Structural determinants of suicide during the global financial crisis in Spain: Integrating explanations to understand a complex public health problem

The Role of Race in Deaths of Despair in Brazil: Is it a White People Problem?

BACKGROUND

A new paradigm has been discussed regarding the impact of economic cycles on the mortality pattern from specific causes. These causes are called deaths of despair, and they selectively impact specific demographic groups. Also, low- and middle-income countries are most affected due to their economic and social instability. In this sense, the objective of study was to compare the magnitude of disparity in deaths from despair according to sex, age, and race in Brazil.

METHODS

We performed Poisson regression modeling to estimate the magnitude of the association between sex, age group, race, and deaths from despair. Also, we estimated the relationship of time as a proxy of economic crisis phase and deaths of despair.

RESULTS

We found an association between mortality from despair and male sex (PR = 6.15, 95%CI 6.09-6.22); emphasis on the age groups from 40 to 49 years old (PR = 2.45, 95% CI 2.41-2.48) and 50 to 59 years old (PR = 2.39, 95% CI 2.36-2.43); and brown (PR = 1.21, 95% CI 1.20-1.22) and black race (PR = 1.36, 95% CI 1.34-1.37).

CONCLUSIONS

The present study preliminarily presents the effect of the economic crisis and mortality in the population, with demographic differences. Association with race was opposite to that verified in the original study in the USA, which suggests that this variable should be analyzed in the light of structural context.

Methodological approaches to measuring mental health in a cost-of-living crisis: A rapid review

BACKGROUND

Cost-of-living crises are damaging to population mental health and require a public health response. It is important to assess whether public health interventions are effective. We aimed to identify population-level methods and measures and the appropriateness of the measures for vulnerable populations.

METHODS

A rapid evidence review was undertaken. Nineteen databases, including grey literature, were searched for evidence published between 1970 and April 2023.

RESULTS

Seven reviews, nine primary studies and two reports from grey literature were identified. Methods consisted of analyses of existing data from national or regional cohort studies, household panel surveys, repeated cross-sectional surveys, routine medical data, or data on suicide death rates. Twelve brief validated mental health measurement tools, embedded in population-level surveys, were identified. Two quasi-experimental studies used data from a UK household panel survey to examine the impact of the introduction of specific welfare policies on mental health. Studies identified socio-economic vulnerabilities, but it was not possible to determine whether data were effectively captured from people from minority ethnic groups.

CONCLUSION

Population-level surveys can be used in quasi-experimental studies to measure the effects of a public health initiative with specific roll out dates to tackle cost-of-living impacts. It is unclear as to whether the identified methods and tools are suitable for use with people from minority ethnic groups.

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.

The associations between suicides, economic conditions and social isolation: Insights from Spain

Suicide is among the main challenges that need to be addressed in developed countries. In this paper, we analyse suicides across the 17 Spanish regions over the period 2014-2019. More precisely, our objective is to re-study the determinants of suicides focusing on the latest economic expansion period. We use count panel data models and sex stratification. A range of aggregate socioeconomic regional-level factors have been identified. Our empirical results show that: (1) a socioeconomic urban-rural suicide gaps exist; (2) there are significant gender differences, for the women a Mediterranean suicide pattern appears whereas unemployment levels have a significant importance for men, (3) social isolation factors, when significant, they show an (a priori) surprisingly positive result. We provide new highlights for suicide prevention in Spain. Precisely, it is highlighted that jointly policies by gender and attending to vulnerable groups are both necessary.

Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age-period-cohort analysis

BACKGROUND

The overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis.

METHOD

This population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005-2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique.

RESULTS

The data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920-1944 and a sharp decline in the 1945-1979 cohort. The lowest risk occurred in the 1980-1994 cohort before a sharp increase in generation Z (birth years in 1995-2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly.

LIMITATIONS

The aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study.

CONCLUSIONS

This study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004-2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.

Conceptualising the commercial determinants of suicide: broadening the lens on suicide and self-harm prevention

Suicide is preventable, yet, in many settings, robust suicide prevention strategies have not been implemented. Although a commercial determinants of health lens is increasingly being applied to industries important to the field of suicide prevention, the interplay between the vested interests of commercial actors and suicide has received little attention. There is a need to shift attention to the causes of the causes, directing more focus to the ways that commercial determinants influence suicide and shape suicide prevention strategies. Such a shift in perspective, with an evidence base and precedents to draw upon, has transformative potential for research and policy agendas dedicated to understanding and addressing upstream modifiable determinants of suicide and self-harm. We propose a framework intended to help guide efforts to conceptualise, research, and address the commercial determinants of suicide and their inequitable distribution. We hope these ideas and lines of inquiry help to catalyse connections between disciplines and open further debate and discussion as to how to take such an agenda forward.

The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach

Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.