Suicide in Italy during a time of economic recession: some recent data related to age and gender based on a nationwide register study

Adolescents Hospitalized in an Acute Psychiatric Ward: The Difference between Males and Females in the Pre- and Pandemic/Post-Pandemic Periods

(1) Background: The pandemic lowered by 10% the psychological wellness among adolescents worldwide. (2) Methods: This observational retrospective study compared the demographic and clinical variables of male and female adolescents hospitalized in an acute psychiatric ward during the pre-pandemic, from 1 July 2017 to 28 February 2020, and the pandemic/post-pandemic, from 1 March 2020 to 30 June 2023. (3) Results: In total, 153 adolescents of 15.8 years on average (±1.14 DS) were more frequently hospitalized (n = 131, 54.4%) in the pre-pandemic than in the pandemic/post-pandemic (n = 110, 45.6%), but female hospitalizations increased in the post-pandemic more than male hospitalizations (62.9% vs. 37.1%) (Pearson Chi2 = 8.54, p = 0.003); in the pandemic/post-pandemic, we reported increased aggressive behavior and schizophrenia spectrum and emotional disorders in males, whereas in females, depressive and emotional disorders were prevalent; more adolescents previously treated in Child Mental Health Services were hospitalized in the pandemic/post-pandemic period; and males hospitalized in the study period reported higher Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scores. (4) Conclusions: In the pandemic/post-pandemic, females more frequently required hospitalizations for depressive behavior and males for aggressive behavior and schizophrenia spectrum disorders, whereas, in both males and females, hospitalizations due to emotional disorders increased. Our results suggest the need for mental health prevention in adolescents, who represent the most vulnerable population in the case of disaster.

The impact of national and international financial crises on mental health and well-being: a systematic review

BACKGROUND

Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being.

AIMS

The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes.

METHODS

After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis.

RESULTS

Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises.

CONCLUSIONS

Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.

A pilot predictive model based on COVID-19 data to assess suicidal ideation indirectly

The COVID-19 pandemic has had a negative impact on the mental health of the population. Many studies reported high levels of psychological distress and rising rates of suicidal ideation (SI). Data on a range of psychometric scales from 1790 respondents were collected in Slovenia through an online survey between July 2020 and January 2021. As a worrying percentage (9.7%) of respondents reported having SI within the last month, the goal of this study was to estimate the presence of SI, as indicated by the Suicidal Ideation Attributes Scale (SIDAS). The estimation was based on the change of habits, demographic features, strategies for coping with stress, and satisfaction with three most important aspects of life (relationships, finances, and housing). This could both help recognize the telltale factors indicative of SI and potentially identify people at risk. The factors were specifically selected to be discreet about suicide, likely sacrificing some accuracy in return. We tried four machine learning algorithms: binary logistic regression, random forest, XGBoost, and support vector machines. Logistic regression, random forest, and XGBoost models achieved comparable performance with the highest area under the receiver operating characteristic curve of 0.83 on previously unseen data. We found an association between various subscales of Brief-COPE and SI; Self-Blame was especially indicative of the presence of SI, followed by increase in Substance Use, low Positive Reframing, Behavioral Disengagement, dissatisfaction with relationships and lower age. The results showed that the presence of SI can be estimated with reasonable specificity and sensitivity based on the proposed indicators. This suggests that the indicators we examined have a potential to be developed into a quick screening tool that would assess suicidality indirectly, without unnecessary exposure to direct questions on suicidality. As with any screening tool, subjects identified as being at risk, should be further clinically examined.

Sociodemographic and Clinical Correlates Associated with the Frequent Service Users in an Italian Psychiatric Emergency Department

BACKGROUND

The aim of the present study is to identify the main sociodemographic and clinical correlates associated with frequent service users (FSUs) in an Italian psychiatric emergency department.

METHODS

This study is an observational and prospective clinical investigation. All subjects (N = 549) consecutively admitted to the Psychiatric Inpatient Unit of the IRCCS Ospedale Policlinico San Martino ((Genoa, Italy) were recruited over a period of 18 months.

RESULTS

On average, FSUs were more likely to be single (75.0% vs. 64.0, p = 0.001), younger (38.79 years ± 14.68 vs. 45.94 years ± 16.94, p = 0.028), with an earlier onset (20.15 years ± 7.22 vs. 29.33 years ± 15.96, p < 0.001), and longer length of hospitalisation (13.65 days ± 12.40 vs. 9.89 ± 10.15, p = 0.006) compared to non-FSUs. While bipolar disorder was the most common primary diagnosis in both FSUs and non-FSUs, cluster B personality disorder was particularly elevated in FSUs (30.3% vs. 10.4%, p < 0.001). Furthermore, FSUs were more prone to substance use disorder (63.6% vs. 40.0%, p < 0.001), particularly cannabis (45.5% vs. 15.3%, p < 0.001), cocaine (33.3% vs. 10.4%, p < 0.001), and heroin (19.7% vs. 5.8%, p < 0.001), and were more likely to have non-suicidal self-injuries (21.2% vs. 6.8%, p < 0.001). FSUs were significantly more likely to be discharged against medical advice (18.2% vs. 5.6%, p < 0.001) or to have at least one escape attempt from the psychiatric ward (12.1% vs. 0.8%, p < 0.001).

