Unemployment insurance program accessibility and suicide rates in the United States

Higher unemployment benefits are associated with reduced drug overdose mortality in the United States before and during the COVID-19 pandemic

OBJECTIVES

Overdose mortality rates in the United States remain critical to population health. Economic , such as unemployment, are noted risk factors for drug overdoses. The COVID-19 pandemic exacerbated economic hardship; as a result, the US government enacted income protection programs in conjunction with existing unemployment insurance (UI) to dampen COVID-19-related economic consequences. We investigate whether UI, operationalized as the weekly benefit allowance (WBA) replacement rate, is negatively associated with drug-related overdoses.

METHODS

Data from the pooled 2014-2020 Detailed Restricted Mortality files for all counties from the Centers for Disease Control and Prevention, restricted to people ≥18 years of age, aggregated at the county-quarter level (n = 89,914). We included any fatal drug, opioid, and stimulant overdose. We modeled the association between WBA replacement rate (e.g., a greater proportion of weekly earnings replaced by UI) on each county-level age-adjusted mortality outcome using separate linear regression models during 2014-2020, pre-COVID (2014-2018), and post-COVID (2019-2020). We conducted sensitivity analyses using multi-level linear regression models.

RESULTS

Results indicated that a more robust WBA replacement rate any drug (Risk Difference [RD]: -0.06, 95 % Confidence Interval [CI]: -0.08, -0.05), opioid (RD: -0.04, 95 % CI: -0.06, -0.03), and stimulant (RD: -0.03, 95 % CI: -0.04, -0.02) across the entire study period (2014-2020). A more robust WBA replacement rate was associated with fewer fatal drug, opioid and stimulant overdoses in the pre-COVID-19 period and on fatal any drug and stimulant overdoses in the COVID-19 period.

CONCLUSIONS

Findings support the notion that income protection policies, such as robust UI, can have a supportive role in preventing fatal drug overdoses, calling for a broader discussion onthe role of the safety net programs to buffer drug-related harms.

Interventions to Support the Return to Work for Individuals with Stroke: A Systematic Review and Meta-analysis

PURPOSE

An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs).

RESULTS

A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity.

CONCLUSION

Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration Number, CRD42023443668.

Factors associated with suicide risk among Brazilian graduate students during the COVID-19 pandemic

Though pandemic-related suicides are a concern, little is known about factors potentially linking graduate student life and suicide risk. This study identified factors associated with suicide risk among Brazilian graduate students (N = 5,344) during the COVID-19 pandemic. Utilizing the Mini International Neuropsychiatric Interview, this study revealed that 31.5% of participants presented some risk for suicide: 16.6% "low risk," 4.7% "moderate risk," and 10.2% "high risk." Higher income and religious affiliation were identified as protective factors. Identified risk factors encompass non-heterosexual orientation, a history of depression or posttraumatic stress or common mental disorders diagnoses, the use of medications-both general and psychopharmaceuticals-without medical prescription, antipsychotics use, alcohol consumption, lack of health insurance, and dissatisfaction with life as a result of accessing social media networks. The high vulnerability of graduate students to suicide risk highlights the need for institutional suicide prevention initiatives.

Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study

BACKGROUND

There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed.

METHODS

We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19-58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides.

RESULTS

The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed.

CONCLUSION

There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.

Disparate impacts on online information access during the Covid-19 pandemic

The COVID-19 pandemic has stimulated important changes in online information access as digital engagement became necessary to meet the demand for health, economic, and educational resources. Our analysis of 55 billion everyday web search interactions during the pandemic across 25,150 US ZIP codes reveals that the extent to which different communities of internet users enlist digital resources varies based on socioeconomic and environmental factors. For example, we find that ZIP codes with lower income intensified their access to health information to a smaller extent than ZIP codes with higher income. We show that ZIP codes with higher proportions of Black or Hispanic residents intensified their access to unemployment resources to a greater extent, while revealing patterns of unemployment site visits unseen by the claims data. Such differences frame important questions on the relationship between differential information search behaviors and the downstream real-world implications on more and less advantaged populations.

