Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe

A meta-narrative review of research traditions on hidden workers in aging population for transdisciplinary implementation research

Hidden workers are defined as the three vulnerable subgroups of workers: the underemployed, the unemployed, and the discouraged workers. Hidden workers indeed the group with multiple identities; a transitioning retiree, jobseeker, caring for some, who may also have long term health conditions and ethnic minority all at the same time. Designing an intervention for this group necessitates the transdisciplinary knowledge. Transdisciplinary knowledge is crucial because it can inform how the intersectoral challenges might be addressed in interventions, and how the intersectoral implementation design and evaluation on hidden workers might be designed. This paper maps the intellectual landscape of the hidden workers in aging population literature to identify key disciplinary research clusters; and to find out how those research clusters are investigating hidden workers. With the meta-narrative review methodology on studies retrieved from the Web of Science Core Collection, five research clusters were identified: (1) public health approaches to hidden workers, (2) welfare state and aging workforce, (3) older jobseekers, (4) life course perspective, (5) retirement transitions. Each research cluster focuses on different aspects of hidden workers, with varying research questions and rationales. These include conceptualising the determinants of the hidden workers in aging populations and the complex interrelation with public health. Furthermore, we suggest an analytical framework to allow for better understanding between the research traditions based on (1) the chosen socioecological level of analysis, (2) whether the research question is on the determinant for hidden workers or on the outcome of being hidden and (3) the chronosystem (early/middle/later life) timeframe of research question that is addressed. Through this study, we can identify the main issues faced by hidden workers among the older adults and the measures to address these issues as well as opening up a possibility for cross-sectoral policy responses.

Economic uncertainty and population health: insights from emerging markets and developing countries

This study employs a Bayesian panel vector autoregressive model to examine the impact of economic uncertainty on public health, using an annual, country-level panel dataset of 103 emerging markets and developing countries spanning the years 1995 through 2019. The results from the full sample suggest that the immediate effects of heightened economic uncertainty on health are marginal, yet it may engender prolonged life expectancy and lowered mortality rates. The analysis unveils considerable heterogeneities among various country classifications. The health-enhancing effects of economic uncertainty are predominantly discernible in emerging markets, low-income and upper-middle-income countries. Additionally, a diminution in suicide rates, attributed to escalated economic uncertainty, is uniquely detected in upper-middle-income countries. Furthermore, economic growth and healthcare expenditure emerge as paramount determinants in bolstering overall population health, particularly in lower-middle-income countries. The detrimental effect of environmental pollution on health is more pronounced in emerging markets and middle-income nations. Excluding high-income countries, it is essential to emphasize the beneficial health outcomes resulting from financial development and globalization, as well as the deleterious effects of environmental pollution. Lastly, several policy implications aligned with the findings are outlined, providing a roadmap for decision-makers in these diverse economies to promote better health outcomes.

Behavioral and location-related antecedents of train suicides

BACKGROUND

In the European Union, over 2000 suicides on railway premises were reported in 2020. Identifying individuals' behavioral and location patterns just before they die or attempt to die by train suicide (ITS) is critical for effective prevention of suicides by train. We conducted a naturalistic study using a newly developed instrument for the assessment of fatalities in rail traffic that used information from on-site video cameras.

METHODS

A total of 56 case files and surveillance recordings of ITS prior to their suicide or suicide attempt were compared to 46 surveillance recordings of matched regular train passengers (RTP) before they boarded their trains. Groups were compared on individuals' behavior as well as location and contextual parameters.

RESULTS

ITS performed unusual movement patterns more frequently, carried luggage less often, stayed on the platform longer, and let more trains pass relative to RTP.

CONCLUSIONS

If this study is replicated with a larger sample, artificial intelligence could be used to detect suspicious/unusual (movement) patterns in order to prevent train suicide. Social awareness campaigns that foster the identification of people in distress at train stations in combination with lower thresholds for the use of emergency devices on platforms may help to detect potential train suicides and reduce their incidence.

The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach

Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.

Suicide as globalisation's Black Swan: global evidence

OBJECTIVES

This empirical study investigated the relationship between globalisation and suicide rates. We examined whether there is a beneficial or harmful relationship between economic, political and social globalisation and the suicide rate. We also estimated whether this relationship differs in high-, middle- and low-income countries.

STUDY DESIGN

Using panel data from 190 countries over the period 1990-2019, we examined the relationship between globalisation and suicide.

METHOD

We compared the estimated effect of globalisation on suicide rates using robust fixed-effects models. Our results were robust to dynamic models and models with country-specific time trends.