CONCLUSIONS

Specific clinical and social profiles of patients who repeatedly utilised the services of a psychiatric emergency department have been identified. Our findings can be used to develop suitable structures to support and reintegrate FSUs into society and work life.

Consequences of COVID-19 on Employees in Remote Working: Challenges, Risks and Opportunities An Evidence-Based Literature Review

The COVID-19 pandemic forced organizations across all sectors and sizes to undertake crucial changes in order to remain productive during the emergency. Among these, the shift towards remote working arrangements is still present in our workplaces, impacting employees' well-being and productivity. This systematic review aims to describe the pandemic's consequences on work organization by analyzing whether and how the shift towards remote or home-working impacted employees' productivity, performance, and well-being. Furthermore, it describes the role of individual and organizational factors in determining employees' adjustment to remote work. Sixty-seven peer-reviewed papers published from 2020 to 2022, written in English, were selected through the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Findings describe how remote working arrangements, the workplace and organizational factors, and the employees' individual traits and skills impacted employees' productivity and well-being. Furthermore, they provide a description of the organizational enforcement actions reported in the literature. Managerial and practical implications, such as enforcement actions, team management strategies, and initiatives to promote employees' physical and mental health, will be discussed in the paper.

Perceived Past and Current COVID-19-Stressors, Coping Strategies and Psychological Health among University Students: A Mediated-Moderated Model

The COVID-19-pandemic entailed abrupt/long-lasting changes in university students' lives, resulting in growing stress and stress-related outcomes. Although nowadays the pre-pandemic-life is gradually re-establishing, past-COVID-19-stressful experiences and strategies adopted to adjust to this condition may significantly impact students' current experiences. Therefore, the development of research exploring the complex interplay between perceived past/present COVID-19-related experiences, coping strategies, and psychological health currently reported by students is needed. This study simultaneously tests the associations between Past-COVID-19-stressors and Current-COVID-19-stressors as moderated by Coping Strategies and the associations between Past-COVID-19-stressors and Psychological Symptoms as mediated by Current-COVID-19-stressors. A mediated-moderated model was tested on 355 university students. COVID-19-Student-Stress-Questionnaire (CSSQ) was used to assess COVID-19-stressors. Two CSSQ-versions were used, one of which was adjusted to assess Past-COVID-19-stressors recalled from previous restrictive pandemic phases. Coping-Orientation-to-Problem-Experienced-New-Italian-Version and Symptom-Checklist-90-Revised were used to assess, respectively, Coping Strategies and Psychological Symptoms. Findings confirmed the hypothesized Mediated-Moderated Model. The effects of Past-COVID-19-stressors on Current-COVID-19-stressors were moderated by Coping Strategies, and the effects of Past-COVID-19-stressors on Psychological Symptoms were mediated by Current-COVID-19-stressors. Unique psychopathological risk profiles deriving from the interplay between specific past/present stressors and coping strategies were found. Researchers and clinicians can use these findings to develop updated research and timely evidence-based interventions fostering students' adjustment in the current period. Future research should further explore the impact of the complex interplay between perceived past/present COVID-19-related experiences and individual characteristics on psychological health conditions reported by people in the aftermath of the COVID-19 pandemic.

Predicting Suicide in Counties: Creating a Quantitative Measure of Suicide Risk

Rising rates of suicide over the past two decades have increased the need for wide-ranging suicide prevention efforts. One approach is to target high-risk groups, which requires the identification of the characteristics of these population sub-groups. This suicidology study was conducted using large-scale, secondary data to answer the question: using the research on suicide, are there variables studied at the community level that are linked to suicide and are measurable using quantitative, demographic data that are already collected and updated? Data on deaths from suicide in U.S. counties for the years 2000, 2005, 2010 and 2015 were analyzed using multiple regression, longitudinal regression, and cluster analysis. Results indicated that the suicide rate in a county can be predicted by measuring the financial stability of the residents, the quality of mental health in the county, and the economic opportunity in the county. The results are further analyzed using two sociological theories, Social Strain Theory and the Theory of Anomie, and two psychological theories, the Shame Model and the Interpersonal Theory of Suicide.

Demoralization in suicide: A systematic review

OBJECTIVE

In psychiatric literature, few original studies exist on the topic of demoralization in suicide. In this review, we aim to identify original studies on suicidal ideation (SI)/suicidal behavior (SB) and demoralization in populations of community-dwellers and patients with somatic or psychiatric disorders.

METHODS

We employed a systematic approach that followed PRISMA guidelines, searching through four major electronic databases (PubMed/MEDLINE, Scopus, Science Direct, and PsychINFO) for relevant titles/abstracts published from January 1980-June 2021. We included original studies that explicitly mentioned the investigation of a potential association between SI/SB and demoralization.

