Government spending, recession, and suicide: evidence from Japan

The Impact of Social Expenditure on Sustainable Human Development: Empirical Evidence on the Suicide Deaths in a Developing Country

Suicide has been a serious international public mental health problem and is one of the top twenty leading causes of death worldwide. This study aims to investigate the impact of social expenditure on suicide deaths in Turkiye as a developing country from 1982 to 2019. The Bounds Testing Approach to Cointegration and Autoregressive Distributed Lag (ARDL) methods were used. The results indicated that social expenditure has a statistically significant and negative effect on total suicide and female suicide deaths, but it has a statistically insignificant and negative impact on male suicide death. The contribution of this study is to examine for the first time whether social expenditure has an impact on total, female, and male suicide mortality in Turkiye. Policymakers should regard increasing social spending in the government budget to prevent suicide deaths in Turkiye.

The effect of economic downturn, financial hardship, unemployment, and relevant government responses on suicide

Economic circumstances and related factors, including unemployment and poverty, can have substantial effects on suicide rates. This relationship applies in all countries, irrespective of their World Bank income status or level of development. Therefore, means of mitigating such influences are essential components of strategies to reduce suicides. In this Series paper, we consider examples of such initiatives, including national policies to try to reduce the effect of economic downturns, efforts to maintain employment and avoid damaging austerity measures, maintenance of reasonable minimum wage levels, and specific policies to assist those most affected by poverty. We also highlight upstream measures such as investment in transport infrastructure, industries, and retraining programmes. Positive public health messaging that encourages coping, together with discouragement of media stories with messages that could contribute to hopelessness in those experiencing economic difficulties, can also be important components of strategies to try to reduce the effect of economic downturn on suicide.

Suicide prevention: reflections on progress over the past decade

Interest in preventing suicides has increased greatly in recent years. In this Personal View, we consider the general global developments related to suicide prevention that have occurred in the decade since The Lancet Psychiatry was first published in 2014. We then review specific advances during this period, first, in relation to public health initiatives, and second, with regard to clinical developments. Finally, we examine some of the challenges that currently confront individuals and organisations responsible for designing and implementing suicide prevention measures.

Psychological consequences among veterans during the COVID-19 pandemic: A scoping review

Although there is an increasing number of studies reporting the psychological impact of COVID-19 on the general population and healthcare workers, relatively less attention has been paid to the veterans. This study aimed to review the existing literature regarding the psychological consequences of COVID-19 on veterans. A systematic search was conducted on PubMed, Embase, and the Cochrane Library from inception to December 3, 2022. A total of twenty-three studies were included with moderate-quality of evidence. Veterans experienced more mental health problems than civilians. The prevalence rates of alcohol use, anxiety, depression, post-traumatic stress disorder, stress, loneliness, and suicide ideation significantly increased during the pandemic, ranging from 9.6% to 47.4%, 9.4% to 53.5%, 8.6% to 55.1%, 4.1% to 58.0%, 4.3% to 39.4%, 15.9% to 28.4%, and 7.8% to 22.0%, respectively. The main risk factors of negative consequences included pandemic-related stress, poor family relationships, lack of social support, financial problems, and preexisting mental disorders. In contrast, higher household income and greater community interaction and support appeared to be resilience factors. In conclusion, the COVID-19 pandemic has increased adverse mental health consequences among veterans. Tackling mental health issues due to the COVID-19 pandemic among veterans should be a priority.

Identifying correlates of suicide ideation during the COVID-19 pandemic: A cross-sectional analysis of 148 sociodemographic and pandemic-specific factors

