Unemployment and Suicide During and After a Deep Recession: A Longitudinal Study of 3.4 Million Swedish Men and Women

Abstract

Objectives. We tested 2 hypotheses found in studies of the relationship between suicide and unemployment: causal (stress and adversity) and selective interpretation (previous poor health). Methods. We estimated Cox models for adults (n = 3 424 550) born between 1931 and 1965. We examined mortality during the recession (1993–1996), postrecession (1997–2002), and a combined follow-up. Models controlled for previous medical problems, and social, family, and employer characteristics. Results. During the recession there was no excess hazard of mortality from suicide or events of undetermined intent. Postrecession, there was an excess hazard of suicide mortality for unemployed men but not unemployed women. However, for unemployed women with no health-problem history there was a modest hazard of suicide. Finally, there was elevated mortality from events of undetermined intent for unemployed men and women postrecession. Conclusions. A small part of the relationship may be related to health selection, more so during the recession. However, postrecessionary period findings suggest that much of the association could be causal. A narrow focus on suicide mortality may understate the mortality effects of unemployment in Sweden.

Educational mismatch and mortality among native‐born workers in Sweden. A 19‐year longitudinal study of 2.5 million over‐educated, matched and under‐educated individuals, 1990–2008

“…The literature on the health effects of under‐employment is substantial and includes studies on the effects of unemployment (Garcy and Vågerö , ) and inadequate employment, including hours (that is, limited working hours or time‐dependent contract length) (Winefield et al . ), pecuniary under‐employment (Feldman et al .…”

Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status

“…Mortality from suicide was classified using ICD codes for intentional self-harm (ICD-9: E950-E959; ICD-10: X60-X84, Y870) and events of undetermined intent (ICD-9: E980-E988; ICD-10: Y10-Y34). The inclusion of codes for events of undetermined intent may provide a more accurate measure of suicide mortality due to frequent underreporting of suicides [37], and also facilitates comparison with prior Swedish studies that have used both pairs of code classifications in combination to assess suicide mortality [5,9].…”

“…Exposure to unemployment has also been shown to be associated with poor mental health [7,8], including severe outcomes like suicide [9,10], which could be the ultimate consequence of mental health deteriorations associated with unemployment or job loss. Unemployment in the destination country may be a key risk factor for poor health among migrants, as persons of foreign-origin in Sweden [11,12] and elsewhere [13,14] have higher rates of unemployment compared to those of native-origin.…”

Strengthening mental health systems to respond to economic crises

“…It is still too early to know but there are likely to be long term consequences to mental health linked to economic shocks. Analysis following more than 3 million Swedes who had been employed in 1990 indicated that suicide rates for those who lost their jobs in the economic crisis in the mid-1990s and were still unemployed up to five years after the end of the recession were at greater risk of suicide than during the crisis itself (12). Individual level data were also used to show that the risks of suicide in Sweden and Denmark (men only) in those who had lost their jobs were almost double those of individuals who remain in employment for up to four years following job loss (13,14).…”