RESULTS

A total of 18 studies met our inclusion criteria. Their synthesis revealed that demoralization can be associated with SI/SB in a wide range of populations (community dwellers, patients with somatic or psychiatric disorders) and lead to significantly higher suicide risk (odds ratios of >6 were encountered in community dwellers experiencing financial hardship or isolation). Moreover, demoralization alone (about half the patients who were demoralized did not meet the criteria for an affective disorder nor were they clinically depressed) or together with depression has been identified as a major risk factor for SI/SB. Regarding the crucial issue of progression from SI to SA, in the context of the "ideation-to-action" frame, some authors found that the interaction of demoralization and over-arousal could be a useful predictor for this progression, while others found that depression alone was sufficient to differentiate attempters from non-attempters or the interaction with shutdown (helplessness and low positive emotions).

CONCLUSION

These results emphasize the possibility to identify demoralization as an independent risk factor for suicide. In patients with psychiatric disorders, the association between demoralization and SI/SB may be transnosographic. Overall, from the clinical implications perspective, our findings highlight that: i. Assessment of demoralization may contribute to a more comprehensive suicide risk detection. This appears particularly relevant in Emergency Departments (EDs) where heterogeneous population typologies are usually admitted and a clinical diagnosis of depression is often difficult to be defined. ii. Additionally, since meaninglessness is considered one of the demoralization subcomponents, meaning-centered psychotherapeutic approaches prove to be indicated and they can be initiated already at the EDs upon first contact with the patient. Further studies are necessary to confirm these findings.

The impact of macroeconomic factors on suicide in 175 countries over 27 years

BACKGROUND

Every year, more than 800,000 people die by suicide, three-quarters of which are males. Economic factors influence suicide rates, but a worldwide perspective of their impact according to age and sex is lacking.

METHOD

We queried publicly available datasets on economic factors and on suicide rates stratified according to sex and age, from 1991 to 2017, for 175 countries. Thus, we analyzed approximately 21 million deaths by suicide using a multivariable regression model approach.

RESULTS

Every 1% increase in global unemployment rates is associated with a 1% upsurge in male deaths by suicide (Relative risk (RR) = 1.01 [CI 95% 1.00-1.01] with respect to females) or 5000 excess male deaths. A 1% higher unemployment rate also exerts age-specific effects on suicide rates, since, among adults aged 30-59, the suicide rate is increased by 2-3%. Lastly, for every 1000 US dollar increase in the GDP per capita, suicide rates are reduced by 2% (RR = 0.98 [0.98-0.98]), corresponding to a reduction of 14,000-15,000 suicide deaths per year globally.

CONCLUSIONS

Males who have lost their jobs in adulthood are those at higher risk of suicide and to whom financial support measures should be delivered in a timely manner.

Lost in transition: a systematic review of the association between unemployment and mental health

BACKGROUND

Unemployment can involve financial strain and major psychosocial challenges. Integration of the existing evidence is needed to better characterize the association between unemployment and mental health, independently of macroeconomic contexts.

AIMS

Main objectives of this study: (a) review, integrate, and summarize evidence about the association between unemployment and anxiety disorders, mood disorders, and suicidal behaviour, and (b) identify variables affecting this association.

METHOD

Systematic review of literature following PRISMA guidelines. PubMed, Web of Science, SciELO, RCAAP, and Cochrane Library databases were searched. Quantitative empirical studies on the association between unemployment and mental illness of community-based samples were included. The quality of the evidence provided in the studies was assessed following pre-defined methodological criteria.

RESULTS

Overall, 294 articles were considered eligible. In total, 55.7% of the studies were conducted in Europe; 91.4% supported a positive association between increased unemployment rates and anxiety, mood disorders, or suicidal behavior. Men and young adults were most severely affected by unemployment. Education and social support were found to buffer the negative outcomes of job loss.

CONCLUSIONS

Unemployment was inversely associated with mental health irrespectively of the economic context; unemployed individuals were more vulnerable to commit suicide and suffer from anxiety and mood disorders.

Unemployment and suicide among the Brazilian population in the crisis of capitalism

The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.

The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review

In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

AIM

The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men.

METHOD

This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis.

RESULTS

The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders' suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased.

DISCUSSION

The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals.

CONCLUSIONS

We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

Suicide mortality data from the Italian police during the COVID-19 pandemic

Suicide is a major public health issue worldwide, with about 880,000 dying annually for such a cause. The COVID-19 pandemic has led to severe social disruption both from health and economic standpoints. Law enforcement personnel have been significantly involved in helping to face the many difficulties due to the pandemic. Police officers have been subjected to further stress from managing social restrictions imposed by governments to contain the pandemic. The Italian State Police steadily approximate 100,000 people aged 25-65 years: 14 subjects (mean age 43.64 years) died by suicide in 2015, 7 (mean age 47.5 years) in 2016, 13 (mean age 45.62 years) in 2017, 10 (mean age 48.1 years) in 2018, 18 (mean age 46.78 years) in 2019, and 12 (mean age 52 years) in 2020. Our records excluded significant changes in suicide incidence rate within 2015-2020 (till December 2020). However, the COVID-19 pandemic spread faster in Italy than in other regions, meaning that the Italian State Police possibly faced prolonged, intense stress. Suicide prevention, therefore, remains a priority, especially during this difficult time.

