The health effects of economic decline

EPA guidance on mental health and economic crises in Europe

This European Psychiatric Association (EPA) guidance paper is a result of the Working Group on Mental Health Consequences of Economic Crises of the EPA Council of National Psychiatric Associations. Its purpose is to identify the impact on mental health in Europe of the economic downturn and the measures that may be taken to respond to it. We performed a review of the existing literature that yields 350 articles on which our conclusions and recommendations are based. Evidence-based tables and recommendations were developed through an expert consensus process. Literature dealing with the consequences of economic turmoil on the health and health behaviours of the population is heterogeneous, and the results are not completely unequivocal. However, there is a broad consensus about the deleterious consequences of economic crises on mental health, particularly on psychological well-being, depression, anxiety disorders, insomnia, alcohol abuse, and suicidal behaviour. Unemployment, indebtedness, precarious working conditions, inequalities, lack of social connectedness, and housing instability emerge as main risk factors. Men at working age could be particularly at risk, together with previous low SES or stigmatized populations. Generalized austerity measures and poor developed welfare systems trend to increase the harmful effects of economic crises on mental health. Although many articles suggest limitations of existing research and provide suggestions for future research, there is relatively little discussion of policy approaches to address the negative impact of economic crises on mental health. The few studies that addressed policy questions suggested that the development of social protection programs such as active labour programs, social support systems, protection for housing instability, and better access to mental health care, particularly at primary care level, is strongly needed.

Effects of Economic Disruptions on Alcohol Use and Problems: Why Do African Americans Fare Worse?

OBJECTIVE

This study tested a model of the effects of recession-related job loss on alcohol use disorder (AUD) and examined why African Americans who lost their jobs during the 2008-2009 recession were at increased risk for AUD relative to Whites. We hypothesized that (a) job loss would be positively associated with psychological distress (i.e., higher levels of depressive symptoms) and increased drunkenness, and (b) low levels of family social support and experiences of racial stigma would exacerbate the effects of job loss on distress, especially among African Americans and Hispanics.

METHOD

Data were drawn from the 2010 U.S. National Alcohol Survey (NAS), a cross-sectional survey of the U.S. general population. Using data from the 2010 NAS (telephone survey of 1,111 African American, 964 Hispanic, and 3,133 White adults), we conducted simultaneous path modeling in Mplus to test mediation and moderation hypotheses. Our key outcome was AUD as measured by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

RESULTS

Recession-related job loss was significantly associated with AUD through its effects on increased drunkenness, and the associations were positive for Whites, stronger for African Americans than Whites, and nonexistent for Hispanics. Job loss was associated with distress in the overall sample, and distress was positively associated with drunkenness among African Americans only, suggesting that distress is another pathway by which job loss affects AUD among African Americans. Higher levels of family social support mitigated the effects of job loss on psychological distress, and this relationship did not differ by race/ethnicity.

CONCLUSIONS

During economic downturns, increased stress and heavy drinking are important pathways through which recession-related job loss can lead to greater AUD among African Americans relative to Whites.

Financial Strain and Mental Health Among Older Adults During the Great Recession

OBJECTIVES

The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health?

METHOD

This study draws on 5,366 respondents from the Health and Retirement Study (2006-2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period.

RESULTS

Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010.

DISCUSSION

Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health.

Health Impacts of the Great Recession: A Critical Review

The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.

The physiological impacts of wealth shocks in late life: Evidence from the Great Recession

Given documented links between individual socioeconomic status (SES) and health, it is likely that-in addition to its impacts on individuals' wallets and bank accounts-the Great Recession also took a toll on individuals' disease and mortality risk. Exploiting a quasi-natural experiment design, this study utilizes nationally representative, longitudinal data from the National Social Life, Health, and Aging Project (NSHAP) (2005-2011) (N = 930) and individual fixed effects models to examine how household-level wealth shocks experienced during the Great Recession relate to changes in biophysiological functioning in older adults. Results indicate that wealth shocks significantly predicted changes in physiological functioning, such that losses in net worth from the pre-to the post-Recession period were associated with increases in systolic blood pressure and C-reactive protein over the six year period. Further, while the association between wealth shocks and changes in blood pressure was unattenuated with the inclusion of other indicators of SES, psychosocial well-being, and health behaviors in analytic models, we document some evidence of mediation in the association between changes in wealth and changes in C-reactive protein, which suggests specificity in the social and biophysiological mechanisms relating wealth shocks and health at older ages. Linking macro-level conditions, meso-level household environments, and micro-level biological processes, this study provides new insights into the mechanisms through which economic inequality contributes to disease and mortality risk in late life.

