The Impacts of Social Protection Policies and Programs on Suicide: A Literature Review

Do social protection programmes have a causal effect on suicide mortality? A protocol for a systematic review and meta-analysis

INTRODUCTION

Recent international and national strategies to reduce suicide mortality have suggested that social protection programmes may be an effective multisectoral response given the link between material deprivation and suicides in observational studies. However, there is a lack of evidence on the causal relationship between social protection programmes and suicide, which may hinder substantial national budget reallocations necessary to implement these policies. Social protection programmes are government interventions that ensure adequate income now and in the future, through changes to earned income (eg, minimum wage increase) or social security (via cash transfers or cash equivalents). Our review aims to evaluate the existing evidence on a causal relationship between social protection programmes and suicide mortality by examining all relevant experimental and quasi-experimental studies between January 1980 and November 2021.

METHODS AND ANALYSIS

The review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We will search references published between 1 January 1980 and 30 November 2021 in 10 electronic databases, including MEDLINE (PubMed), PsycINFO, EMBASE and Applied Social Sciences Index Abstracts. Seven reviewers will independently participate in screening studies from titles, abstracts and full texts across all the stages. Experimental (ie, randomised controlled trials) and quasi-experimental studies (ie, non-randomised interventional studies) written in English, French, Spanish, German, Chinese, Korean and Japanese examining the impact of income security programmes on suicide mortality were included. Meta-analyses will be conducted if there are at least three studies with similar income security programmes.

ETHICS AND DISSEMINATION

Our proposed review does not require ethical approval. In collaboration with our community partners, we will develop a policy brief for stakeholders to support efforts to implement social protection programmes to help prevent suicides. Our findings will be presented at conferences, published in a peer-reviewer journal and promoted on social media platforms.

PROSPERO REGISTRATION NUMBER

CRD42021252235.

The role of context in shaping the relationship between physical health and suicide over the life course

U.S. suicide rates are at a thirty-year high while physical health, as measured by life expectancy and pain, has declined, particularly for those without a college degree. We investigate how these patterns may be related by exploring the role of physical health problems in suicide deaths using 2019 data from the National Violent Death Reporting System. We estimate multilevel logistic regression models to examine (1) how individual risk factors are associated with the likelihood of a physical health circumstance underlying a suicide over the life course and (2) how context – the socioeconomic, health and policy environment of the state in which a decedent resides – may play a role. Physical health circumstances were present in about 20% of all suicides and in over half of suicide deaths for the older population in 2019. A gender crossover effect exists, in which women are more likely to have a physical health problem contribute to a suicide prior to age 60, but men surpass women after age 60 in that probability. Net of individual characteristics, we find significant variation across states in the likelihood of physical health circumstances. For all age groups, physical health circumstances are more likely in states that are less densely populated with weaker gun control laws and higher suicide rates. Among decedents younger than 65, the likelihood is elevated in states with limited health care access. This study highlights the critical interaction between physical and mental well-being, the ways in which that interaction may be experienced differently by gender, and the important role of social safety nets in prevention.

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Poor physical health is an important risk factor for suicide.

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Overall, women and older suicide decedents are more likely to have a physical health circumstance.

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A gender crossover effect exists, with older men more likely to have a physical health circumstance.

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State health and policy environment affects the likelihood of a physical health circumstance.

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Improving physical health and social support is an avenue to suicide prevention.

Adaptation of evidence-based suicide prevention strategies during and after the COVID-19 pandemic

Suicide is preventable. Nevertheless, each year 800,000 people die of suicide in the world. While there is evidence indicating that suicide rates de-crease during times of crises, they are expected to increase once the immediate crisis has passed. The COVID-19 pandemic affects risk and pro-tective factors for suicide at each level of the socio-ecological model. Economic downturn, augmented barriers to accessing health care, increased access to suicidal means, inappropriate media reporting at the societal level; deprioritization of mental health and preventive activities at the community level; interpersonal conflicts, neglect and violence at the relationship level; unemployment, poverty, loneliness and hopelessness at the individual level: all these variables contribute to an increase of depression, anxiety, post-traumatic stress disorder, harmful use of alcohol, substance abuse, and ultimately suicide risk. Suicide should be prevented by strengthening universal strategies directed to the entire population, including mitigation of unemployment, poverty and inequalities; prioritization of access to mental health care; responsible media reporting, with information about available support; prevention of increased alcohol intake; and restriction of access to lethal means of suicide. Selective interventions should continue to target known vulnerable groups who are socio-economically disadvantaged, but also new ones such as first responders and health care staff, and the bereaved by COVID-19 who have been deprived of the final contact with loved ones and funerals. Indicated preventive strategies targeting individuals who display suicidal behaviour should focus on available pharmacological and psychological treatments of mental disorders, ensuring proper follow-up and chain of care by increased use of telemedicine and other digital means. The scientific community, health care professionals, politicians and decision-makers will find in this paper a systematic description of the effects of the pandemic on suicide risk at the society, community, family and individual levels, and an overview of how evidence-based suicide preventive interventions should be adapted. Research is needed to investigate which adaptations are effective and in which con-texts.