The COVID-19 Outbreak and Subjects With Mental Disorders Who Presented to an Italian Psychiatric Emergency Department

ABSTRACT

We performed a retrospective study from January to May 2020 to establish the sociodemographic and clinical characteristics of patients with mental health problems who arrived at an Italian emergency department during the COVID-19 outbreak. We divided the sample into two groups taking as a watershed March 11, when the World Health Organization announced COVID-19 outbreak as a pandemic. Chi-square/t-tests, adjusted p values (Bonferroni method), and regression analysis were performed. Patients who arrived at the emergency department during the lockdown decreased by 56%; showed greater active suicidal ideation, more tension, and more severe psychopathological state; were living alone more frequently; and were taking home treatment mainly based on second-generation antipsychotics. According to our study, it seems that patients with mental disorders have consulted psychiatric services less frequently during the pandemic, but the economic, health, and social distress may be linked with an increase in suicidal risk and the severity of the psychopathological state.

The health of Italians before and after the economic crisis of 2008

This article examines the relationship between the financial crisis of 2008 and the health of Italians using aggregate and individual health indicators in correlation with the socioeconomic changes which have occurred in the Italian population. First, the study contextualises the changes referring to some important health indicators (life expectancy, death and suicide rates). Then, the main hypothesis on the relation between worsened individual health conditions and socioeconomic deterioration is tested. For this purpose, individual data from 2005 to 2013 stemming from Health Condition and Use of Health Services surveys (Italian National Institute of Statistics) are analysed. The results show that the social categories most severely affected by the crisis, in both employment and economic terms, were basically the same as those that experienced a worsening of their physical and psychological health conditions. These categories of people have a low level of educational attainment, live in southern and insular regions and are most often men.

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.

The impact of the great economic crisis on mental health care in Italy

The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007-2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.

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.

Late life suicide in Italy, 1980-2015

AIM

Suicide trends in older adults were examined in Italy from 1980 to 2015. Age groups considered were 65-74 years, 75-84 and 85 + years.

METHODS

Data on suicide deaths were obtained from the Italian Mortality Database (IMDB) collected by the Italian National Institute of Statistics (ISTAT) and processed by the Statistics Unit of the Italian National Institute of Health (Istituto Superiore di Sanità). Joinpoint regression analyses were carried out for age subgroups by sex. In addition, data related to four main macro-areas of Italy were considered: North-West, North-East, Centre, and South with Islands (Sicily and Sardinia).

RESULTS

Starting by 1985, declines were noted in all age groups with more noticeable decreases in older adults aged 75-84 and 85 + years. Female subjects demonstrated more ample falls in rates than male individuals. Declines were detected in all macro-areas of Italy.

CONCLUSION

Improved health assistance and quality of life of older individuals have probably contributed to the decline of suicide rates of senior citizens, who also showed improved poverty indices in the country, differently from all other age groups.

Suicides in Greece before and during the period of austerity by sex and age group: Relationship to unemployment and economic variables

BACKGROUND

There is disagreement on the specific mechanism through which the economic recession increased suicides in Greece. Unemployment is considered by many authors to be the determining factor but the data are inconclusive and often negative, especially concerning the temporal relationship between onset of increase in unemployment and increase in suicides AIMS: The aim of this paper was to clarify the specific role of unemployment as well as of other socioeconomic variables on specific age-by-gender groups concerning the increase in suicides.

METHODS

Data of the Hellenic Statistical Authority ELSTAT (www.

STATISTICS

gr) were analyzed with Linear Regression Analysis and Bonferroni correction for multiple testing RESULTS: Unemployment correlates with suicide rates only in males aged 20-24, 50-54 and 60-64 years (p < 0.001). Unemployment could held responsible for an additional 148 male deaths during the period 2009-2015, which accounts for 5.3% of the total (29 additional deaths per year). The changes in all the socioeconomic conditions could held responsible for 317 cases of suicide or 9.4% of total CONCLUSIONS: The results of the current study suggest that there was a 33% increase in deaths by suicide in Greece during the early years of recession (2009-2015); one third could be directly attributed to unemployment, one third to other consequences of recession while another third is of unknown origin. The effect of unemployment is specifically restricted to males at the beginning of their working career (20-24 years old) and to middle aged (45-49 and 55-59 years old).

Age and sex trends for suicide in Brazil between 2000 and 2016

PURPOSE

To evaluate changes in standardized suicide rates in Brazil between 2000 and 2016, stratified by sex and age.

METHODS

Descriptive analyses of data from the Brazilian Mortality Information System were performed.

RESULTS

156,292 suicides were registered in the period, with a standardized rate of 4.82/100,000. The risk for males was 3.81 times higher than for females, without meaningful regional variations. This ratio was 8.2 at the 80+ group. An increase from 2000 to 2016 was demonstrated in nearly all subgroups over the 17, especially men aged 20-39 and women aged 40-59.

CONCLUSIONS

Suicide rates continue to rise in Brazil, especially among young men and middle-aged women. Older men remain exposed to the highest absolute risk.