Committed to work but vulnerable: self-perceptions and mental health in NEET 18-year olds from a contemporary British cohort

BACKGROUND

Labour market disengagement among youths has lasting negative economic and social consequences, yet is poorly understood. We compared four types of work-related self-perceptions, as well as vulnerability to mental health and substance abuse problems, among youths not in education, employment or training (NEET) and among their peers.

METHODS

Participants were from the Environmental Risk (E-Risk) longitudinal study, a nationally representative UK cohort of 2,232 twins born in 1994-1995. We measured commitment to work, job-search effort, professional/technical skills, 'soft' skills (e.g. teamwork, decision-making, communication), optimism about getting ahead, and mental health and substance use disorders at age 18. We also examined childhood mental health.

RESULTS

At age 18, 11.6% of participants were NEET. NEET participants reported themselves as committed to work and searching for jobs with greater diligence than their non-NEET peers. However, they reported fewer 'soft' skills (B = -0.98, p < .001) and felt less optimistic about their likelihood of getting ahead in life (B = -2.41, p < .001). NEET youths also had higher rates of concurrent mental health and substance abuse problems, but these did not explain the relationship with work-related self-perceptions. Nearly 60% of NEET (vs. 35% of non-NEET) youths had already experienced ≥1 mental health problem in childhood/adolescence. Associations of NEET status with concurrent mental health problems were independent of pre-existing mental health vulnerability.

CONCLUSIONS

Our findings indicate that while NEET is clearly an economic and mental health issue, it does not appear to be a motivation issue. Alongside skills, work-related self-perceptions and mental health problems may be targets for intervention and service provision among this high-risk population.

The impact of the Great Recession on mental health and its inequalities: the case of a Southern European region, 1997-2013

Background

Numerous studies have shown that macroeconomic changes have a great influence on health, prompting different concerns in recent literature about the effects of the current recession. The objetive of the study was to assess the changes in the mental health of the working-age population in the Basque Country (Spain) and its social inequalities following the onset of the 2008 recession, with special focus on the role of unemployment.

Methods

Repeated cross-sectional study on the population aged 16–64, using four Basque Health Surveys (1997–2013). Age-adjusted prevalences of poor mental health and incremental prevalence ratios (working status and social class adjusted) between years were calculated. Absolute/relative measures of social inequalities were also calculated.

Results

From 2008, there was a clear deterioration in the mental health, especially among men. Neither changes in employment status nor social class accounted for these changes. In men, the deterioration affected all working status categories, except the retired but significant changes occurred only among the employed. In women, poor mental health significantly increased among the unemployed. Students were also especially affected. Relative inequalities increased only in men.

Conclusions

The Great Recession is being accompanied by adverse effects on mental health, which cannot be fully explained by the increase of unemployment. Public health professionals should closely monitor the medium and long-term effects of the crisis as these may emerge only many years after the onset of recessions.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012)

BACKGROUND

There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services.

AIM

The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain.

METHOD

Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed.

RESULTS AND CONCLUSIONS

Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Unemployment Rate, Smoking in China: Are They Related?

