SSB contributed to formulation of the hypothesis, interpretation of the data, and writing the paper. SA collected all the data and contributed to the analysis of the data and writing of the paper. CPF led the analysis of the data and contributed to the design of the study, interpretation of results, and writing the paper. JIH will act as guarantor.Funding: None.Competing interests: None declared. Results Mortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation.Conclusions Suicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level.

No abstract

Antidepressant prescribing has increased in all age and sex groups. This indicates either that there have been changes in the presentation, recognition and management of depression in general practice or that the prevalence of depression has increased, or a combination of these two phenomena. The higher prescribing rate in females is in keeping with evidence from psychiatric morbidity surveys suggesting that women experience higher levels of psychiatric morbidity than men. Decreases in the ratio of female to male prescribing, however, support other data indicating that, relative to females, the mental health of young males has declined in recent years. Changes in patterns of help-seeking may also contribute to the observed trends.

The concept of a neighbourhood effect within British voting patterns has largely been discarded, because no data have been available for testing it at the appropriate spatial scales. To undertake such tests, bespoke neighbourhoods have been created around the home of each respondent to the 1997 British Election Study survey in England and Wales, and small-area census data have been assembled for these to depict the socio-economic characteristics of voters' local contexts. Analyses of voting in these small areas, divided into five equal-sized status areas, provides very strong evidence that members of each social class were much more likely to vote Labour than Conservative in the low-status than in the high-status areas. This is entirely consistent with the concept of the neighbourhood effect, but alternative explanations are feasible. The data provide very strong evidence of micro-geographical variations in voting patterns, for which further research is necessary to identify the processes involved.The class cleavage within the British electorate has been waning for over four decades, since Crewe and his colleagues first charted its onset: 1 its death notice was posted by Sanders in 1997. 2 In place of the once enduring relationship between class and voting, studies of recent British general elections, and also of inter-election voting intentions, have focused on economic voting modelswith considerable success. In this article, we return to the class cleavage, but do so by looking at it in a spatially disaggregated way, taking up ideas suggested by Miller in the 1970s. 3 We show that micro-scale patterns of voting at the 1997 general election in England and Wales are entirely consistent with the now * Iain MacAllister is in the