RESULTS

The effect of the KOF Globalisation Index on suicide was initially positive, leading to an increase in the suicide rate before decreasing. Concerning the effects of economic, political, and social dimensions of globalisation, we found a similar inverted U-shaped relationship. Unlike the middle-income and high-income countries, we found a U-shaped relationship for the case of low-income countries, indicating that suicide decreased with globalisation and then increased as globalisation continues to increase. Moreover, the effect of political globalisation disappeared in low-income countries.

CONCLUSION

Policy-makers in high- and middle-income countries, below the turning points, and low-income countries, above the turning points, must protect vulnerable groups from globalisation's disruptive forces, which can increase social inequality. Consideration of local and global factors of suicide will potentially stimulate the development of measures that might reduce the suicide rate.

The application of spatial analysis to understanding the association between area-level socio-economic factors and suicide: a systematic review

BACKGROUND

Little is known about what impact the use of different spatial methodological approaches may have on understanding the relationship between area-level socio-economic factors and suicide.

METHODS

In this systematic review, we searched PubMed, Embase, CINAHL and PsycInfo for original empirical studies examining the relationship between socio-economic factors and suicide with a spatial lens, published up to January 22, 2022. Data on applied spatial methods, indicators of socio-economic factors, and risk of suicide related to socio-economic factors were extracted. The protocol for this systematic review was registered with PROSPERO (CRD42021251387).

RESULTS

A systematic search yielded 6290 potentially relevant results; 58 studies met the inclusion criteria for review. Of the 58 included studies, more than half of the studies (n = 34; 58.6%) used methods that accounted for spatial effects in analyses of the association between socio-economic factors and suicide or examined spatial autocorrelation, while 24 (41.4%) studies applied univariate and multivariate models without considering spatial effects. Bayesian hierarchical models and spatial regression models were commonly used approaches to correct for spatial effects. The risk of suicide relating to socio-economic factors varied greatly by local areas and between studies using various socio-economic indicators. Areas with higher deprivation, higher unemployment, lower income, and lower education level were more likely to have higher suicide risk. There was no significant difference in results between studies using conventional versus spatial statistic methods.

CONCLUSION

An increasing number of studies have applied spatial methods, including Bayesian spatial models and spatial regression models, to explore the relationship between area-level socio-economic factors and suicide. This review of spatial studies provided further evidence that area-level socio-economic factors are generally inversely associated with suicide risk, with or without accounting for spatial autocorrelation.

Macroeconomic fluctuations and individual use of psychotropic medications: evidence from Swedish administrative data

BACKGROUND

A growing literature finds that adult mental health worsens during economic downturns. Current insights on the relationship between macroeconomic fluctuations and psychotropic medication are based on self-reported information or aggregate measures on prescriptions. This study assesses the relationship between local macroeconomic conditions and individual use of psychotropic medication as reported in administrative registers.

METHODS

We use local information on unemployment linked to individual-level longitudinal data on detailed psychotropic drug consumption from administrative registers, for individuals in working age (20-65) in Sweden 2006-13. Any psychotropic medication uptake and the related number of redeemed prescriptions are the primary outcomes. Mortality is considered a secondary outcome.

RESULTS

Among young men (aged 20-44) and older women (aged 45-65), we find reduced use of psychotropic medication (2-4% compared to the mean) when the local labor market conditions deteriorate. The relationship is driven by reduced use of antidepressants. The same age-gender groups experience a significantly higher risk of mortality in bad times.

CONCLUSIONS

This study shows that economic downturns may not only put strain on individuals' mental health but also on their access to psychopharmaceutic treatments.

Socio-economic, health and environmental factors influencing suicide rates: A cross-country study in the Eastern Mediterranean region

BACKGROUND

Suicide is a crucial concern for public health in the world. To date, there is no synthesized evidence about the cross-country impact of suicide risk factors in the Eastern Mediterranean (EMRO). This paper aims to cover the gap and assess socio-economic, health, and environmental (SHE) factors influencing suicide rates among the EMRO countries from 1990 to 2019.

METHODS

This analysis is a cross-sectional time-series design which uses random-effect panel data from 17 EMRO countries. SHE variables are inflation rate, economic growth, unemployment rate, urbanization, and female labor force participation rate, mental disorders prevalence and individuals using the internet.

RESULTS

The models indicate that male suicide rates was positively associated with inflation rate (coefficient = 0.002, p < 0.05) unemployment rate (0.06, p < 0.01), mental disorders prevalence (0.0008, p < 0.01), and urbanization (0.08, p < 0.05). Conversely, individuals using the internet (-0.019, p < 0.01) was related to a reduction in male suicide rates. Variables correlated with an increase in female suicide rates included inflation rate (0.001, p < 0.05), mental disorders prevalence (coefficient = 0.0004, p < 0.01) and urbanization (0.03, p < 0.01). Individuals using the internet (-0.006, p < 0.01) and education index (-4.8, p < 0.01) had negative effect on female suicide rates.

