Suicidality, Economic Shocks, and Egalitarian Gender Norms

Are employment and social integration more strongly associated with deaths of despair than psychological or economic distress?

The label "deaths of despair" for rising US mortality related to drugs/alcohol/suicide seems to implicate emotional distress as the cause. However, a Durkheimian approach would argue that underlying structural factors shape individuals' behavior and emotions. Despite a growing literature on deaths of despair, no study has directly compared the effects of distress and structural factors on deaths of despair versus other causes of mortality. Using data from the Midlife in the United States study with approximately 26 years of mortality follow-up, we evaluated whether psychological or economic distress, employment status, and social integration were more strongly associated with drug/alcohol/suicide mortality than with other causes. Cox hazard models, adjusted for potential confounders, showed little evidence that psychological or economic distress were more strongly associated with mortality related to drugs/alcohol/suicide than mortality from other causes. While distress measures were modestly, but significantly associated with these deaths, the associations were similar in magnitude for many other types of mortality. In contrast, detachment from the labor force and lower social integration were both strongly associated with drug/alcohol/suicide mortality, more than for many other types of mortality. Differences in the estimated percentage dying of despair between age 25 and 65 were larger for employment status (2.0% for individuals who were neither employed nor retired versus only 0.6% for currently employed) and for social integration (1.9% for low versus 0.7% for high integration) than for negative affect (1.2% for high versus 0.8% for no negative affect). Most of the association between distress and drug/alcohol/suicide mortality appeared to result from confounding with structural factors and with pre-existing health conditions that may influence both the perception of distress and mortality risk. While deaths of despair result from self-destructive behavior, our results suggest that structural factors may be more important determinants than subjective distress.

Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan

OBJECTIVE

Female labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years.

METHODS

Annual national labor-participation rates for women ages 25-64, and female and male suicide-rates, for 1980-2020, were obtained from Taiwan's Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects.

RESULTS

Higher FLFP rates were associated with lower female suicide-rates (ß = -0.06, 95% CI (Credibility Interval) = [-0.19, -0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]).

CONCLUSION

This study's findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers' support. Therefore, this study's findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men's disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.

The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study

BACKGROUND

Masculinity norms play a crucial role in men's help-seeking behaviors, service-use, and coping strategies for depression. While previous studies provided evidence for the association between gender role orientations, work related attitudes, stigmatization of men with depression and depressive symptoms, it remains unclear to what extent gender role orientations change over time and whether psychiatric and psychotherapeutic treatment have an impact on these transformations. Additionally, the role of partners in supporting depressed men and the impact of dyadic coping on these processes have not been explored. The aim of this study is to investigate how masculinity orientations and work-related attitudes change over time in men treated for depression, and to examine the role of their partners and dyadic coping in these transformation processes.

METHODS

TRANSMODE is a prospective longitudinal mixed-methods study investigating the transformation of masculinity orientations and work-related attitudes in men treated for depression between the ages of 18 and 65 from different settings in Germany. The study will recruit 350 men from various settings for quantitative analysis. By applying a latent transition analysis, the primary outcome are changes in masculine orientations and work-related attitudes over time, measured at four times (t0, t1, t2, t3) with intervals of 6 months. Qualitative interview with a subsample of depressed men selected using latent profile analysis, will be conducted between t0 and t1 (a1) with a follow-up of 12 months (a2). In addition, qualitative interviews with the partners of depressed men will be conducted between t2 and t3 (p1). Qualitative data will be analysed using qualitative structured content analysis.

DISCUSSION

A comprehensive understanding of the transformation processes of masculinity orientations over time including the impact of psychiatric/psychotherapeutic treatment and the role of partners can lead to the development of gender-sensitive depression treatment tailored to the unique needs of men with depression. Thus, the study can promote more effective and successful treatment outcomes and further contribute to reducing the stigma surrounding mental health issues among men and encourage them for mental health service use.

TRIAL REGISTRATION

This study is registered in the German Clinical Trail Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (Date of registration 06 February 2023).

The association between nation-level social and economic indices and suicide rates: A pilot study

Ever since the pioneering work of Emile Durkheim, it has been known that regional or national suicide rates can be influenced by a variety of social and economic factors. Recent research has found a robust association between two country-level economic indices-gross national product and unemployment rate-and suicide rates, particularly in men. However, the association between other country-level social indices-such as measures of social integration, inequality, environmental preservation and political freedom-and suicide rates has not been studied at the cross-national level. In the current study, national suicide rates for men and women were examined in relation to seven indices measuring subjective wellbeing, sustainable development, type of political regime, economic and gender inequality, and social capital. It was found that the Happy Planet Index, a composite measure of subjective wellbeing and sustainable development, was negatively associated with suicide rates independent of gender, and even after adjusting for possible confounding factors. Economic inequality was associated with suicide in men, and social capital was associated with suicide in women. Moreover, the strength and direction of the associations observed between socioeconomic indices and suicide varied across income groups. These results highlight the need for a closer evaluation of the link between large-scale ("macro") social factors and individual ("micro") psychological factors, as well as the importance of integrating these factors into suicide prevention programmes at the national level.

