Unemployment and suicide. Evidence for a causal association?

Abstract

Objectives: To determine the independent associations of labour force status and socioeconomic position with death by suicide. Design: Cohort study assembled by anonymous and probabilistic record linkage of census and mortality records. Participants: 2.04 million respondents to the New Zealand 1991 census aged 18-64 years. Main outcome measure: Suicide in the three years after census night. Results: The age adjusted odds ratios (95% confidence intervals) of death by suicide among 25 to 64 year olds who were unemployed compared with employed were 2.46 (1.10 to 5.49) for women and 2.63 (1.87 to 3.70) for men. Similarly increased odds ratios were observed for the non-active labour force compared with the employed. Strong age only adjusted associations of suicide death with the socioeconomic factors of education (men only), car access, and household income were observed. Compared with those who were married on census night, the non-married had odds ratios of suicide of 1.81 (1.22 to 2.69) for women and 2.08 (1.66 to 2.61) for men. In a multivariable model the association of socioeconomic factors with suicide reduced to the null. However, marital status and labour force status remained strong predictors of suicide death. Unemployment was also strongly associated with suicide death among 18-24 year old men. Sensitivity analyses suggested that confounding by mental illness might explain about half, but not all, of the association between unemployment and suicide. Conclusions: Being unemployed was associated with a twofold to threefold increased relative risk of death by suicide, compared with being employed. About half of this association might be attributable to confounding by mental illness. : unemployment may confer vulnerability by increasing the impact of stressful life events; it may indirectly cause suicide by increasing the risk of factors that precipitate suicide (for example, mental illness, financial difficulties); or it may be a non-causal association because of confounding or selection by factors that predict both unemployment status and suicide risk.Studies controlling for confounding by social factors find an approximately twofold excess suicide risk among the unemployed, 4 5 but the possibility remains of health selection or residual confounding. Health selection is where poor health precedes and predicts both unemployment and death causing a spurious association of unemployment with suicide. Data from the British general household survey on the prevalence of limiting longstanding illness by labour force status were consistent with health selection into the non-active labour force (that is, excluding both the employed and unemployed), but not into the unemployed category (that is, actively seeking and available for work). 6 Another test of health selection is that a weaker association of unemployment with poor health would be expected in times of high background unemployment rates, as a greater proportion of "ordinary" people (that is, not just people with poor health or other characteristics conferring...

The effect of economic insecurity on mental health: Recent evidence from Australian panel data

“…This concept refers to the anxiety felt by individuals when they are threatened by the prospect of severe economic losses, and emerging evidence suggests it is a major cause for concern. Survey data routinely shows that financial worries rank amongst the most troubling for households, and related problems have been associated with many social ills including familial breakup (Larson, Wilson & Beley, 1994), depression (Meltzer et al, 2009;Tsutsumi, Kayaba, Theorell & Siegrist, 2001), and suicide (Blakely, Collings, & Atkinson, 2003;Hintikka, Saarinen & Viinamaki, 1999). The importance of economic security has also been emphasized by Stiglitz, Sen and Fitoussi (2009) who argue that it should be considered as a part of measures of economic performance and social progress; and by the United Nations which declares economic security a universal human right (United Nations, 1948).…”

Patterns of suicide by occupation in England and Wales: 2001–2005

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Although the relationship between suicide and unemployment has been extensively studied [1][2][3][4] demonstrating an increased rate of suicide among the unemployed, the relationship between suicide and occupation has been much less frequently studied, probably because of the relatively smaller number of people in each occupational group compared with the population in other socio-demographic groups defined, for example, by age or geography. Mortality data collated by the Office for National Statistics (ONS) in England and Wales have, however, been an invaluable source for examining the relationship between suicide and occupation.

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Inpatient Profile of Patients with Major Depression in Portuguese National Health System Hospitals, in 2008 and 2013: Variation in a Time of Economic Crisis

“…Indeed, there is ample evidence from previous economic crises showing that people affected by unemployment, impoverishment and family problems have a significantly higher risk of mental health problems such as major depression, suicide and problems related to alcohol consumption and psychoactive substances, than unaffected people (Blakely et al 2003;Chang et al 2009;Dee 2001;Dooley et al 1994;Dorling 2009;Fryers et al 2005;Gunnell et al 1999;Lewis and Sloggett 1998;Mathers and Schofield 1998;McKee-Ryan et al 2005;Murphy and Athanasou 1999).…”