CONCLUSIONS

This research confirms that SHE factors appear to affect suicide. So policymakers should endeavor to control them if the nations are aimed at preventing suicides. Future researches are essential to scrutinize paradoxes in the field.

The spatiotemporal dynamics and structural covariates of homicide in the Republic of Korea, 2008-2017: A dynamic spatial panel data approach

This study examined the relationship between the homicide rate and diverse indicators of social disorganization in the Republic of Korea (South Korea) using datasets collected between 2008 and 2017. Due to the statistical limitations of previous homicide research, which used either cross-sectional or longitudinal methodology, this study applied the dynamic spatial panel data model to explore both the spatial and temporal aspects of homicide. The results demonstrate that the homicide rate is spatially and temporally dependent on those of neighbouring units and the time-lagged homicide rate. Moreover, this study found that divorce rate, unemployment rate, number of males in the neighbourhood and ethnic heterogeneity have a statistically significant impact on the homicide phenomenon. This study contributes to the existing literature by taking a new approach - the dynamic spatial panel data model - to investigate the homicide phenomenon in Korea. In doing so, several suggestions are made for policymakers to respond to homicide rates. Based on the social disorganization theory, these indicators have been found to impact the social network and community members' willingness to engage in social control. This study suggests that customized policies should be implemented to alleviate the level of social disorganization and promote social control over lethal violence.

The association of COVID-19 employment shocks with suicide and safety net use: An early-stage investigation

This paper examines whether the COVID-19-induced employment shocks are associated with increases in suicides and safety net use in the second and third quarters of 2020. We exploit plausibly exogenous regional variation in the magnitude of the employment shocks in Japan and adopt a difference-in-differences research design to examine and control for possible confounders. Our preferred point estimates suggest that a one-percentage-point increase in the unemployment rate in the second quarter of 2020 is associated with, approximately, an additional 0.52 suicides, 28 unemployment benefit recipients, 88 recipients of a temporary loan program, and 10 recipients of public assistance per 100,000 population per month. A simple calculation based on these estimates suggests that if a region experienced a one-percentage-point increase in the unemployment rate caused by the COVID-19 crisis in the second quarter of 2020, which is roughly equivalent to the third-highest regional employment shock, this would be associated with 37.4%, 60.5%, and 26.5% increases in the total, female, and male suicide rates respectively in July 2020 compared with July 2019. These results are primarily correlational rather than causal due to the limitation of our data and research design, but our baseline findings are robust to several different model specifications.

Criminalisation of suicide and suicide rates: an ecological study of 171 countries in the world

OBJECTIVE

In the last half of the 20th century, many countries have already abolished antisuicide laws; however, more than 20 countries still adopt them. This paper is the first to systematically explore the association between criminalisation of suicide and national suicide rates in 171 countries/regions to examine the deterring effects of the antisuicide laws.

DESIGN

A cross-sectional ecological study.

SETTING

171 countries in the world.

PARTICIPANTS

In 2012, 25 countries were identified to carry antisuicide laws. A linear regression analysis was adopted to explore the association between national suicide rates (log transformed) and criminalisation of suicide in the world in 2012, having controlled for the Human Development Index (HDI), majority religious affiliations and the national unemployment rate.

MAIN OUTCOME MEASURE

Sex-specific age standardised suicide mortality rates.

RESULTS

Criminalisation of suicide was associated with slightly increased national suicide rates (β estimate=0.29, 95% CI -0.04 to 0.61). Stronger association was found in women (β estimate=0.40, 95% CI 0.06 to 0.74), connecting criminalisation of suicide and higher suicide rates. The harmful effect of antisuicide laws on women was particularly prominent in non-Muslim countries and countries with lower HDI.

CONCLUSIONS

Laws penalising suicide were associated with higher national suicide rates and even more so in the female population in the low HDI, non-Muslim countries. The non-supportive patriarchal culture with laws penalising suicide may render women vulnerable to suicidality. Instead of criminalising suicide, alternative approaches such as providing good mental healthcare and adjusting the socioeconomic, legal and cultural factors that contribute to suicide should be considered.

Suicide rates and institutional quality in an emerging country

Purpose

The purpose of this study is to investigate the relationship between suicide rates and institutional quality.

Design/methodology/approach

This study used autoregressive distributed lag model and error correction model to examine short-run and long-run relationships during 1996–2017 in Lebanon.

Findings

The study shows that in the long-run, suicide rates are significantly associated to the control of corruption, voice and accountability and rule of law, but not to regulatory quality, political stability and government efficiency. In the short-run, nearly all variables of institutional quality have a negative and significant relationship to suicide rates. Results are discussed in detail.

