New Findings On Gender: The Effects Of Employment Status On Suicide

Female Labor-Force Participation as Suicide Prevention: A Population Study in Taiwan

OBJECTIVE

Female labor-force participation (FLFP) has been theorized as contributing to higher suicide rates, including among women. Evidence on this relationship, however, has been mixed. This study explored the association between FLFP and suicide in an understudied context, Taiwan, and across 40-years.

METHODS

Annual national labor-participation rates for women ages 25-64, and female and male suicide-rates, for 1980-2020, were obtained from Taiwan's Department of Statistics. The associations between FLFP rates and sex/age-stratified suicide-rates, and between FLFP rates and male-to-female suicide-rates ratios were assessed via time-series regression-analyses, accounting for autoregressive effects.

RESULTS

Higher FLFP rates were associated with lower female suicide-rates (ß = -0.06, 95% CI (Credibility Interval) = [-0.19, -0.01]) in the adjusted model. This association held in the age-stratified analyses. Associations for FLFP and lower male suicide-rates were observed in the ≥45 age-groups. FLFP rates were significantly and positively associated with widening male-to-female suicide-rates ratios in the adjusted model (ß = 0.24, 95% CI = [0.03, 0.59]).

CONCLUSION

This study's findings suggest that FLFP protects women from suicide, and point to the potential value of FLFP as a way of preventing suicide. In Taiwan, employed women carry a double-load of paid and family unpaid care-work. Child care-work is still done by mothers, often with grandmothers' support. Therefore, this study's findings contribute to evidence that doing both paid work and unpaid family care-work has more benefits than costs, including in terms of suicide-protection. Men's disengagement from family care-work may contribute to their high suicide rates, despite their substantial labor-force participation.

The risk of suicidal intention in severe mental illness: An ecological perspective

OBJECTIVE

Guided by the ecosystem theory model framework, we aimed to explore the influence of three ecological dimensions (social, family and psychological factors) on suicidal intention in people with severe mental illness (SMI). We hypothesized that three factors influence suicidal intention, and that psychological factors may play a mediating role in the influence of social and family factors on suicidal intention.

METHODS

We collected 994 patients with SMI aged 18 and above from May 2021 to March 2022 in the Fourth Hospital of Fuzhou City. We used logistic regression to analyse the association between social, family, psychological factors and suicidal intention. Furthermore, we explored the mediating effects among the influencing factors.

RESULTS

Younger male patients with schizophrenia were more likely to have suicidal intention due to psychosocial family factors (p < .05). Social factors (poor interpersonal relations, social retreat, social activities outside the home), family factors (parental functions, activities within the family, family functions), psychological factors (anxiety, depression, interest in the outside world, overt aggression, lack of accountability and planning) were all independent risk factors for suicidal intention in patients. Mediation analysis showed anxiety and depression mediated the role of social and family factors on suicidal intention (p < .05).

CONCLUSION

Social, family and psychological factors were important risk factors for suicidal intention, with anxiety and depression being partial mediators for suicidal intention. Therefore, interventions that enhance family and social functioning and reduce anxiety and depression may be effective in reducing suicidal intention in SMI.

Predictors of self-harm and emergency department attendance for self-harm in deprived communities

Emergency departments (EDs) are often the first point of contact for individuals following self-harm. The majority of previous research relies on hospital-based data, yet only a minority of individuals who self-harm in the community present to healthcare services. The study design is cross-sectional survey design. Data from the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC) Household Health Survey, a community-based public health survey in North West England, was collected using stratified random sampling. Three thousand four hundred twelve people were recruited in 2018 from relatively disadvantaged areas. The sample included 1490 men and 1922 women aged 18 to 100 years (M = 49.37, SD = 18.91). Logistic regression analysis was employed to examine demographic, health and socioeconomic predictors of self-harm and ED attendance for self-harm. Age (18-24 years), lower financial status, depression, anxiety and physical and mental health co-morbidity was associated with significantly higher levels of self-harm. People aged 18-24 years, with physical and mental health co-morbidity and lower levels of social support had significantly higher levels of attending EDs for self-harm. Improving people's financial situations, social connectivity, mental and physical health may help to reduce individual risk for self-harm and strain on health services.

The Trends of Suicidality Over the Past 10 Years (1999-2022) in the Ethiopian General Population and the Way Forward in Tackling It

Suicide is defined as a death caused by willful acts of taking one's own life. It might be a way for people to get away from suffering or anguish. Globally, an estimated a million people individuals lose their life due to suicide annually. Before the age of 50 years old more than half (58%) of all suicide deaths occur. This commentary aims to highlight the Ethiopian context, feasible preventive measures, and the way forward in tackling suicidal behavior. Worldwide in adolescent age groups between the ages of 15 and 29, suicide is the fourth leading cause of death. Even though suicide occurs everywhere in the world, according to data in 2019, 77% of all suicides that occurred in the world reside in developing countries. Due to the numerous psychosocial pressures present in Ethiopia, one in four citizens suffers from a mental disorder. According to Ethiopian national data figures, suicide ideation affects 9%, 5-16% of people, whereas suicidal attempt affects 4%, 1-8%. Even though, there is a variation of prevalence over the years based on the variation in design, settings, and sample size. There is an increment in the prevalence's suicidal ideation and attempts in the past 10 years. The country's Ministry of Health needs to act to address and prevent this urgent public health situation. The prevention of suicide should be a top concern, and working with numerous stakeholders is an efficient and practical approach.

