[Suicide, antidepressant prescription and unemployment in Andalusia (Spain)]

Unemployment and mental health in a community population from a border city in Mexico

BACKGROUND

The constant changes in the global economy generate instability in the markets, favoring the closing of companies, dismissals of personnel, job losses. Unemployment has been associated with adverse psychological effects, serving as a predictor of poor mental health.

OBJECTIVE

The main goal was to analyze the relation between work status and mental health.

METHODS

A cross-sectional, quantitative study was carried out with a sample of community population, inhabitants of the urban area of a Mexican city. The sample consisted of 1351 participants, being 577 men (43%) and 774 women (57%) with an average age of 41.46 (SD = 17.00). The participants were selected by a quota sampling, in 13 representative points of Matamoros' city urban area. Home surveys were applied; the Spanish version of the Symptom Checklist 90 (SCL-90) was used for mental health assessment.

RESULTS

The model explaining the relation between work status and mental health (GFI) was significant (p < 0.01). Unemployment was related to higher scores in all sub-scales of psychopathologies evaluated by the SCL-90, in comparison with the rest of work status categories.

CONCLUSIONS

The unemployed, followed by housewives, presented indicators of poorer mental health, while the retired and those in strikes or lockouts showed the best mental health indexes.

Structural determinants of suicide during the global financial crisis in Spain: Integrating explanations to understand a complex public health problem

INTRODUCTION

Suicide is a complex public health problem in contemporary societies. Macroeconomic downturns derived from the economic crisis have been found to be associated with growing suicide mortality in the United States and in Europe. The present work is aimed to assess the association between the recent economic downturns and suicide patterns using interrupted time series analysis and, particularly, adjusting this relationship by indicators of social cohesion and community values that might provide additional insights on the complex explanation of suicidal trends.

METHODS

We combined suicide, social and economic data extracted from the National Statistics Institute (INE), the Eurostat database, and the World Values Survey to assess the association between the socio-economic factors and trends in suicide rates. To study the association between the financial crisis and changes in suicide rates in Spain, we used interrupted time series analysis (ITSA).

RESULTS

Our findings confirm that suicides increased after the 2011 recession, but remained moderately constant after the 2008 economic downturn. Suicides particularly increased after the 2011 recession in the 10-14, and 45-64 years old intervals between males and females, and apparently in older groups. However, during the 2008-2011 time period suicide rates decreased during working years (specifically among 40-44, 45-49, and 55-59 years old groups). Our results highlight the importance of social protection against unemployment and, to a lesser extent, social protection in disability and family, in reducing suicides, as well as the economic prosperity of the country.

CONCLUSION

This result corroborates that the economic crisis has possibly impacted the growing suicide rates of the most vulnerable groups, but exclusively during the period characterised by economic cuts after the 2011 recession. This study highlights the need to implement tailored policies that protect these collectives against suicide.

The Evolution of Mental Health in the Context of Transitory Economic Changes

BACKGROUND

Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies.

OBJECTIVE

This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain.

METHOD

We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered.

RESULTS

We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women.

CONCLUSION

Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals' socioeconomic situation, including education, unemployment and social class.

Prevalence and correlates of suicidality in Andalusia (Spain): Results of the epidemiological study PISMA-ep

BACKGROUND

Suicidality is an important public health problem. Hence, the aims of this study are to report prevalence rates and correlates of suicidality in Andalusia (Southern Spain).

METHODS

This is a cross-sectional household survey conducted on a representative sample of adults living in Andalusia. 4507 subjects were interviewed using the Mini International Neuropsychiatric Interview (MINI) to assess suicidality and standardized instruments were employed to evaluate associated variables. A multivariate logistic regression analysis was used to explore independent associations with suicidality.

RESULTS

Current prevalence of suicidality was 6.4%, 4.4% showed death wish, 1.4% had ideas of self-harm, 2.4% had suicidal thoughts, 1.1% had a suicidal plan, 0.6% had attempted suicide during the month prior to the interview, and, lastly, 2.6% reported to have had any sort of suicide attempt during his/her previous life. Independent factors associated with suicidality were being female, older age, not having a stable couple, lower levels of social support, having had physical childhood abuse experience, having experienced an increasing number of stressful life events, higher neuroticism scores, having a family history of mental disorder and nicotine or drugs dependence.