Originality/value

This research is the first to inspect the relation between the quality of institutions and suicide rates. Empirical results of this study add new evidence to the literature and provide support to policymakers.

Whose mental health declines during economic downturns?

Prior research shows that economic downturns are associated with increases in mental illness. However, we know little about whose mental health is most negatively affected. Is it the young or old, men or women, employed or non-employed, rich or poor? Using an 18-year panel dataset of Australians, we contribute to this understanding by estimating the impact of changes in unemployment on mental health, separately by population subgroups. Our mental health measure captures psychological distress and emotional difficulties, which are often missed by infrequent event indicators such as suicides. We find that young women suffer most during economic downturns. Men and women of older ages are not significantly affected. The effects for young women are driven by those in insecure employment, and those from low socioeconomic backgrounds. Our results suggest that public health programs should emphasize the mental health of young women during economic downturns.

Lives saved during economic downturns: Evidence from Australia

Worldwide, countries have been restricting work and social activities to counter the emerging public health crisis due to the coronavirus pandemic. These measures have caused dramatic increases in unemployment. Some commentators argue that the "draconian measures" will do more harm than good due to the economic contraction, despite a large literature that finds mortality rates decline during recessions. We estimate the relationship between unemployment, a proxy for economic climate, and mortality in Australia, a country with universal health care. Using administrative time-series data on mortality by state, age, sex, and cause of death for 1979-2017, we find no relationship between unemployment and mortality on average. However, we observe beneficial health effects in economic downturns for young men, associated with a reduction in transport accidents. Our estimates imply 431 fewer deaths in 2020 if unemployment rates double as forecast. For the early 1980s, we find a procyclical pattern in infant mortality rates. However, this pattern disappears starting from the mid-1980s, coincident with the 1984 implementation of universal health care. Our results suggest that universal health care may insulate individuals from the health effects of macroeconomic fluctuations.

The impact of temporary contracts on suicide rates

The number of suicides has increased in the last decades in several developed countries. For instance, Spain has experienced a gradual but steady increase in suicides since the 80's and it is currently the leading external cause of death in the country. At the same time, the dualisation of the labor market, with a strong and persistent incidence of temporary contracts, has increased the instability of employment conditions. Both developments have a stronger incidence for individuals with lower levels of education. Therefore, in this paper we use rich administrative data in order to estimate the impact of the wide spread use of temporary contracts on suicides. In order to do that we exploit a reform that liberalised the use of fix-term contracts in Spain in 1984. Our results show strong long-term effects of the reform, which increased the suicide mortality rate of affected cohorts (those entering the labor market just after the liberalisation) by at least 25.3%. We believe that this result has important policy implications and should be taken into account in the design of the national suicide prevention plans.

Analysing spatial and temporal dynamics of suicide in South Korea: An application of the dynamic spatial panel data model

This study examines the relationship between the suicide mortality rate and structural covariates in South Korea from 2008 to 2017 under Durkheim's theory of suicide. It applies the dynamic spatial panel data model to explore both spatial and temporal aspects of the suicide phenomena recognising statistical limitations in previous suicide research based on either cross-sectional or longitudinal methodology. The results demonstrate that the suicide mortality rates in South Korea are spatially and temporally dependent on those of neighbouring units or its own time-lagged suicide mortality rates. Moreover, this study estimates that the divorce rate, unemployment rate and land price index, which are assumed to be proxies of social integration and regulation, significantly impact the suicide mortality rates. The results imply that deteriorating socioeconomic conditions are risk factors for the suicide mortality rate and suggests implementing policies to alleviate the high level of social disintegration caused by Korea's deteriorating socioeconomic conditions.

The Werther effect of celebrity suicides: Evidence from South Korea

Since 2003 Korea has experienced the highest suicide rate among OECD countries. One of the societal risk factors that triggers suicide is the contagious nature of suicide. This paper empirically examines the effect of celebrity suicide reports on subsequent copycat suicides, using daily suicide data and information of highly publicized suicide stories in Korea from 2005 to 2018. The findings from the Poisson regression model suggest that the number of public suicides soars after media reports on celebrity suicides. On average, the number of suicides in the population increased by 16.4% within just one day after the reports. Further analysis reveals that female and younger subgroups are more likely to be affected by celebrity suicides. Moreover, the public reacts more strongly to suicide incidents of celebrities of the same gender and even imitates the methods of suicide used by celebrities. This paper highlights the significance of careful and responsible media coverage of suicide stories to prevent copycat suicide. For policymakers, it is crucial to implement regulations not only for traditional media but also for new media where younger people can freely access unfiltered information.