Unemployment and suicide in Italy: evidence of a long-run association mitigated by public unemployment spending

From the mid-1990s on, the suicide rate in Italy declined steadily, then apparently rose again after the onset of the Great Recession, along with a sharp increase in unemployment. The aim of this study is to test the association between the suicide rate and unemployment (i.e., the unemployment rate for males and females in the period 1977-2015, and the long-term unemployment rate in the period 1983-2012) in Italy, by means of cointegration techniques. The analysis was adjusted for public unemployment spending (referring to the period 1980-2012). The study identified a long-run relationship between the suicide rate and long-term unemployment. On the other hand, an association between suicide and unemployment rate emerged, though statistically weaker. A 1% increase in long-term unemployment increases the suicide rate by 0.83%, with a long-term effect lasting up to 18 years. Public unemployment spending (as percentage of the Italian gross domestic product) may mitigate this association: when its annual growth rate is higher than 0.18%, no impact of unemployment on suicide in detectable. A decrease in the suicide rate is expected for higher amounts of social spending, which may be able to compensate for the reduced level of social integration resulting from unemployment, helping the individual to continue to integrate into society. A corollary of this is that austerity in times of economic recession may exacerbate the impact of the economic downturn on mental health. However, a specific "flexicurity" system (intended as a combination of high employment protection, job satisfaction and labour-market policies) may have a positive impact on health.

'Suicide rates in Crete, Greece during the economic crisis: the effect of age, gender, unemployment and mental health service provision'

BACKGROUND

Recently, suicides in Greece have drawn national and international interest due to the current economic crisis. According to published reports, suicides in Greece have increased up to 40% and Crete has been highlighted as an area with the sharpest increase.

AIM

To investigate the suicide mortality rates in Crete between 1999 and 2013 and their association with the economic crisis.

METHODS

Data on suicides were selected from the Department of Forensic Medicine files of the University of Crete.

RESULTS

Our analysis showed that (1) Crete, has the highest suicide mortality rate in Greece, however no significant increase was observed between 1999 and 2013, (2) there were opposing trends between men and women, with women showing a decrease whereas men showed an increase in that period, (3) there was a significant increase of suicides in middle-aged men (40-64 yrs) and elderly, although the highest unemployment rates were observed in young men and women, and (4) finally, there was a regional shift of suicides with a significant decrease in Western Crete and a significant increase in Eastern Crete.

CONCLUSIONS

Although, Crete has the highest suicide mortality rates in Greece, we did not observe an overall increase during the last 15 years, including the period of economic crisis. Furthermore, there was an increase in middle-aged and elderly men, whereas young men and women showed oppositional trends during the years of austerity. This may be related to the culturally different expectations for the two genders, as well as that younger individuals may find refuge to either strong family ties or by immigrating abroad. Finally, the relative increase of suicides in Eastern Crete may be explained by factors, such as the lack of community mental health services in that area.

Availability and use of mental health services in European countries: Influence on national suicide rates

BACKGROUND

Previous research suggests significant increases in suicide mortality rates in European countries following the economic crisis of 2008. However, the relationship between national differences in availability and use of mental health services and suicide rates has not been extensively examined yet.

MATERIALS AND METHODS

Data on mental health services and socioeconomic variables were derived from Eurostat for the years 2000-2013 for ten European countries. The national health care variables consisted of suicide mortality rate (SMR), average length of hospital stay and number of hospitalizations due to affective disorder or any psychiatric disorder, number of psychiatric beds and number of prescribed antidepressants. Economic variables included the gross domestic product (GDP), the gross domestic product per 1000 inhabitants (Real GDP), the rate of unemployment and the GINI-coefficient as a measurement for the equality of wealth distribution. Mixed models were used to investigate the potential influence of the onset of the economic crisis in 2008 on each of the psychiatric variables. Multivariable regression analyses were used to assess the influence on suicide mortality rates.

RESULTS

In this study, a significant change in slope starting from 2008 was revealed for the number of psychiatric beds, hospitalizations due to affective disorder or any psychiatric disorder and for prescribed antidepressants. Furthermore, a significant step change for hospitalizations due to affective disorder was observed in 2008. SMR exhibited a significant step change in 2008 for males and females as well as a significant change in slope from 2008 onwards for males only. Contrary to our hypothesis, most variables showed no statistically significant influence on SMR. Only a higher number of available psychiatric beds was significantly associated with higher suicide mortality rates. This effect, however, was only significant for females and did not remain significant after correcting for economic variables. Less than 10% of suicide mortality rate variability could be explained by a model including all variables, further corroborating the multifactorial etiology of suicide.

LIMITATIONS

Since administrative registry data was used, the results should be interpreted with caution. Results might not be applicable to countries not included.

CONCLUSION

While significant changes in the psychiatric variables, as well as SMR, were observed, no statistically significant influence on SMR remained after correcting for country, time and economic variables. Our study suggests the necessity of a more comprehensive international data gathering effort. Further research is needed to identify populations at risk of suicide.