The coronavirus disease 2019 (COVID-19) pandemic has created a global health crisis, with disproportionate effects on vulnerable sociodemographic groups. Although the pandemic is showing potential to increase suicide ideation (SI), we know little about which sociodemographic characteristics or COVID-19 experiences are associated with SI. Our United States-based sample (n = 837 adults [mean age = 37.1 years]) completed an online survey during August-September 2020. The study utilized an online convenience sample from a prior study, which was enriched for exposure to trauma and experiences of posttraumatic stress symptoms. We assessed SI using the Beck Depression Inventory-II. Traditional (i.e., logistic regression) and machine learning (i.e., LASSO, random forest) methods evaluated associations of 148 self-reported COVID-19 factors and sociodemographic characteristics with current SI. 234 participants (28.0%) reported SI. Twenty items were significantly associated with SI from logistic regression. Of these 20 items, LASSO identified seven sociodemographic characteristics (younger age, lower income, single relationship status, sexual orientation other than heterosexual as well as specifically identifying as bisexual, non-full-time employment, and living in a town) and six COVID-19 factors (not engaging in protective COVID-19 behaviors, receiving mental health treatment (medication and/or psychotherapy) due to the COVID-19 pandemic, socializing during the pandemic, losing one's job due to COVID-19, having a friend with COVID-19, and having an acquaintance with COVID-19) associated with SI. Random forest findings were largely consistent with LASSO. These findings may inform multidisciplinary research and intervention work focused on understanding and preventing adverse mental health outcomes such as SI during and in the aftermath of the pandemic.

Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model

Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran's I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

Suicide trends in Norway during the first year of the Covid-19 pandemic. A register-based cohort study

Background

There is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases.

Methods

This is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019.

Results

In 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3).

Conclusion

There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.

The association of COVID-19 employment shocks with suicide and safety net use: An early-stage investigation

This paper examines whether the COVID-19-induced employment shocks are associated with increases in suicides and safety net use in the second and third quarters of 2020. We exploit plausibly exogenous regional variation in the magnitude of the employment shocks in Japan and adopt a difference-in-differences research design to examine and control for possible confounders. Our preferred point estimates suggest that a one-percentage-point increase in the unemployment rate in the second quarter of 2020 is associated with, approximately, an additional 0.52 suicides, 28 unemployment benefit recipients, 88 recipients of a temporary loan program, and 10 recipients of public assistance per 100,000 population per month. A simple calculation based on these estimates suggests that if a region experienced a one-percentage-point increase in the unemployment rate caused by the COVID-19 crisis in the second quarter of 2020, which is roughly equivalent to the third-highest regional employment shock, this would be associated with 37.4%, 60.5%, and 26.5% increases in the total, female, and male suicide rates respectively in July 2020 compared with July 2019. These results are primarily correlational rather than causal due to the limitation of our data and research design, but our baseline findings are robust to several different model specifications.

Factors influencing self-harm thoughts and behaviours over the first year of the COVID-19 pandemic in the UK: longitudinal analysis of 49 324 adults

BACKGROUND

There is concern that the COVID-19 pandemic and its aftermath will result in excess suicides by increasing known risk factors such as self-harm, but evidence on how pandemic-related risk factors contribute to changes in these outcomes is lacking.

AIMS

To examine how different COVID-19-related experiences of and worries about adversity contribute to changes in self-harm thoughts and behaviours.

METHOD

Data from 49 324 UK adults in the University College London COVID-19 Social Study were analysed (1 April 2020 to 17 May 2021). Fixed-effects regressions explored associations between weekly within-person variation in five categories of adversity experience and adversity worries with changes in self-harm thoughts and behaviours across age groups (18-29, 30-44, 45-59 and 60+ years).

RESULTS

In total, 26.1% and 7.9% of respondents reported self-harm thoughts and behaviours respectively at least once over the study period. The number of adverse experiences was more strongly related to outcomes than the number of worries. The largest specific adversity contributing to increases in both outcomes was having experienced physical or psychological abuse. Financial worries increased the likelihood of both outcomes in most age groups, and having had COVID-19 increased the likelihood of both outcomes in young (18-29 years) and middle-aged (45-59 years) adults.

CONCLUSIONS

Findings suggest that a significant portion of UK adults may be at increased risk for self-harm thoughts and behaviours during the pandemic. Given the likelihood that the economic and social consequences of the pandemic will accumulate, policy makers can begin adapting evidence-based suicide prevention strategies and other social policies to help mitigate its consequences.

Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan

Suicide mortality in Japan reduced in the period of 2009-2018. A number of studies identified the impact of financial governmental support for social welfare systems on suicide mortality; however, the detailed effects of specific regional policies, designed according to regional cultural, economic, education and welfare situations, on suicide mortality remain to be clarified. Therefore, the present study analyses the associations between the regional governmental expenditure of six major divisions, "public health", "public works", "police", "ambulance/fire services", "welfare" and "education", and suicide mortalities caused by six major suicidal motives, related to "family", "health", "economy", "employment", "romance" and "school", across the 47 prefectures in Japan during the period of 2009-2018, using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure of "public works" displayed a positive relationship with suicide mortality of females caused by family-related motives but was not related to other suicide mortalities, whereas the expenditures in "public health", "police", "ambulance/fire services", "welfare" and "education" contributed to a reduction in suicide mortality, at least in some statistical indicators. The expenditures of both "ambulance/fire" and "education" were predominantly effective among the six major divisions of regional governmental expenditure in reducing suicide mortalities. In the education subdivisions, the expenditure of "kindergarten" was related to a reduction in suicide mortalities caused by a wide spectrum of motives. The amount of expenditure of welfare indicated the limited possibility of facilitating a reduction in suicide mortalities caused by only motives associated with economy or employment. However, in the welfare subdivisions, the expenditure of "child welfare" and "social welfare" was effective in reducing suicide mortalities, but the expenditure of "elderly welfare" was unexpectedly related to an increase in suicide mortalities. These results suggest that most Japanese people are struggling to bring up children even in the situation of an increasing elderly population with a decreasing birth rate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. Although the issue of an increasing elderly population and a decreasing birth rate in Japan has not yet improved, the obtained results suggest that evidence-based welfare expenditure redistributions of prefectures and municipalities could improve Japanese society and welfare systems.

Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model

BACKGROUND

The number of suicides in Japan increased during the COVID-19 pandemic. Predicting the number of suicides is important to take timely preventive measures.

OBJECTIVE

This study aims to clarify whether the number of suicides can be predicted by suicide-related search queries used before searching for the keyword "suicide."

METHODS

This study uses the infoveillance approach for suicide in Japan by search trends in search engines. The monthly number of suicides by gender, collected and published by the National Police Agency, was used as an outcome variable. The number of searches by gender with queries associated with "suicide" on "Yahoo! JAPAN Search" from January 2016 to December 2020 was used as a predictive variable. The following five phrases highly relevant to suicide were used as search terms before searching for the keyword "suicide" and extracted and used for analyses: "abuse"; "work, don't want to go"; "company, want to quit"; "divorce"; and "no money." The augmented Dickey-Fuller and Johansen tests were performed for the original series and to verify the existence of unit roots and cointegration for each variable, respectively. The vector autoregression model was applied to predict the number of suicides. The Breusch-Godfrey Lagrangian multiplier (BG-LM) test, autoregressive conditional heteroskedasticity Lagrangian multiplier (ARCH-LM) test, and Jarque-Bera (JB) test were used to confirm model convergence. In addition, a Granger causality test was performed for each predictive variable.

RESULTS

In the original series, unit roots were found in the trend model, whereas in the first-order difference series, both men (minimum tau 3: -9.24; max tau 3: -5.38) and women (minimum tau 3: -9.24; max tau 3: -5.38) had no unit roots for all variables. In the Johansen test, a cointegration relationship was observed among several variables. The queries used in the converged models were "divorce" for men (BG-LM test: P=.55; ARCH-LM test: P=.63; JB test: P=.66) and "no money" for women (BG-LM test: P=.17; ARCH-LM test: P=.15; JB test: P=.10). In the Granger causality test for each variable, "divorce" was significant for both men (F₁₀₄=3.29; P=.04) and women (F₁₀₄=3.23; P=.04).

CONCLUSIONS

The number of suicides can be predicted by search queries related to the keyword "suicide." Previous studies have reported that financial poverty and divorce are associated with suicide. The results of this study, in which search queries on "no money" and "divorce" predicted suicide, support the findings of previous studies. Further research on the economic poverty of women and those with complex problems is necessary.

