Primary Care Corner with Geoffrey Modest MD: Unemployment and suicide rates

By: Dr. Geoffrey Modest

A rather disturbing but not unexpected article was just published in Lancet Psychiatry correlating suicide rates with unemployment (see Lancet Psychiatry 2015; 2: 239–45​). About 1 million people per year die by suicide around the world. Prior data on the relationship between unemployment and suicide have been a bit mixed, though several studies have found a relationship and some with a time-lag.  This study looked at the 2008 world-wide economic crisis from a larger perspective than others: using databases from the WHO and the International Monetary Fund, the researchers looked at 63 countries (based largely on sample size and completeness of data) and assessed the long time period of 2000-2011, evaluating  suicide differences by 4 age groups and gender. As background, the 2008 economic crisis led to a 2% decline in world per capita GDP in 2009, and 31.8 million more people were unemployed in 2013 than 2007.

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Results:

–the 63 countries were divided into 4 regions: Americas (Argentina, Brazil, Canada, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Mexico, Nicaragua, Panama, Paraguay, Suriname, Uruguay, USA); northern and western Europe (the usual suspects, with n=15); southern and eastern Europe (Belarus, Bulgaria, Croatia, Czech Republic, Greece, Hungary, Italy, Macedonia, Moldova, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Ukraine); and non-Americas, non-Europe (Australia, Egypt, Georgia, Hong Kong, Israel, Japan, Kazakhstan, Kuwait, Kyrgyzstan, Mauritius, New Zealand, Singapore, South Africa, South Korea).

–the overall annual relative risk of suicide decreased  by 1.1% (0.8-1.4%) between 2000 and 2011

–but there was a nonlinear effect in the relationship between unemployment and suicide:

–a higher suicide rate preceded a rise in unemployment by 6 months

–higher suicide rates were in areas with lower baseline unemployment rates

–not much difference in terms of male/female ratio over time (about 4/1) or between the different age groups. There were quite different trends in the different regions, some with increasing and some decreasing suicide rates over the time period, but there was a consistent bump associated with the economic crisis

–overall, the relative risk of suicide associated with unemployment was elevated by 20-30% during the crisis period i​n all world regions (somewhat less in northern/western Europe and somewhat more in southern/eastern Europe)

–the overall excess suicide rate associated with unemployment decreased from 3.53/100K in 2000, to 2.75/100K in 2007, increased to 3.03/100K in 2009, and decreased thereafter to 2.82/100K

–therefore 41,148 excess suicides were associated with unemployment in 2007 and 46,131 in 2009

So, a few striking features.

–there was not a strong age component (one might have thought that the working population would have more significant psych trauma from not working), or much of a gender difference percentage-wise

–despite differences in different regions, some with a trend to increasing and some to decreasing unemployment over the 11 year period, there was a consistent bump in suicides with the economic crisis

–the effect was non-linear: countries used to lower unemployment rates had higher % increases in unemployment-attributable suicides

–the reverse time-lag (increase in suicides predating the upward swing in unemployment) could be from several factors, including the economic contraction beginning before the unemployment rate increases (suggesting that people felt more vulnerable in the period before the countries actually posted their increase in unemployment​), lags in accumulating data on unemployment rates, etc,

–and, perhaps most importantly, this study highlights the huge human and social costs of this economic crisis, one which occurred because of gross malfeasance by banks (though remarkably few bankers have been punished for this world-wide disaster, from which the world is still slowly recovering).

–and, it reinforces our general conception that there is a strong, integral relationship between one’s social environment, in the broadest sense, and one’s health…