". . . If You're Not Part of the Institution You Fall by the Wayside": Service Providers' Perspectives on Moving Young Men From Disconnection and Isolation to Connection and Belonging

There have been increasing calls for more gender-specific service provision to support young men's (20-29 years) mental health and well-being. In Ireland, young men are the demographic group that are most likely to die by suicide but among the least likely to seek help. This study sought to investigate service providers' perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their mental/emotional well-being. Qualitative methodologies (focus groups, n = 9; interviews, n = 7) were used for this study. Disconnection from family and community was identified as a key indicator of "at-risk" groups of young men who, more typically, had experienced significant disruption in their lives. The discord between demands and expectations facing young men on one hand, and insufficient life-management and coping skills on the other, left many young men vulnerable and bereft. The desire to save face and preserve one's masculine identity was linked to young men's reluctance to seek help when feeling down. There was a strong consensus that there could be no shortcuts to [re]connecting with young men. While sport, technology, and social media were cited as appropriate media in which to engage young men, the essence of sustained connection revolved around creating safety, trust, rapport, and meaningful relationships. The findings from this study have informed the development of a Train the Trainer program ("Connecting with Young Men"), which is currently being delivered to service providers in Ireland and which may have implications for service provision elsewhere.

Characteristics of Mexican children and adolescents who died by suicide: A study of psychological autopsies

OBJECTIVE

In recent years, suicide in children and adolescents has increased considerably, becoming the second cause of death in this age group. Therefore, the aim of this study was to identify characteristics and factors that could precipitate deaths by suicide in children and adolescents.

METHODS

Using the psychological autopsy method, we studied 28 suicide cases of children and adolescents between 10 and 17 years old. Socio-demographic factors, characteristics of the suicide and family history were documented.

RESULTS

The proportion of deaths by suicide was the same in females and males (50% each). Most of the suicides were performed at the child/adolescent's home (78.6%) and no history of previous suicide attempts were registered (85.7%). Also, the majority of suicidal individuals came from a dysfunctional family (60.7%).

CONCLUSIONS

Our results identified characteristics of children and adolescents that had died by suicide, such as dying at their homes and coming from dysfunctional families. Knowing the characteristics of children and adolescents that had ended their lives by suicide should be considered in future studies to help developing preventive programs and strategies for treating suicidal behaviors in Mexican children and adolescents.

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.

Sociodemographic Antecedent Validators of Suicidal Behavior: A Review of Recent Literature

Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.

Relationships of local lithium concentrations in drinking water to regional suicide rates in Italy

OBJECTIVES

Higher natural concentrations of lithium in drinking water may be associated with lower local rates of suicide.

METHODS

Lithium concentrations in drinking water were assayed by mass spectrometry at 145 sites in Italy, and compared with reported local suicide rates for men and women between 1980 and 2011.

RESULTS

Lithium concentrations in drinking water averaged 5.28 [CI: 4.08-6.48] μg/L (0.761 [0.588-0.934] μEq/L) and ranged from 0.110 to 60.8 μg/L (1.58 to 8.76 μEq/L). Lithium concentrations and local suicide rates were not significantly inversely related, except in 1980-1989, particularly among women.

CONCLUSIONS

A proposed association between trace lithium concentrations in drinking water and risk of suicide was only partially supported, and mechanisms for potential clinical effects of trace levels of lithium are unknown.

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.

Trends in suicidal behaviour in Dutch general practice 1983-2013: a retrospective observational study

OBJECTIVES

To analyse trends in suicidal behaviour as reported by the Dutch sentinel general practices from 1983 to 2013. Second, to examine the relationship between suicidal behaviour and several patient characteristics. Finally, to compare the relationship between suicidal behaviour and patient characteristics before (1983-2007) and after (2008-2013) the start of the crisis.

SETTING

40 general practices in the Netherlands during the period 1983-2013.

PARTICIPANTS

Patients with an ICPC code of P77 (suicide attempt).

PRIMARY AND SECONDARY OUTCOMES

Primary outcomes were age-adjusted and gender-specific trends in reported suicides (342) and suicide attempts (1614). Secondary outcomes were the relationship between suicidal behaviour and age, household composition, history of depression, recognition of suicide ideation, treatment before the suicidal behaviour and contact within the past month before suicidal behaviour for the period 1983-2013. Additionally, separate frequencies for the periods 1983-2007 and 2008-2013 were presented.

RESULTS

Join-point analyses revealed a significant rise in male suicides from 2008 (b=0.32, SE=0.1, p=0.008), and an increase in male suicide attempts since 2009 (b=0.19, SE=0.04, p<0.001). Female suicidal behaviour showed a steady decrease from 1989 to 2013(b=-0.03, SE=0.007, p<0.0001 for female suicide, b=-0.02, SE=0.002, p<0.001 for female attempts). Before 2007, a history of depression was reported in 65% (168/257) of the suicides. After the start of the recession, a depression was recognised in 44% (22/50) of the patients who died by suicide.

CONCLUSIONS

Since 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. General practitioners less often reported a history of depression within patients who died due to suicide after 2007 than before. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care.

A case-control study of hopelessness and suicidal behavior in the city of Athens, Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients' age positively correlated with hopelessness (r_s = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.

Suicide in Serbia

BACKGROUND

Suicide remains a significant public health problem worldwide. The aim of this study was to assess the mortality trend of suicide in Serbia for the years 1991-2014.