The Role of Unemployment, Financial Hardship, and Economic Recession on Suicidal Behaviors and Interventions to Mitigate Their Impact: A Review

Understanding the social determinants and risk factors for suicidal behaviors underlies the development of effective suicide prevention interventions. This review focused on recently published literature (2010 onwards), with the aim to determine the role of economic factors (at the individual and population level) on suicidal behaviors and ideation as well as the effectiveness of interventions addressing these factors in reducing suicidal behaviors and ideation. Where available, literature examining the economic impact of COVID-19 was highlighted. Economic recession and unemployment are associated with increased risk of suicidal behavior at the population and individual level. Additionally, personal financial problems such as debt and financial strain are associated with increased risk of suicidal behavior and ideation at the individual level. Regarding interventions, unemployment benefits, employment protection legislation, higher minimum wage and active labor market programs may reduce suicide at the population level. However, it is not clear what impact they have at the individual level, nor in relation to suicide attempts, self-harm, or suicidal ideation. There was a lack of evidence as to the effectiveness of financially focused suicide prevention interventions at either level. Current findings were contextualized within, and advance, prominent social theoretical models. Recommendations focused on future areas of research, including the unfolding economic impact of COVID-19, as well as the co-design and evaluation of tailored interventions and/or gatekeeper training for those in the financial and welfare sector, and enhanced early education aimed at increasing financial literacy in young people before onset or exacerbation of financial hardship.

Impact of the COVID-19 pandemic on temporal patterns of mental health and substance abuse related mortality in Michigan: An interrupted time series analysis

Background

The emergence of SARS-CoV2 (COVID-19) had wide impacts to health and mortality and prompted unprecedented containment efforts. The full impact of the COVID-19 pandemic and resulting responses on mental health and substance abuse related mortality are unknown.

Methods

We obtained records for deaths from suicide, alcohol related liver failure, and overdose from the Michigan Department of Health and Human Services (MDHHS) for 2006 to 2020. We compared mortality within sex, age, marital, racial and urban/rural groups using basic statistical methods. We compared standardized mean daily mortality incidence before and after the onset of the pandemic using t-tests. We used an interrupted time series approach, using generalized additive Poisson regression models with smoothed components for time to assess differences in mortality trends before and after the onset of the pandemic within demographic groups.

Findings

There were 19,365 suicides, 8,790 deaths from alcohol related liver failure, and 21,778 fatal drug overdoses. Compared with 2019, suicides in 2020 declined by 17.6%, overdose mortality declined by 22.5%—while alcohol deaths increased by 12.4%. Crude comparisons suggested that there were significant declines in suicides for white people, people 18 to 65 and increases for rural decedents, overdoses increased for Black people, females and married/widowed people, and alcohol mortality increased for nearly all groups. ITS models, however, suggested increased suicide mortality for rural residents, significantly increased alcohol related mortality for people ≥65 and increased overdose mortality in men.

Interpretation

The onset of the pandemic was associated with mixed patterns of mortality between suicide, alcohol and overdose deaths. Patterns varied within demographic groups, suggesting that impacts varied among different groups, particularly racial and marital groups.

Funding

This work was supported by the United States National Institute of Environmental Health Sciences [K99/R00ES026198] and their Michigan Center on Lifestage Environmental Exposures and Disease [grant number P30ES017885]; and the Institute for Global Biological Change at the University of Michigan.

Caregiving as suicide-prevention: an ecological 20-country study of the association between men's family carework, unemployment, and suicide

PURPOSE

Suicide rates are generally higher in men than in women. Men's higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men's suicide vulnerability is also related to their private-life behaviors, particularly men's low engagement in family carework, this ecological study explored the association between men's family carework, unemployment, and suicide.

METHODS

Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men's engagement in family carework and suicide rates by sex was estimated, with OECD's unemployment-benefits index and United-Nations' Human Development-Index (HDI) evaluated as controls. The moderation of men's carework on the unemployment-suicide relationship was also assessed.

RESULTS

Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country's HDI. Unemployment benefits were not associated with suicide rates. Men's family carework moderated the association between unemployment and suicide rates.

CONCLUSION

This study's findings that higher levels of men's family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men's family carework. They are consistent with evidence that where gender equality is greater, men's and women's well-being, health, and longevity are greater.