Effects of graduating during economic downturns on mental health

PURPOSE

This study examined the effects of economic downturns at the time of graduation on short-term and long-term mental health of graduates.

METHODS

Using a large longitudinal dataset whose respondents graduated from their highest level of education between 2001 and 2018 in Australia, the study investigated the effects of initial labor market conditions on psychological distress measures, quality-of-life mental health scales, and diagnoses of depression or anxiety since graduation.

RESULTS

Evidence suggests the presence of a scarring effect of graduating during a recession on the mental health of young adults, particularly significant and persistent for men. Higher unemployment rates at graduation were associated with increased risks of high psychological distress and diagnoses of depression or anxiety, and lower levels of social functioning and mental well-being among men lasting over a decade. The psychological effect was largely driven by young adults with vocational or secondary qualifications or receiving no government allowance at graduation.

CONCLUSIONS

Policies should consider the psychological effect of graduating during recessions and focus particularly on vulnerable groups who are susceptible to adverse labor market conditions, such as graduates who are in cyclically sensitive occupations and have less or no work benefits and social protection.

Gender differences in the pathways to higher education

It is well known that far fewer men than women enroll in tertiary education in the United States and other Western nations. Developed nations vary in the degree to which men are underrepresented, but the Organization for Economic Co-operation and Development (OECD) average lies around 45% male students. We use data from the OECD Education at a Glance statistical reports, the Program for International Student Assessment (PISA), and the World Values Survey to explain the degree to which men are underrepresented. Using a multiple regression model, we show that the combination of both the national reading proficiency levels of 15-y-old boys and girls and the social attitudes toward girls attending university can predict the enrollment in tertiary education 5 y later. The model also shows that parity in some countries is a result of boys' poor reading proficiency and negative social attitudes toward girls' education, which suppresses college enrollment in both sexes, but for different reasons. True equity will at the very least require improvement in boys' reading competencies and the liberalization of attitudes regarding women's pursuit of higher education. At this time, there is little reason to expect that the enrollment gap will decrease, given the stagnating reading competencies in most countries.

Revisiting the Relationship Between Suicide and Unemployment in Mexico: Evidence From Linear and Non-linear Co-integration

This study attempts to investigate if suicide is interlinked with unemployment in Mexico by making use of a recently developed Bootstrap ARDL bound test over the years of 1981–2016. To avoid omitting variable bias, we use economic growth rate as a control variable. The empirical results indicate that no co-integration among these three variables and there is a positively bidirectional causality between suicide rate and the unemployment rate. This study will showcase that the economic growth rate negatively affects unemployment rate and unidirectional Granger causality running from economic growth rate to the unemployment rate in Mexico. The findings presented in this study could provide with valuable information for society and health policy makers to formulate the policies on suicide prevention in Mexico.

Government spending, recession, and suicide: evidence from Japan

Backgrounds

Austerity has been shown to have an adverse influence on people’s mental health and suicide rates. Most existing studies have focused on the governments’ reactions to a single event, for example, the Great Recession of 2008.

Methods

This study focused on significant changes in fiscal policy between 2001 and 2014 in Japan. The size of expenditures by national and local governments decreased dramatically between 2001 and 2006 under the neoliberal reform and then increased after the global economic crisis and the Great East Japan Earthquake. Using the data from 47 prefectures between 2001 and 2014, we tested whether more spending by the local governments was associated with a lower suicide rate in their jurisdiction. We also investigated whether this relationship was particularly salient during a more severe recession.

Results

Our analysis revealed that an increase of 1% in the per capita local government expenditures was associated with a decrease of 0.2% in the suicide rates among males and females aged between 40 and 64 and that this correlation was strengthened as the unemployment rate increased, particularly among males.

Conclusions

Government’s reaction to economic crises can either exacerbate or mitigate the negative impact of the economic recession on people’s mental health and suicide rates.

Influence of Area-Level Characteristics on the Suicide Rate in Korean Adolescents

OBJECTIVE

We aimed to investigate the influence of area-level factors on adolescent suicide and to determine which variables differ according to age and sex.

METHODS

We selected variables that were available for collection through an online database from 2005 to 2015 in the Korean Statistical Information Service and the Korea Labor Institute. We used administrative districts of Korea in 2017 for geographical classification. We examined the relationships between regional suicide rates and area-level variables in male and female subjects aged 10-14 years and 15-19 years. In addition, we analyzed area-level variables in adolescents aged 15-19 years according to sex.

RESULTS

Our findings indicated that several area-level variables affected adolescent suicide rates, varying according to age and sex. Economic problems were shown to be more associated with suicide in male adolescents than in female adolescents. On the other hand, social fragmentation and health services were shown to be more associated with suicide in females.