The Role of Unemployment, Financial Hardship, and Economic Recession on Suicidal Behaviors and Interventions to Mitigate Their Impact: A Review

Understanding the social determinants and risk factors for suicidal behaviors underlies the development of effective suicide prevention interventions. This review focused on recently published literature (2010 onwards), with the aim to determine the role of economic factors (at the individual and population level) on suicidal behaviors and ideation as well as the effectiveness of interventions addressing these factors in reducing suicidal behaviors and ideation. Where available, literature examining the economic impact of COVID-19 was highlighted. Economic recession and unemployment are associated with increased risk of suicidal behavior at the population and individual level. Additionally, personal financial problems such as debt and financial strain are associated with increased risk of suicidal behavior and ideation at the individual level. Regarding interventions, unemployment benefits, employment protection legislation, higher minimum wage and active labor market programs may reduce suicide at the population level. However, it is not clear what impact they have at the individual level, nor in relation to suicide attempts, self-harm, or suicidal ideation. There was a lack of evidence as to the effectiveness of financially focused suicide prevention interventions at either level. Current findings were contextualized within, and advance, prominent social theoretical models. Recommendations focused on future areas of research, including the unfolding economic impact of COVID-19, as well as the co-design and evaluation of tailored interventions and/or gatekeeper training for those in the financial and welfare sector, and enhanced early education aimed at increasing financial literacy in young people before onset or exacerbation of financial hardship.

A time-series analysis of the association between alcohol and suicide in Australia

INTRODUCTION

800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017.

MATERIALS AND METHODS

Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined.

RESULTS

A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality.

DISCUSSION

Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

Psychiatric and psycho-social characteristics of suicide completers: a 13-year comprehensive evaluation of psychiatric case records and post-mortem findings

Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Nonconcordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide.

The Association Between Employment Status and Mental Health in Young Adults: A Nationwide Population-Based Study in Korea

BACKGROUND

There has been limited evidence on the association between employment status and mental health among young adults. Therefore, this study investigated the association between employment status and mental health in Korean young adults.

METHODS

Data from 15,649 adults aged 19-39 years who participated in the Korea National Health and Nutrition Examination Survey (2007-2013, 2015, and 2017) were analyzed. Employment status was categorized by those who worked in paid jobs or those who did unpaid work for relatives. Mental health problems included depressive mood and suicide ideation. We performed a multiple logistic regression analysis.

RESULTS

Of the participants, 33.5% were unemployed. The odds ratio (OR) of depressive mood (1.28, 95% CI: 1.06-1.55) was higher in unemployed 20-year-olds than employed ones and ORs of suicide ideation were higher among unemployed males (1.59, 1.16-2.20) and 30-year-olds (1.38, 1.13-1.70) than employed ones, respectively. Further, compared to employed males, the ORs of depressive mood (3.10, 2.54-3.77) and suicide ideation (4.44, 3.57-5.53) were the highest among unemployed females.

LIMITATIONS

This study could not explain the causal relationship between employment status and mental health because it was a cross-sectional study. We did not include the relationship between mental health and employment status before the last week.

CONCLUSIONS

Among young adults, unemployed status was significantly associated with an increased risk of mental health problems such as depressive mood and suicide ideation. Multifaceted efforts are required to reduce these mental health issues among unemployed young adults.

Caregiving as suicide-prevention: an ecological 20-country study of the association between men's family carework, unemployment, and suicide

PURPOSE

Suicide rates are generally higher in men than in women. Men's higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men's suicide vulnerability is also related to their private-life behaviors, particularly men's low engagement in family carework, this ecological study explored the association between men's family carework, unemployment, and suicide.

METHODS

Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men's engagement in family carework and suicide rates by sex was estimated, with OECD's unemployment-benefits index and United-Nations' Human Development-Index (HDI) evaluated as controls. The moderation of men's carework on the unemployment-suicide relationship was also assessed.

RESULTS

Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country's HDI. Unemployment benefits were not associated with suicide rates. Men's family carework moderated the association between unemployment and suicide rates.

CONCLUSION

This study's findings that higher levels of men's family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men's family carework. They are consistent with evidence that where gender equality is greater, men's and women's well-being, health, and longevity are greater.

Disability Status, Unemployment, and Alcohol-Related Liver Disease (ALD) Mortality: A Large Sample Individual Level Longitudinal Study

Purpose

Unlike previous research, we evaluate disability within expanded employment status factors and stratify gender, race and ethnicity in alcohol-related liver disease (ALD) mortality in a large sample individual level longitudinal study.