LIMITATIONS

The instrument employed to measure suicidality is a screening tool rather than a more in-depth diagnostic measure. We have not included all potential correlates of suicidality. This is a cross-sectional study which cannot establish causal relationships between exposures and outcomes.

CONCLUSIONS

This is the first epidemiological study in Andalusia on suicidality offering important results of clinical interest for suicide prevention.

Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use?

BACKGROUND

We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants.

METHODS

We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption.

RESULTS

The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model.

LIMITATIONS

This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance.

CONCLUSIONS

AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.

Methodological barriers to studying the association between the economic crisis and suicide in Spain

BACKGROUND

The hypothetical relationship between economic recession and the increase in suicides in Spain is subject to various arguments. In addition to the inherent complexity of capturing and explaining the underlining mechanisms that could describe this causal link, different points of contention have been be identified. The period of this association and its possible starting points, the socioeconomic determinants that may explain the variation in suicide rate, and the data sources available are the main focus of controversy. The present study aims to identify the phases of association between different periods of economic recession and suicide rates, and compare the effect of different social determinants of health that have been mentioned in previous studies.

METHODS

We have used interrupted time series analyses to assess the impact of economic recession on national rates of suicide mortality provided by the Spanish Statistical Office (1980-2014). In an attempt to consider the factors that have affected the study of suicide in Spain, different data sources/periods, predictors, and regions in Spain were analysed.

RESULTS

The analysis revealed a positive and significant relationship between the Great Recession and suicide rates during the second period of economic recession (2011-2014), while appeared to decrease during the first recession period. However, the first decreasing trend was not statistically significant in the global analysis of the evolution of monthly suicide rates for the entire country. Both unemployment and per capita GDP were positively related to suicide trends. Finally, the regional analysis demonstrates a similar pattern in different Spanish areas.

CONCLUSION

Although previous studies have mentioned the double-dip in the suicide rate associated with the corresponding period of double recession, our study only identify a positive relationship during the second recession period. These results points out that the major impact of economic problems might have had a delayed effect due to initial protection policies.

Economic crisis and suicides in Spain. Socio-demographic and regional variability

BACKGROUND

Evidence from previous recessions suggests that at times of economic deterioration, suicides increase. Spain has been one of the European countries hardest hit by the financial crisis that started in 2008. The aim of this paper is to examine the impact of the double-dip recession in Spain on the most recent trends in suicide.

METHODS

Suicide data from the years 2002-2012 were obtained from the 'Death Statistic according to Cause of Death' of the National Statistics Institute (NSI). Population figures were obtained from the population estimates of the NSI.

RESULTS

While the suicide rate decreased between 2002 and 2012, the downward trend has reversed twice, in 2008-2009, and in 2012. This rise was particularly pronounced in males, with the rate ratio of 1.12 (95 % CI 1.05-1.20) in 2008 and 1.10 (95 % CI 1.03-1.18) in 2009. Following a decrease in 2010 and 2011, suicides among males have increased again in 2012-with RR of 1.10 (95 % CI 1.03-1.18) compared to 2007, however the difference between 2011 amounted to 14 % rise-the biggest interannual change in a decade. There was a similar but less pronounced pattern in females. Regional data showed variable results.

CONCLUSIONS

These results suggest that the Spanish economic crisis has been associated with suicide rates in 2008, 2009, and 2012. These findings are consistent with the double-dip recession that Spain experienced.

The effectiveness of suicide prevention programmes: urban and gender disparity in age-specific suicide rates in a Taiwanese population

OBJECTIVE

The effectiveness of suicide prevention programmes is an important issue worldwide today. The impact of urbanization and gender is controversial in suicide rates. Hence, this study adjusted on potential risk factors and secular changes for suicide rates in gender and rural/urban areas.

STUDY DESIGN

Observational study.

METHODS

A Suicide Prevention Center was established by the Executive Yuan in Taiwan in 2005 and tried to carry out suicidal intervention in the community in every city and town. There were two phases, including the first phase of the programme from 2005 to 2008, and the second phase of the programme from 2009 to 2013. The crude suicide rates data from the period of 1991-2013, which recruited nine urban and 14 rural areas in Taiwan, were extracted from the Taiwanese national mortality data file. The suicide rates in two areas of Taiwan (Taipei city and Yilan County) were further used to compare the differences between urban and rural areas.