METHODS

Data on persons who died of suicide and self-inflicted injury (site codes E950-E959 revision 9 and X60-X84 revision 10 of the International Classification of Diseases to classify death, injury and cause of death) were obtained from the Statistical Office of the Republic of Serbia. The age standardized rate was calculated by direct method (per 100,000 persons, using Segi's World population as standard population). Average annual percentage change (AAPC) with the corresponding 95% confidence interval (CI) was computed for trend using the joinpoint regression analysis.

RESULTS

Total 33,930 (24,016 men and 9914 women) suicide deaths occurred in Serbia during the observed period, with the average annual age-standardized mortality rate being 12.7 per 100,000 inhabitants (19.5 per 100,000 in men and 6.7 per 100,000 in women). Suicide mortality in all age groups was higher among men than women. In both genders, suicide rates were highest in the oldest age group. Significantly decreased trend in suicide mortality was recorded continuously from 1991 to 2014 (AAPC=-1.9%, 95%CI -2.2 to -1.6). The most frequently used suicide method in both genders was hanging, strangulation or suffocation with 61.2% off all suicides. Changes in mortality rates were significant both for suicide by firearms, air guns and explosives (AAPC=-1.5% (AAPC=-1.5% in men and -3.1%-3.1% in women) and for suicide by hanging, strangulation, and suffocation (AAPC=-1.2% (AAPC=-1.2% in men and -3.0%-3.0% in women). In men, nonsignificant increase in suicide by firearms, air guns and explosives observed during the period 1991-1997 (by +6.1% per year) was followed by a significant decrease until 2014 (by -3.1% per year). The significantly increased mortality in suicide by firearms, air guns, and explosives was observed in older men (aged 40-69 years and 80 years and over).

LIMITATIONS

The low rate of autopsies in Serbia, as well as the accuracy, reliability and comparability of the suicide mortality data is always a question.

CONCLUSIONS

Downward trend in suicide mortality occurred in Serbia in last two decades. However, suicide rates are still very high in Serbia compared with the rates of suicides in developed countries. Particularly worrisome is the increase in mortality in older men, especially due to firearm suicides, air rifles, and explosives. Thus, additional efforts in the prevention of suicide are very important.

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.

Disparities in suicide mortality trends between United States of America and 25 European countries: retrospective analysis of WHO mortality database

The objective was to examine changes in temporal trends in suicide mortality in 26 Western countries by retrospective trend analysis of the WHO mortality database on causes of deaths. From 1990 to 2010, there was a median reduction in suicide mortality of 22.7%, ranging from a 46% reduction in Estonia to a 26.2% increase in Romania. Suicide mortality decreased by ≥ 20% in 15 countries, and the reduction tended to be greater in countries with higher mortality in 1990. In most of the central European countries mortality strongly declined. The median changes in the age groups were -25.3% (range -62.9% to 72.6%) in people aged 15-24 years, -36.9% (-60.5% to 32.4%) in 25-34 years, -3.6% (-57.1% to 92%) in 35-54 years, -12.2% (-37% to 65,7%) in 55-74 years and -16.1% (-54.5% to 166.7%) in ≥ 75 years. Suicide prevention programs in youths and in the elderly seem to be effective (at least in females for the elderly) and efforts should be pursued in this way. However, suicide mortality of the people aged 35-54 years has increased in half of the studied countries between 1990 and 2010. Public policies should further orientate their efforts toward this population.

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.

The World Health Organization (WHO) dataset for guiding suicide prevention policies: A 3-decade French national survey

BACKGROUND

Public health policies aim to prevent suicide in the general population. Assessing their effectiveness is required to further guide public health policies. The present article focuses on the French paradox. The French health care system was classified as the best in the world according the World Health Organization (WHO). However, suicide rates in France remain high compared to other European countries. The aim of the present article was to analyze (i) the evolution of suicide Age-Standardized Death (ASDRs) in France during the last three decades and the associations with socio-economic parameters and (ii) to understand which populations may specifically benefit from further targeted suicide prevention policies.

METHODS

The database of the World Health Organization (WHO), freely available, was explored in April 2015. ASDRs were calculated each year by ratio between the number of deaths by suicide and the total population (per 100,000 inhabitants). Number of deaths by gender and age were also analyzed.

RESULTS

Overall, ASDR suicide has decreased since 1987 in France (-32.8% between 1987 and 2010). However, France kept the same rank (10/26) when compared to other European countries between 1987 and 2010. The relative burden of suicide in all-causes mortality increased during the same period (+28.2%) while the total number of deaths by suicide increased only slightly (+3.9%). More specifically, the number of deaths by suicide increased substantially in [35-54] years old (+40%) and 75+ years old (+27%) males, and in [35-54] (+41%) years old females. Between 2000 and 2010, suicide rates significantly decreased when yearly mean income increased, and when general and psychiatric care beds decreased.

CONCLUSION

Although ASDR suicide has decreased in France since 1987, this decline is quite modest when considering its universal access to care, the prevention of depression and suicide public policies. Suicide prevention public policies should focus on evaluation and improvement of prevention and care in the [35-54] years old population, and in the males aged 75+.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain

Background

Spain’s financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period.