Female political representation and the gender health gap: a cross-national analysis of 49 European countries

Background

Does increased female participation in the social and political life of a country improve health? Social participation may improve health because it ensures that the concerns of all people are heard by key decision-makers. More specifically, when women’s social participation increases this may lead to health gains because women are more likely to vote for leaders and lobby for policies that will enhance the health of everyone. This article tries to examine whether female participation is correlated with measures of health inequality.

Methods

We draw on data from the World Health Organization Health Equity Status Report initiative and the Varieties of Democracy project to assess whether health is better and health inequalities are smaller in countries where female political representation is greater.

Results

We find consistent evidence that greater female political representation is associated with lower geographical inequalities in infant mortality, smaller inequalities in self-reported health (for both women and men) and fewer disability-adjusted life-years lost for women and men. Finally, we find that greater female political representation is not only correlated with better health for men and women but is also correlated with a smaller gap between men and women because men seem to experience better health in such contexts.

Conclusions

Greater female political representation is associated with better health for everyone and smaller inequalities.

Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis

OBJECTIVES

to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession.

METHODS

interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data.

RESULTS

there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide.

CONCLUSIONS

the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.

Efeitos da recessão econômica na mortalidade por suicídio no Brasil: análise com séries temporais interrompidas

RESUMO Objetivos: analisar as tendências nas taxas de suicídio no Brasil, no período antes e depois do início da recessão econômica. Métodos: estudo de séries temporais interrompidas utilizando dados nacionais de suicídio registrados no período entre 2012 e 2017 com análises por subgrupos socioeconômicos. Modelo de regressão quasi-Poisson foi empregado para analisar as tendências dos dados ajustados sazonalmente. Resultados: observou-se aumento abrupto no risco de suicídio após recessão econômica na população com menor escolaridade (12,5%; RR = 1,125; IC95%:1,027; 1,232) e na Região Sul (17,7%; 1,044; 1,328). Após redução abrupta, ocorreu aumento progressivo no risco para a população de pretos e pardos e na de maior escolaridade. Na maioria dos demais estratos populacionais, verificou-se aumento progressivo no risco de suicídio. Conclusões: a recessão econômica brasileira produziu efeitos diferentes nas taxas de suicídio, considerando os estratos sociais, o que demanda estratégias de saúde e políticas sensíveis às populações mais vulneráveis.

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.

Contributing factors to suicide: Political, social, cultural and economic

This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. The social institutions of marriage, as well as parenting, continue to serve as protective factors against suicide, although the degree of protection is often gendered. Religiousness tends to be inversely associated with suicide deaths at the individual level of analysis, but the mediators need exploration to determine what accounts for the association: social support, better mental health, better physical health, less divorce, or other covariates. Cultural definitions of the traditional male role (e.g., breadwinner culture) continue to help explain the high male to female suicide ratio. New work on the "culture of suicide" shows promise. The degree of approval of suicide is sometimes the single most important factor in predicting suicide. At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.

Suicidal behaviour and the coronavirus (COVID-19) pandemic: Insights from Durkheim's sociology of suicide

Whilst suicide is well established as a critical global public health burden causing around 800,000 deaths annually along with many more attempts, there is a concern that the impact of the coronavirus (COVID-19) pandemic might intensify suicidality. The purpose of this study is to draw attention to the budding correlation between the COVID-19 pandemic and suicidality from the theoretical perspective of Emile Durkheim's sociology of suicide. A review of online newspaper databases (1 January to 30 April 2020) that reported suicide cases and attempts triggered as a result of the disruptions caused by the COVID-19 pandemic were included and analysed. Out of the 28 identified cases, there were three suicide attempts, one homicide-suicide/pact-suicide, and 24 suicides spanning 10 countries. Durkheim explained the social causation of suicide and provided a four-fold suicide typology. The cases were analysed according to their appropriate typology, and classified as egoistic (9), altruistic (3), anomic (8), and fatalistic (8). Durkheim suggests that the rise and fall of suicide rates will depend on the nature of social change. As society is undergoing massive social disruption resulting from the COVID-19 pandemic, suicide rates may increase unless suicide prevention measures align with the current social reconstruction process.