RESULTS

The results show that unemployment increased the suicide rate in men aged 45-64 years and in women older than 65 years of age in Taiwan. High divorce and unemployment rates resulted in increased suicide rates in men in the city, whereas emotional distress was the main cause of suicides in men in rural areas. The main method of suicide was jumping from a high building for both sexes in the city, whereas drowning was the most common method of suicide for men in rural areas.

CONCLUSION

Following the intervention programme, suicide behaviour began to decrease in all urban and rural areas of Taiwan. This study showed the cumulative effect of the intervention programme in decreasing the suicide rate in Taiwan. Moreover, the gender-specific suicidal rate and disparity in suicidal methods in urban and rural areas should be considered in further preventive strategies in Taiwan.

Socio-economic factors linked with mental health during the recession: a multilevel analysis

BACKGROUND

Periods of financial crisis are associated with higher psychological stress among the population and greater use of mental health services. The objective is to analyse contextual factors associated with mental health among the Spanish population during the recession.

METHODOLOGY

Cross-sectional, descriptive study of two periods: before the recession (2006) and after therecession (2011-2012). The study population comprised individuals aged 16+ years old, polled for the National Health Survey. There were 25,234 subjects (2006) and 20,754 subjects (2012). The dependent variable was psychic morbidity.

INDEPENDENT VARIABLES

1) socio-demographic (age, socio-professional class, level of education, nationality, employment situation, marital status), 2) psycho-social (social support) and 3) financial (GDP per capita, risk of poverty, income per capita per household), public welfare services (health spending per capita), labour market (employment and unemployment rates, percentage of temporary workers). Multilevel logistic regression models with mixed effects were constructed to determine change in psychic morbidity according to the variables studied.

RESULTS

The macroeconomic variables associated with worse mental health for both males and females were lower health spending per capita and percentage of temporary workers. Among women, the risk of poor mental health increased 6% for each 100€ decrease in healthcare spending per capita. Among men, the risk of poor mental health decreased 8% for each 5-percentage point increase in temporary workers.

CONCLUSIONS

Higher rates of precarious employment in a region have a negative effect on people's mental health; likewise lower health spending per capita. Policies during periods of recession should focus on support and improved conditions for vulnerable groups such as temporary workers. Healthcare cutbacks should be avoided in order to prevent increased prevalence of poor mental health.

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.

Suicide mortality trends in Galicia, Spain and their relationship with economic indicators

BACKGROUND

Recent research has shown an association between unemployment and suicide, but the mediating factors in this relationship are still unknown. In this study, we investigated the effect of unemployment and economic recession on suicide rates in the Spanish region of Galicia between 1975 and 2012 Method. We analysed age-standardised suicide rates in men and women and in four age groups: less than 25 years, 25-45 years, 45-65 years and more than 65 years and performed a joinpoint analysis to determine trend changes throughout 1975-2012 period. Also we analysed the association between suicide, recession and unemployment by means of a temporal trend model with a Generalised Additive Model.

RESULTS

Suicide rates increased from 145 suicides in 1975 to a high in 1993, with 377 deaths by suicide, representing 1.38% of all causes of death, and thereafter they tend to decrease to 335 suicides in 2012. Joinpoint analyses revealed that suicide rates changed differently across sex and age groups. For men, the annual percentage of change (APC) between 1975 and 1988 (CI 95% 1986-1994) was 5.45 (CI 95% = 3.5, -7.2) but from 1988 the APC became negative [-0.66 (CI 95% = -1.3, -0.1)]. For women, APC between 1974 and 1990 (CI 95% 1986-1992) was 4.86 (CI 95% = 3.2, -6.4) and -1.46 subsequently (CI 95% = -2.2, -0.5). Women aged 24 years or less showed stable suicide rates while men from 45-65 years showed two incidence peaks. When we studied the independent correlation between unemployment, recession and suicide, we found a significant association between unemployment and suicide, but not between recession and suicide for both sexes together and for men while for women there was no significant correlation between suicide and unemployment or recession. Finally, when we studied the effect of the interaction between unemployment and recession on suicide we found economic recession and unemployment interacted with regards to suicide rates (F = 5.902; df = 4.167; p = 0.00098) and after adjusting by sex, the effect was confirmed among men (F = 4.827; df = 2.823; p = 0.0087), but not among women (F = 0.001; df = 1.000; p = 0.979).