Financial distress and suicidal behaviour during COVID-19: Family identification attenuates the negative relationship between COVID-related financial distress and mental Ill-health

COVID-19 provides a 'perfect storm' of social and economic suicide risk-factors. Recent research has evidenced an initial impact of the pandemic upon suicide rates, but has yet to understand how elevated financial threat and social isolation may predict suicide ideation/behaviour, or which social factors promote resilience. This study addressed these shortcomings. An online longitudinal survey study (N = 370) which took place from May to September 2020 showed COVID-related financial distress predicts suicidal thoughts and behaviour via increased depression and loneliness. Family identification attenuates these relationships. Our findings reaffirm the importance of social factors in reducing mental ill-health outcomes of economic crises.

The Great East Japan Earthquake and suicide: The long-term consequences and underlying mechanisms

How and why do major natural disasters affect suicide? This study revisits this question by focusing on the Great East Japan Earthquake (GEJE) in March 2011 as a historically important natural disaster. Using an event-study analysis, we assessed how the GEJE changed the suicide rates in the regions affected by it and whether its effect persisted, attenuated, or escalated over time. In addition, we explored the political and social channels underlying the relationship between the GEJE and suicide. Using prefecture-level data, our analysis reveals that suicide by men aged 40-64 years and 65 years and over showed a large decline in the GEJE-affected prefectures in the years following the earthquake, and this decline attenuated over time. Furthermore, following the GEJE, government spending increased while divorce rates decreased in the affected prefectures, both of which were correlated with male suicide rates. These findings indicate that suicide after major natural disasters is preventable when political and social reactions to disasters provide a safety net, especially for men.

Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction

Objective

The objective of this research was to evaluate the impact of federal, public health and social support programs on national suicide rates in Canada.

Design

Cross-sectional study.

Setting

Canadian National Database (i.e., Statistics Canada) and Statista.

Participants

Population-level data, and economic and consumer market data.

Main Outcome Measures

Suicide mortality data, population data and unemployment data were obtained from available statistical databases (e.g. Statistics Canada). We quantified suicide rate by dividing the total number of suicide deaths by the national population expressed as a rate per 100,000 population.

Results

Overall suicide mortality rate decreased in Canada from 10.82 deaths per 100,000 in the March 2019 - February 2020 period to 7.34 per 100,000 (i.e. absolute difference of 1300 deaths) in the March 2020 - February 2021 period. The overall Canadian unemployment rate changed from an average monthly rate of 5.7% in 2019 to 9.5% in 2020.

Conclusion

Our results indicate that for the first post-pandemic interval evaluated (i.e., March 2020 - February 2021), suicide rates in Canada decreased against a background of extraordinary public health measures intended to mitigate community spread of COVID-19. An externality of public health measures was a significant rise in national unemployment rates in population measures of distress. Our results suggest that government interventions that broadly aim to reduce measures of insecurity (i.e., economic, housing, health), and timely psychiatric services, should be prioritised as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic.

Effects of Financial Expenditure of Prefectures/Municipalities on Regional Suicide Mortality in Japan

In Japan, suicide mortality has been improving from 2009; however, suicide remains one of the leading causes of death. Although previous studies identified solid relationships between governmental financial support for social welfare systems and suicide mortality, little attention is paid to how specific regional policies, designed according to regional cultural, economic, and social welfare situations, affect suicide mortality. Therefore, the present study analyses the relationships between the regional governmental expenditure of six major divisions and suicide mortality across the 47 prefectures in Japan from 2009 to 2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure in “public health”, “police”, “ambulance/fire services”, “welfare” and “education” is associated with reduction in suicide mortality, at least in some statistical indicators, whereas expenditure of “public works” indicated the influence of increasing suicide mortality or had no effect. Welfare expenditure was the most predominantly effective among the six major divisions of regional governmental expenditure. In the welfare subdivisions, expenditure of “child welfare” and “social welfare” was effective in a reduction in suicide mortality, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortality. Child welfare expenditure negatively impacted suicide mortality in wide-ranging generations of both males and females; the positive effects of elderly welfare expenditure reached were limited as working-age populations increased, but unexpectedly did not affect the suicide mortality of elderly populations. The relatively increasing expenditure of elderly welfare with the relatively decreasing child welfare are unavoidable due to the Japanese social issues associated with a declining birth rate and ageing population. Furthermore, the budget of that regional government that can modify its expenditure structure by making its own policies is limited since most regional governmental expenditure is composed of essential expenditure for maintaining and operating regional social welfare systems. Although severe social situations in Japan are still unoptimised, the present results suggest that scientific-evidence-based redistributions of welfare expenditure in regional governments can at least partially improve Japanese society and welfare systems.