Methods

An ecological longitudinal study was carried out in Spain’s 17 regions. Two study periods were defined: pre-crisis period (2005–2007) and crisis period (2008–2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design.

Results

Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008.

Discussion

The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates.

Conclusions

The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

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.

Do macroeconomic contractions induce or 'harvest' suicides? A test of competing hypotheses

BACKGROUND

Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment-induction or displacement.

METHODS

We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women.

RESULTS

Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later.

CONCLUSIONS

Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.

Systematic review of suicide in economic recession

AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide.

METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycINFO and PsycARTICLES was performed to identify studies that had investigated the association between economic recession and suicide.

RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive.

CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.

Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000-11

BACKGROUND

As with previous economic downturns, there has been debate about an association between the 2008 economic crisis, rising unemployment, and suicide. Unemployment directly affects individuals' health and, unsurprisingly, studies have proposed an association between unemployment and suicide. However, a statistical model examining the relationship between unemployment and suicide by considering specific time trends among age-sex-country subgroups over wider world regions is still lacking. We aimed to enhance knowledge of the specific effect of unemployment on suicide by analysing global public data classified according to world regions.

METHODS

We retrospectively analysed public data for suicide, population, and economy from the WHO mortality database and the International Monetary Fund's world economic outlook database from 2000 to 2011. We selected 63 countries based on sample size and completeness of the respective data and extracted the information about four age groups and sex. To check stability of findings, we conducted an overall random coefficient model including all study countries and four additional models, each covering a different world region.

FINDINGS

Despite differences in the four world regions, the overall model, adjusted for the unemployment rate, showed that the annual relative risk of suicide decreased by 1·1% (95% CI 0·8-1·4) per year between 2000 and 2011. The best and most stable final model indicated that a higher suicide rate preceded a rise in unemployment (lagged by 6 months) and that the effect was non-linear with higher effects for lower baseline unemployment rates. In all world regions, the relative risk of suicide associated with unemployment was elevated by about 20-30% during the study period. Overall, 41,148 (95% CI 39,552-42,744) suicides were associated with unemployment in 2007 and 46,131 (44,292-47,970) in 2009, indicating 4983 excess suicides since the economic crisis in 2008.

INTERPRETATION

Suicides associated with unemployment totalled a nine-fold higher number of deaths than excess suicides attributed to the most recent economic crisis. Prevention strategies focused on the unemployed and on employment and its conditions are necessary not only in difficult times but also in times of stable economy.

FUNDING

University of Zurich.

Suicide attempts and emergency room psychiatric consultation

BACKGROUND

Suicidal behaviours are major public health concerns worldwide. They are associated with risk factors that vary with age and gender, occur in combination, and may change over time. The aim of our study was to investigate how frequently patients visiting a hospital emergency room (ER) require a psychiatric consultation for attempted suicide, and to outline the characteristics of this population.

METHODS

Determinants of emergency room visits for psychiatric reasons were studied prospectively from 2008 to 2011 at the "Maggiore" Hospital in Novara.

RESULTS

280 out of 1888 patients requiring psychiatric consultation were referred to the ER because of suicide attempt. Suicide attempters were more often female. The rate of suicide attempters among Italian people was 14.2%, compared to 19.5% in foreigners. Subjects living with parents or own family and those having a permanent job had a higher frequency of suicide attempt. Suicide attempts were more frequent among patients with a history of psychiatric disorders; nonetheless, suicide attempts were more common among those who had not previously been hospitalized in a psychiatric ward or were not under the care of a psychiatrist. The multivariate analysis found that female gender was a risk factor for suicide attempt, while being in the colder months of the year and, surprisingly, unemployment were protective factors.

CONCLUSIONS

A better understanding of patients referring to the ER due to attempted suicide may allow the identification of at-risk subjects and the implementation of targeted treatment approaches.

The use of regression methods for the investigation of trends in suicide rates in Hungary between 1963 and 2011

PURPOSE

Suicide rates in Hungary have been analyzed from different aspects in recent decades. However, only descriptive rates have been reported. The aim of our epidemiological study was to characterize the pattern of annual rates of suicide in Hungary during the period 1963-2011 by applying advanced statistical methods.

METHODS

Annual suicide rates per 100,000 population (>6 years) for gender, age group and suicide method were determined from published frequency tables and reference population data obtained from the Hungarian Central Statistical Office. Trends and relative risks of suicide were investigated using negative binomial regression models overall and in stratified analyses (by gender, age group and suicide method). Joinpoint regression analyses were additionally applied to characterize trends and to find turning points during the period 1963-2011.

RESULTS

Overall, 178,323 suicides (50,265 females and 128,058 males) were committed in Hungary during the investigated period. The risk of suicide was higher among males than females overall, in all age groups and for most suicide methods. The annual suicide rate exhibited a significant peak in 1982 and remained basically constant after 2006. Different segmented patterns were observed for the suicide rates in the various age groups.

CONCLUSIONS

Suicide rates revealed segmented linear pattern. This is the first detailed trend analysis with risk estimates obtained via joinpoint and negative binomial regression methods simultaneously for age-specific suicide frequencies in Hungary.