CONCLUSIONS

Although suicide rates in Galicia are gradually decreasing in the last decades, there are important sex and age differences. Unemployment was related with suicide during economic recession periods according to our results.

Effects of the Financial Crisis on Psychotropic Drug Consumption in a Cohort from a Semi-Urban Region in Catalonia, Spain

Purpose

Evidence of whether the recent economic crisis has or has not had an effect on psychotropic drug consumption is very scarce. Our objective was to determine if there had in fact been an increase in psychotropic drug use as a result of the financial crisis.

Methods

In our study a retrospective cohort (between January 1, 2005, and December 31, 2012) was made up of individuals from the general population in a region in the northeast of Catalonia, Spain. We specified a generalized linear mixed model along with combined ‘selection on observables’ as (propensity scoring) matching and ‘selection on unobservables’ as (random coefficient) the panel data model methods, and performed inferences using a Bayesian framework.

Results

In the period following the economic crisis (post 2009), there was an increase in the consumption of psychotropic drugs which was significantly higher among those who had already been consuming psychotropic drugs prior to 2009 and those most likely to be unemployed. The increase was of greater significance when consumption was measured by the number of drugs being taken, rather than by the defined daily dose (DDD), with the greatest increase occurring in 2011; the very year in which Spain was most affected by the crisis.

Conclusions

Once the financial crisis had ended, there was an increase in the severity, rather than the intensity, of mental health disorders in individuals who had already had disorders before the crisis. This increase occurred in those most likely to be unemployed, and the severity was accentuated in the toughest year of the economic crisis.

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.

Use of antidepressants in the treatment of major depressive disorder in primary care during a period of economic crisis

OBJECTIVE

To describe antidepressant (AD) use in the treatment of major depressive disorder during a period of economic crisis.

PATIENTS AND METHODS

This was a retrospective, observational study using population-based databases. Two periods were considered: 1) 2008-2009, precrisis, and 2) 2012-2013, economic crisis. Certain inclusion/exclusion criteria were taken into account for the study (initiation of AD treatment). Patients were followed up for 12 months. The main measures were use (defined daily doses), epidemiologic measures, strategies used and treatment persistence, referrals, and use of resources. Statistical significance was set at P<0.05.

RESULTS

In the precrisis period, 3,662 patients were enrolled, and 5,722 were enrolled in the period of economic crisis. Average age was 58.8 years and 65.4% were women. Comparing the two periods, major depressive disorder prevalence was 5.4% vs 8.1%, P<0.001. During the period of economic crisis, AD use rose by 35.2% and drug expenditures decreased by 38.7%. Defined daily dose per patient per day was 10.0 mg vs 13.5 mg, respectively, P<0.001. At 12-month follow-up, the majority of patients (60.8%) discontinued the treatment or continued on the same medication as before, and in 23.3% a change of AD was made.

CONCLUSION

Primary health care professionals are highly involved in the management of the illness; in addition, during the period of economic crisis, patients with major depressive disorder showed higher rates of prevalence of the illness, with increased use of AD drugs.

Inequalities in suicide mortality rates and the economic recession in the municipalities of Catalonia, Spain

INTRODUCTION

While previous research already exists on the impact of the current economic crisis and whether it leads to an increase in mortality by suicide, our objective in this paper is to determine if the increase in the suicide rate in Catalonia, Spain from 2010 onwards has been statistically significant and whether it is associated with rising unemployment.

METHODS

We used hierarchical mixed models, separately considering the crude death rate of suicides for municipalities with more than and less than 10,000 inhabitants as dependent variables both unstratified and stratified according to gender and/or age group.

RESULTS

In municipalities with 10,000 or more inhabitants there was an increase in the relative risk of suicide from 2009 onwards. This increase was only statistically significant for working-aged women (16-64 years). In municipalities with less than 10,000 inhabitants the relative risk showed a decreasing trend even after 2009. In no case did we find the unemployment rate to be associated (statistically significant) with the suicide rate.

CONCLUSIONS

The increase in the suicide rate from 2010 in Catalonia was not statistically significant as a whole, with the exception of working-aged women (16-64 years) living in municipalities with 10,000 or more inhabitants. We have not found this increase to be associated with rising unemployment in any of the cases. Future research into the effects of economic recessions on suicide mortality should take into account inequalities by age, sex and size of municipalities.