CONCLUSION

Suicide in adolescents was attributable to area-level factors such as economic status, social fragmentation, and community health services. By identifying area-level variables affecting adolescent suicide rates, we will be able to contribute to implement mental health policies related to adolescent suicide.

Mental health and politics since the eurozone crisis: The role of mental health professionals

Some of the most immediate health effects of the 2008 economic crisis concerned the mind, not the body. Rates of generalized anxiety, chronic depression, and even suicide spiked in many European societies. This viewpoint highlights the role of mental health professionals in responding to this emergency, and argues that their sustained mobilization is necessary to its long-term resolution.

The trend in mortality due to suicide in urban and rural areas of Colombia, 1979-2014

Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described. Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014. Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method. Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men. Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.

How did the 2008-11 financial crisis affect work-related common mental distress? Evidence from 393 workplaces in Great Britain

This paper analyses how the 2008-11 financial crisis relates to work-related common mental distress of those with continuous employment during the crisis. The literature connecting the 2008-11 financial crisis to common mental distress (anti-depressant drug use, suicide, etc.) generally estimates a negative effect. We used a sample of 393 workplaces from the 2011 Work and Employment Relations Study (WERS) for which employers and worker representatives agreed on that the crisis affected the workplace. WERS then provides detailed questions about how the financial crisis affected the workplace. We use these questions to show which crisis-induced work-changes are important for work-related common mental distress. In the British-context, increased workload and changes in nonfinancial benefits of work are most relevant worsening work-related common mental distress by 1.8 and 0.9 on a scale from 0-30 respectively.

The role of social support in suicidal ideation: a comparison of employed vs. unemployed people

Background: With the financial crisis, the number of unemployed has grown up, and so has suicidal ideation in these individuals. Although extensive research has been done about the factors associated with it, studies about protective factors are also necessary.Aims: To examine the relationship between unemployment and suicidal ideation, and the protective effect of social support.Methods: Participants were 149 people in full-time employment (age M = 41.63, SD = 10.37), 55 unemployed (M = 42.25, SD = 10.23 years), and 32.72 months average unemployment time (SD = 26.13). Instruments were a sociodemographic questionnaire, the Suicide Ideation Questionnaire (SIQ) and the Social Support Appraisal (SSA). Results: Suicidal ideation was significantly higher in the unemployed group, and positively associated with duration of unemployment. Social support, both from family and friends, was found to be a protective factor in suicidal ideation, particularly in long-term unemployment.Limitations: Cross-sectional study, convenience sample.Conclusions: Suicidal ideation is markedly present in unemployed individuals, particularly those unemployed for a year or more, and social support from family and friends may act as a significant protective factor.

Gun prevalence and suicide

In light of the ongoing debate over tighter firearm regulations, this paper considers the relationship between gun prevalence and suicide. I exploit a reform in Switzerland that reduced the prevalence of military-issued guns in private households. In Switzerland, military service is compulsory for men, and military-issued guns account for nearly half of the total number of firearms available. The results show that the firearm suicide rate decreases by 9% for a reduction in gun prevalence of 1000 guns per 100,000 inhabitants. The elasticity of gun suicides with respect to firearm prevalence is +0.48, but converges towards zero for low levels of gun prevalence. The overall suicide rate is negatively and significantly related to firearm prevalence, which indicates that non-gun methods of suicide are not perfect replacements for firearms.

Core Self-Evaluations and Individual Strategies of Coping with Unemployment among Displaced Spanish Workers

Unemployment has negative but also positive effects on mental health and general well-being depending on which coping strategies the individual use. Our aim was to determine the contribution of core self-evaluations in explaining the coping strategies of job search and job devaluation, as well as to test the potential moderation effect of job search and mediation effect of job devaluation on the relationship between self core-evaluations and both positive and negative experience of unemployment. One hundred seventy-eight individuals who lost their jobs involuntarily for a longer period than one month completed a questionnaire while attending to employment office. Results show that there is a significant relation between core-self evaluations and job devaluation (.37**). Furthermore, core-self evaluations were positively related to positive experience of unemployment (r = .31; p < .01) and negatively related to negative experience of unemployment (r = .60; p < .01). Moreover, self-core evaluations predicted both coping with unemployment strategies (job devaluation; β = .26; p < .01 and job search β = .19; p < .05). However, job search did not moderate the relationship between core self-evaluations and experience of unemployment. But, individuals with a longer duration of the current period of unemployment and higher core self-evaluations had a more positive experience of unemployment, and job devaluation partially mediated this relation (SE = .002; p = .038). These results imply that programs interventions should include the improvement of core self-evaluations and the positive experience of unemployed people.