Social-Economic Environments and Depressive Symptoms in Community-Dwelling Adults: A Multi-Level Analysis for Two Nationwide Datasets in Taiwan

Most studies have focused on factors associated with depression at the individual level, and evidence on ecological models linking social-economic features with depression is rare in Taiwan. This study aimed to use multi-level analysis to explore the effects of social-economic environments on depressive symptoms among Taiwanese adults. The 2009 National Health Interview Survey (NHIS) and the Age-Friendly Environments database were linked in this study. A total of 6602 adults aged 20 years and older were included in the analysis. A Chinese version of the 10-item CESD was used as the outcome measure. Three social indicators (population density, divorce rate, and crime rate) and three economic indicators (unemployment rate, per capita disposable income, and per capita government expenditures) at the ecological level were examined. Results showed that two social environments and two economic features were significantly associated with depressive symptoms. However, the effects of these factors were different by gender and age groups. The economic environments were critical for males and young adults aged 20–44 years old, whereas the social environments were significant for females and middle-aged and older adults. Intervention efforts for depression prevention should integrate ecological approaches into the effects of social-economic environments on depressive symptoms.

Impact of Social Distancing on the Mental Health of Parents and Children in Qatar

This study investigated the effects of COVID-19-related social distancing practices on parents and children's mental health and explored joint parent-child activities and coping strategies among Arab families in Qatar. The sample of 308 parents answered self-reported questionnaires regarding their mental health, coping strategies, activities with their children, social distancing practices, and their children's mental health. Pearson's correlation coefficient and structural equation modeling were carried out. The results showed a significant positive correlation between social distancing and parents' activities with their children and their coping strategies, as well as between parents' mental health, activities with their children, children's mental health, and parents' coping strategies. Path analysis showed that social distancing practices influence both parents' and children's mental health through parents' activities with children and their coping strategies. Our findings revealed how living under stressful conditions, such as COVID-19, could enhance the mental health of family members.

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.

Projected increases in suicide in Canada as a consequence of COVID-19

Macroeconomic indicators, notably unemployment, are significant moderators of suicide. We projected the number of excess suicides in Canada as a consequence of the impact of COVID-19 on unemployment. Annual suicide mortality (2000-2018) and unemployment (2000-2019) data were derived from Statistics Canada. Time-trend regression models were used to evaluate and predict the number of excess suicides in 2020 and 2021 for two possible projection scenarios following the COVID-19 pandemic: 1) an increase in unemployment of 1.6% in 2020, 1.2% in 2021, or 2) an increase in unemployment of 10.7% in 2020, 8.9% in 2021. A percentage point increase in unemployment was associated with a 1.0% increase in suicide between 2000 and 2018. In the first scenario, the rise in unemployment rates resulted in a projected total of 418 excess suicides in 2020-2021 (suicide rate per 100,000: 11.6 in 2020). In the second scenario, the projected suicide rates per 100,000 increased to 14.0 in 2020 and 13.6 in 2021, resulting in 2114 excess suicides in 2020-2021. These results indicate that suicide prevention in the context of COVID-19-related unemployment is a critical priority. Furthermore, timely access to mental healthcare, financial provisions and social/labour support programs, as well as optimal treatment for mental disorders is urgently needed.