Materials and Methods

The National Longitudinal Mortality Study (NLMS) was used covering the period 1990–2011. Statistical analysis involved the use of proportional hazards regression on a sample of almost 1.4 million people aged 18 and older, of whom 2638 died of ALD by the end of the follow-up period.

Results

With expanded employment status factors, disability (HR=3.76 [95%] CI 3.22, 4.39), unemployment (HR=1.90, CI 1.56, 2.31), and those not otherwise in the labor force (HR=2.31, CI 2.08, 2.56) were strongly related to ALD mortality compared to the employed. When stratified, gender, race, and ethnicity were not important modifiers in the relationships between disability, unemployment, those not in the labor force and subsequent ALD mortality. Consistent with other studies, males, minority status, living in a highly urban area, renting as opposed to owning a home, lower educational attainment, marital statuses other than marriage, low income, and age were related to ALD mortality.

Conclusion

In addition to unemployment which has been previously studied in a large longitudinal sample, disabled people who were unable to work and those not looking for work had a higher risk of ALD mortality. Alcohol consumption, abuse and morbidity in these populations are of considerable clinical concern.

The Association between Unstable Employment and Suicidal Behavior in Young-Adult Precarious Workers

OBJECTIVE

Precarious workers have increased over the past two decades in South Korea. Employment instability, especially among young adults, is considered a serious social problem. The unstable employment status of precarious workers has negative impacts on their mental health, such as suicidal behavior. This study aims to identify the effect of the unstable employment conditions on the suicidal behavior of precarious workers.

METHODS

An online survey was conducted with a panel sample of South Korean adults (n=797) who were precarious workers aged between 25-34 years. We applied Model 6 of SPSS PROCESS MACRO 3.5 to examine the multiple mediation effects of depression and anger in the relationship between employment instability and suicide.

RESULTS

Unstable employment had no direct effect on suicidal behavior. The path of unstable employment to suicidal behavior via depression and anger had a significant indirect effect. However, employment and anger were negatively related. The indirect effect of depression and anger on the relation between unstable employment and suicidal behavior was statistically significant.

CONCLUSION

This study suggests an association between unstable employment and suicidal behavior, mediated by depression and anger. Specifically, a high level of unstable employment status increased depression. In contrast, a low level of unstable employment status increased anger, which ultimately led to an increase in suicidal behavior. These contrasting findings are likely to reflect the heterogeneity of precarious workers. Further longitudinal studies are necessary to identify the causality between precarious employment and suicidal behavior over time.

Diabetes Mellitus and Marital Status: Evidence from the National Longitudinal Mortality Study on the Effect of Marital Dissolution and the Death of a Spouse

Purpose

This study evaluates the full impact of marital status on diabetes mellitus by stratifying the analysis by gender, including socioeconomic covariates and, unlike most studies, extending marital status by separating out previously conflated status categories.

Methods

Release 5 of the National Longitudinal Mortality Study (NLMS) was used for the data. Logistic regression was applied to the data from 1990 to 2011. The effective sample size consists of 1,384,507 individuals age 18 and above recruited into the study (via the Current Population Surveys), 3,955 of whom had died of diabetes mellitus by 2011.

Results

For minority men and non-Hispanic white men, divorced/separated status was significantly related to diabetes mortality, respectively (OR=1.318, CI=1.010, 1.719; and OR=1.283, CI=1.054, 1.562). For minority women and non-Hispanic white women, widowed status was related to diabetes mortality, respectively (OR=1.349, CI=1.107, 1.643; and OR=1.262, CI=1.113, 1.431).

Conclusion

Contrary to recent epidemiological studies in which divorced/separated and widowed status were combined into one covariate, this United States study finds that divorced/separated men and widowed women are at increased risk for diabetes mellitus mortality, and that among these populations at risk, minorities are at higher risk than whites. The study highlights the importance of marital status and gender differences in the risk of death from diabetes.

The knife's edge: Masculinities and precarity in East Africa

In our field sites and clinical practice in East Africa, we regularly encounter men who have become overwhelmed by "thinking too many thoughts" and "gone crazy from confusion," brought about by the problems of life created by deepening social, economic and political precarity. Across diverse settings, many African men continue to be enmeshed in social and material obligations and expectations that position them as economic consumers and providers for those they care for and love. When these gendered obligations, expectations and fantasies are left unfulfilled, this sense of failure can be embodied to produce particular kinds of health effects. Namely, men may become plagued by troublesome and confusing thoughts, leading them in some cases to "give up on" (as our research subjects put it) pursuing work and education, to become immersed in problematic drug and alcohol use, and even to take their own lives. While these afflictions can be glossed using the language of depression, anxiety, addiction and suicide, such medicalizing frames may obscure more nuanced social, structural and affective diagnoses of what is happening to men across Africa and globally. Anthropology provides us with alternative frames through which to understand how psychological wounds are made-and healed.