Conceptualizations of suicide through time and socio-economic factors: a historical mini-review

Objectives

Suicide is a complex phenomenon determined by the interplay of an articulated network of factors including socio-economic factors which have a decisive role. This paper investigates the development of the modern conceptualization of suicide in Europe, its sociological understandings and its intertwinement with economic cycles throughout time.

Methods

MEDLINE, SCHOLAR, EMBASE using the keywords ‘socioeconomic factors AND suicide’; ‘economic cycles AND suicide’; ‘history AND suicide’ without timeframe limitations. Moreover, journal-by-journal search in journals of related areas was performed.

Results

In total, 51 historical studies focusing on the subjects in European countries were included. Three main areas arose: (a) development of the conceptualization of suicide over time; (b) sociological understandings of suicide according to the structure of society and its economy of power; (c) economic theories explaining the intertwinement of economic cycles and suicides.

Conclusions

Suicide is a deeply human phenomenon inescapably linked to and grounded in society and economic cycles. Understandings from the past show the importance of accurate analysis of socio-economic contexts that shape societies together with man’s own sense of self in order to organize multi-layered tangible and intangible support strategies to better understand and prevent suicide in this day and age.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.

Spatiotemporal Suicide Risk in Germany: A Longitudinal Study 2007-11

Despite comprehensive prevention programs in Germany, suicide has been on the rise again since 2007. The underlying reasons and spatiotemporal risk patterns are poorly understood. We assessed the spatiotemporal risk of suicide per district attributable to multiple risk and protective factors longitudinally for the period 2007–11. Bayesian space–time regression models were fitted. The nationwide temporal trend showed an increase in relative risk (RR) of dying from suicide (RR 1.008, 95% credibility intervals (CI) 1.001–1.016), whereas district-specific deviations from the grand trend occurred. Striking patterns of amplified risk emerged in southern Germany. While the number of general practitioners was positively related (RR 1.003, 95% CI 1.000–1.006), income was negatively and non-linearly related with suicide risk, as was population density. Unemployment was associated and showed a marked nonlinearity. Neither depression prevalence nor mental health service supply were related. The findings are vital for the implementation of future suicide prevention programs. Concentrating preventive efforts on vulnerable areas of excess risk is recommended.

The association between attempted suicide and stock price movements: Evidence from Taiwan

This study is the first comprehensive analysis to investigate the potential association between stock market fluctuations and attempted suicide events as measured by self-inflicted injuries treated in hospitalization. Using nationwide, 15-year population-based data from 1998 through 2012, we observe that the occurrences for the hospitalizations of attempted suicides are apparently predicted by stock price movements. A low stock price index, a daily fall in the stock index, and consecutive daily falls in the stock index have been shown to be associated with increased risk of hospitalization in patients with attempted suicide. More specifically, stock price index is found to be significant impact on attempted suicide in the 45-54 age groups of both genders, whilst daily change is significant for both genders in the 25-34 and 55-64 age groups and accumulated change is only significant in female aged 25-44 and above 65. On the basis of the results, relevant organizations should consider the suicidal factors that relate prime-working-age and near-retirement-age people to better carry out specific suicide prevention measures, and, meanwhile, encourage those people to pay less attention towards daily stock price movements.

Suicide, unemployment, and economic recession in Spain

INTRODUCTION

The aim of the present work is to determine the association between unemployment and suicide, and to investigate whether this association is affected by changes in the economic cycle or other variables such as age and sex.

METHODS

A time-trend analysis was conducted to study changes in the number of suicides between 1999 and 2013 in Spain. Pearson's correlation coefficients and regression models were used to find the association between unemployment and suicide.

RESULTS

A significant positive association was found between unemployment and suicide in the pre-crisis period in men. In that period (1999-2007), each 1% annual increase in unemployment was associated with a 6.90% increase in the annual variation of suicide in the total population, and with a 9.04% increase in the annual variation of suicide in working age men.

CONCLUSIONS

The correlation between unemployment and suicide is significant in periods of economic stability, but has weakened during the recent financial crisis. Unemployment and suicide have a complex relationship modulated by age, sex and economic cycle.

Crisis, suicide and labour productivity losses in Spain

OBJECTIVES

Suicide became the first cause of death between the ages of 15 and 44 in Spain in the year 2013. Moreover, the suicide rate in Spain went up by more than 9 % with respect to the previous year. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this sense, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Firstly, this article examines the relationship between the variables related to the economic cycle and the suicide rates in the 17 Spanish regions. Secondly, an estimate is made of the losses in labour productivity owing to these suicides.

