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Goto H, Kawachi I, Vandoros S. The association between economic uncertainty and suicide in Japan by age, sex, employment status, and population density: an observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101069. [PMID: 38711964 PMCID: PMC11070334 DOI: 10.1016/j.lanwpc.2024.101069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
Background Suicide is one of the ten leading causes of death globally, and previous research has revealed a link between economic conditions and mental health. However, the literature has focused primarily on recessions and unemployment, i.e. actual economic developments, as opposed to uncertainty, which relates to economic developments that have not (yet) materialised. This study examines the differential association between economic uncertainty and suicide in Japan, depending on age, sex, employment status, and population density, in order to identify the groups that are affected the most. Methods Using monthly prefectural suicide mortality data from the Ministry of Health, Labour and Welfare and a monthly economic uncertainty index for the period 2009 to 2019, we employed a fixed effects panel data approach to examine the association between uncertainty and suicide by population group. Findings We found that a 1% increase in economic uncertainty is associated with a 0.061 increase in the monthly number of suicides per 100,000 people per prefecture, on average (coefficient: 6.08; 95% CI: 5.07-7.08), which constitutes a 3.62% increase. Self-employed people, as well as men in their 50s and unemployed men, experience the highest additional risk of suicide when uncertainty increases. The association was approximately three times stronger for males than for females, and a strong association was observed for self-employed males living in more densely-populated areas. Interpretation Uncertainty appears to relate to suicides for most groups, but self-employed people, males, and those living in more densely populated areas appear to be more at risk of suicide in periods of increased economic uncertainty. Our results provide an indication of which groups mental health services and prevention strategies can focus on in times of economic uncertainty. Funding None.
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Affiliation(s)
- Haruka Goto
- University College London (UCL), London, United Kingdom
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, United States
| | - Sotiris Vandoros
- University College London (UCL), London, United Kingdom
- Harvard T.H. Chan School of Public Health, Boston, United States
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Willeke K, Janson P, Zink K, Stupp C, Kittel-Schneider S, Berghöfer A, Ewert T, King R, Heuschmann PU, Zapf A, Wildner M, Keil T. Occurrence of Mental Illness and Mental Health Risks among the Self-Employed: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8617. [PMID: 34444369 PMCID: PMC8393630 DOI: 10.3390/ijerph18168617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.
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Affiliation(s)
- Kristina Willeke
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
| | - Patrick Janson
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
| | - Katharina Zink
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
| | - Carolin Stupp
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (A.B.); (R.K.)
| | - Thomas Ewert
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
| | - Ryan King
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (A.B.); (R.K.)
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
- Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Andreas Zapf
- Bavarian State Ministry of the Environment and Consumer Protection, 81925 Munich, Germany;
- Pettenkofer School of Public Health, University of Munich, 81377 Munich, Germany
| | - Manfred Wildner
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- Pettenkofer School of Public Health, University of Munich, 81377 Munich, Germany
| | - Thomas Keil
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany; (P.J.); (K.Z.); (C.S.); (T.E.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
- Institute of Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany; (A.B.); (R.K.)
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