"I'm Not Afraid of Dying Because I've Got Nothing to Lose": Young Men in South Africa Talk About Nonfatal Suicidal Behavior

First-person narratives of suicidal behavior may provide novel insights into how individuals with lived experience of suicide understand and narrate their behavior. Our aim was to explore the narratives of young men hospitalized following nonfatal suicidal behavior (NFSB), in order to understand how young suicidal men construct and understand their actions. Data were collected via narrative interviews with 14 men (aged 18–34 years) admitted to hospital following an act of NFSB in Cape Town, South Africa. Narrative analysis was used to analyze the data. Two dominant narratives emerged in which participants drew on tropes of the “great escape” and “heroic resistance,” performing elements of hegemonic masculinity in the way they narrated their experiences. Participants position themselves as rational heroic agents and present their suicidal behavior as goal-directed action to solve problems, assert control, and enact resistance. This dominant narrative is incongruent with the mainstream biomedical account of suicide as a symptom of psychopathology. The young men also articulated two counter-narratives, in which they deny responsibility for their actions and position themselves as defeated, overpowered, wary, and unheroic. The findings lend support to the idea that there is not only one narrative of young men’s suicide, and that competing and contradictory narratives can be found even within a dominant hyper-masculine account of suicidal behavior. Gender-sensitive suicide prevention strategies should not assume that all men share a common understanding of suicide. Suicide can be enacted as both a performance of masculinity and as a resistance to hegemonic gender roles.

Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study

Background

Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition.

Methods

Data were retrieved on all suicides in Iceland during 2002–14. The study period was divided into a pre-collapse period (2002–08) and a post-collapse period (2008–14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex.

Results

A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94–1.35). This was true for both men and women (RR 1.18; CI 0.96–1.46 and RR 0.96; CI 0.67–1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86–1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94–1.79) or balance of trade (RR 1.08; CI 0.96–1.22).

Conclusion

The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.

The knife's edge: Masculinities and precarity in East Africa

In our field sites and clinical practice in East Africa, we regularly encounter men who have become overwhelmed by "thinking too many thoughts" and "gone crazy from confusion," brought about by the problems of life created by deepening social, economic and political precarity. Across diverse settings, many African men continue to be enmeshed in social and material obligations and expectations that position them as economic consumers and providers for those they care for and love. When these gendered obligations, expectations and fantasies are left unfulfilled, this sense of failure can be embodied to produce particular kinds of health effects. Namely, men may become plagued by troublesome and confusing thoughts, leading them in some cases to "give up on" (as our research subjects put it) pursuing work and education, to become immersed in problematic drug and alcohol use, and even to take their own lives. While these afflictions can be glossed using the language of depression, anxiety, addiction and suicide, such medicalizing frames may obscure more nuanced social, structural and affective diagnoses of what is happening to men across Africa and globally. Anthropology provides us with alternative frames through which to understand how psychological wounds are made-and healed.

Does gender inequity increase men's mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study

A number of theoretical approaches suggest that gender inequity may give rise to health risks for men. This study undertook a multilevel analysis to ascertain if state-level measures of gender inequity are predictors of men's mortality in the United States. Data for the analysis were taken primarily from the National Longitudinal Mortality Study, which is based on a random sample of the non-institutionalised population. The full data set included 174,703 individuals nested within 50 states and had a six-year follow-up for mortality. Gender inequity was measured by nine variables: higher education, reproductive rights, abortion provider access, elected office, management, business ownership, labour force participation, earnings and relative poverty. Covariates at the individual level were age, income, education, race/ethnicity, marital status and employment status. Covariates at the state level were income inequality and per capita gross domestic product. The results of logistic multilevel modelling showed a number of measures of state-level gender inequity were significantly associated with men's mortality. In all of these cases greater gender inequity was associated with an increased mortality risk. In fully adjusted models for all-age adult men the elected office (OR 1.05 95% CI 1.01–1.09), business ownership (OR 1.04 95% CI 1.01–1.08), earnings (OR 1.04 95% CI 1.01–1.08) and relative poverty (OR 1.07 95% CI 1.03–1.10) measures all showed statistically significant effects for each 1 standard deviation increase in the gender inequity z-score. Similar effects were seen for working-age men. In older men (65+ years) only the earnings and relative poverty measures were statistically significant. This study provides evidence that gender inequity may increase men's health risks. The effect sizes while small are large enough across the range of gender inequity identified to have important population health implications.

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Theoretical approaches link gender inequity to increased health risks for men.

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Multilevel analysis allows investigation of a contextual effect of gender inequity.

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The study modelled the effect of state-level gender inequity on men's mortality.

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Aspects of gender inequity predicted an increased mortality risk for men.

Why is depression more common among women than among men?

Women are about twice as likely as are men to develop depression during their lifetime. This Series paper summarises evidence regarding the epidemiology on gender differences in prevalence, incidence, and course of depression, and factors possibly explaining the gender gap. Gender-related subtypes of depression are suggested to exist, of which the developmental subtype has the strongest potential to contribute to the gender gap. Limited evidence exists for risk factors to be specifically linked to depression. Future research could profit from a transdiagnostic perspective, permitting the differentiation of specific susceptibilities from those predicting general psychopathologies within and across the internalising and externalising spectra. An integration of the Research Domain Criteria framework will allow examination of gender differences in core psychological functions, within the context of developmental transitions and environmental settings. Monitoring of changing socioeconomic and cultural trends in factors contributing to the gender gap will be important, as well as the influence of these trends on changes in symptom expression across psychopathologies in men and women.