METHODOLOGY

In this article, panel data models are used to consider different variables related to the economic cycle. Demographic variables and the suicide rates for regions across Spain from 2002 to 2013 also come into play. The present and future production costs owing to premature death from suicide are calculated using a human capital model. These costs are valued from the gross salary that an individual no longer receives in the future at the very moment he or she leaves the labour market.

RESULTS

The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 38,038 potential years of working life were lost in 2013. This has an estimated cost of over 565 million euros.

CONCLUSIONS

The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.

Global trends in suicide epidemiology

PURPOSE OF REVIEW

Suicide is a major cause of mortality accounting for nearly 1 million deaths globally per year. Suicide occurs throughout the lifespan; therefore, large epidemiological samples are needed to identify patterns in suicide death. This review examines emerging evidence relating to risk and protective factors as well as preventive measures for suicide.

RECENT FINDINGS

The global financial crisis, natural disasters, air pollution and second-hand smoke have all been associated with increased suicide rates. At an individual level, past self-harm, parental loss or separation and younger age relative to classmates all confer risk. There is mixed evidence for religious affiliation and lithium levels in drinking water as protective factors. Means restriction strategies including barriers at suicide hotspots, firearms restrictions and limiting access to both pesticides and charcoal have all prevented suicide. Other interventions with recent evidence include improvements in mental health systems, selective serotonin reuptake inhibitor (SSRI) and lithium treatment in youth and mental health awareness in schools.

SUMMARY

The evidence for risk/protective factors for suicide continues to grow and, more importantly, numerous prevention efforts continue to demonstrate positive outcomes. Public policy experts should attend to the environmental and social determinants of health when devising suicide prevention programs, and the evidence-based prevention strategies identified here should be implemented more broadly.

Patterns of life expectancy before and during economic recession, 2003-12: a European regions panel approach

BACKGROUND

Previous research has reported a decrease in all-cause mortality during times of economic recession. Our objective was to identify the short-term effects of the current Great Recession on life expectancy at birth in Europe, and the role of social protection typology, income and gender.

METHODS

We used a pooled time series cross-sectional design, with 232 European regions (level 2 of the Nomenclature of Territorial Units for Statistics) as the unit of analysis over 10 years (2003-12). The dependent variable was life expectancy at birth, and the independent variable was unemployment rate. We fit a model in first differences for the periods before and during the Great Recession (2003-07 and 2008-12, respectively), and stratified by sex, social protection typology (Eastern, Mediterranean and Northern) and regional income per capita RESULTS: We observed a negative association during the Great Recession between life expectancy (in years) and in unit change in unemployment among men and women in low-income Mediterranean regions [-0.048(95%CI: -0.081,-0.014) and -0.050(95%CI:-0.091,-0.007), respectively] but no change in trend, and a change in trend to a non-significant negative association among men in high-income Mediterranean and Northern regions (P = 0.005 and P = 0.002, respectively). We also observed a positive association among men in middle-income Mediterranean regions [0.044 (95%CI:0.004,0.084)], with change in trend (P = 0.047), and Eastern regions [0.042 (95%CI:0.001,0.072)] without change in trend.

CONCLUSION

Overall, our data do not support the notion that increased life expectancy is associated with unemployment during the Great Recession.

EPA guidance on mental health and economic crises in Europe

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Mental health outcomes in times of economic recession: a systematic literature review

Background

Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations’ health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes.

Methods

Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered.

Results

One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours.

Conclusion

On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.

Comparison of Social Trust's effect on suicide ideation between urban and non-urban areas: The Case of Japanese Adults in 2006

An increasing number of studies have addressed the determinants of suicide. Social capital is a key factor in preventing suicide. However, little is known about the experience of suicide ideation using subjective values. From the viewpoint of suicide prevention, it is worth examining how people think of suicide. This paper attempts to examine the effect of social capital on suicide ideation. Furthermore, the paper compares the effect of social capital between urban and non-urban areas. In this paper, urban areas are equivalent to mega-cities with populations over one million. Non-urban areas are cities with populations of less than one million, towns and villages. Individual-level data from the Japanese General Social Surveys (JGSSs) are used. The survey, which was conducted in 2006, provides information about the subjective value of suicide ideation. The survey was answered by 1413 subjects with a mean age of 54.5. Of the subjects, 49% were male. Social trust is used to measure the degree of social capital, and the outcome of interest is suicide ideation within the past 5 years. After controlling for various factors, the major findings are that both individual-level social trust and social trust accumulated in one's residential administrative district reduce the probability that one will consider suicide. After dividing the sample into urban and non-urban residents, particularized trust plays a role in deterring suicide ideation in urban areas, while generalized trust plays a role in deterring suicide ideation in non-urban areas. The effect of each type of trust depends on its scarcity in residential areas.