Background: Studies on the relationship between unemployment rate and smoking have yielded mixed results. The issue in China has not been studied. This study aims to examine the influence of unemployment rate on smoking in China. Methods: Logit model and two-stage least squares (2SLS) estimation were used to estimate the effects. Estimations were done for 4585 individual over 45 using data from China Health and Retirement Longitudinal Study conducted in Zhejiang and Gansu provinces in 2008 and 2012. Results: A percent increase in the unemployment rate resulted in the increase in the likelihood of smoking by a combined 9.1 percent for those who smoked including a 2.9% increase for those who smoked 1–10 cigarettes per day; a 2.8% increase for those who smoked 11–20 cigarettes per day; and a 3.4% increase for those who smoked 20 cigarettes or more per day. The effects were stronger for those who were employed. Non-drinkers were more likely to engage in smoking with increased unemployment rate. 2SLS estimation revealed the same association. Conclusions: The unemployment rate was positively associated with smoking behavior. Smoking control and intervention strategies should focus on both the individual′s characteristics and the physical environment in which unemployment rate tend to rise.

Which group of smokers is more vulnerable to the economic crisis?

OBJECTIVES

Studies investigating whether smoking increases or decreases during economic downturn provided contrasting results. For the first time, we used direct questions to analyse changes in smoking behaviour due to the 2008 financial crisis, comparing socio-economic characteristics of smokers who changed with those who kept their smoking intensity.

STUDY DESIGN

Cross-sectional survey.

METHODS

We used data from three annual surveys conducted in Italy in 2012-2014 on representative samples of the Italian general population aged ≥15 years.

RESULTS

A total of 1919 current smokers were asked specific questions on the influence of the economic crisis that started in 2008 on their smoking behaviour. Overall, 77.4% of 1919 current smokers reported not to have changed their smoking behaviour, 19.1% to have reduced, and 3.5% to have increased their smoking intensity as a consequence of the economic crisis. The reduction in cigarette smoking increased with age: compared to the respondents aged <25 years, the multivariate odds ratio (OR) for those aged 25-44, 45-64 and ≥65 years were 0.65, 0.46 and 0.33, respectively (P for trend<0.001). Reduction was significantly lower among intermediate (OR = 0.68 compared to low) and high education levels (OR = 0.28; P for trend<0.001). A significant inverse trend for increasing consumption was observed with age (P = 0.022), education (P = 0.003) and family income (P < 0.001).

CONCLUSIONS

The large majority of current smokers did not change their smoking habit following the economic crisis. However, there are specific vulnerable subgroups of smokers, constituted by the young and subjects with low socio-economic status, that were reactive to the global economic crisis. These groups are more prone to change their smoking behaviours, either for better or -, in a smaller proportion -, for worse.

Photovoice: Assessing the Long-Term Impact of a Disaster on a Community's Quality of Life

Photovoice is a qualitative method of inquiry whereby individuals can document their lived experiences, particularly individuals whose voices are not typically heard in regard to promoting social change and policy development. We used photovoice to elicit major themes regarding community members' perceptions of the long-term impact on their quality of life as a deadly technological disaster hit a small, rural town in South Carolina. Overall, participants photographed more negative images than positive. Overarching themes included residential and business vacancies, economic decline, the need for clean-up and modernization, attention to wellness or rehabilitation, and concerns for safety. Emergency response agencies should consider the themes elicited from these community residents to help identify where to focus disaster response efforts both in the immediate aftermath and during the long-term recovery period of technological disasters, particularly in underserved, rural communities.

Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans

Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95% confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95% confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss.

Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies

In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.

Soybeans or Soybean Products Consumption and Depressive Symptoms in Older Residents in Rural Northeast China: A Cross-Sectional Study

OBJECTIVE

Depression is one of the most common mental disorders among elderly subjects. The purpose of this study is to estimate the prevalence of depressive symptoms and the association between soybeans consumption and depressive symptoms among older residents in rural Northeast China.

DESIGN

Cross-sectional study.

SETTING

A representative sample of the rural Northeast residents.

PARTICIPANTS

This survey was conducted from July 2012 to August 2013 which randomly selected and examined a total of 1717 residents aged ≥ 65 years from the rural Northeast China.

MEASUREMENTS

All participants completed the Patient Health Questionnaire-9 (PHQ-9). Information on demographic and lifestyle characteristics and blood biochemical indexes were collected by well-trained personnel.

RESULTS

The prevalence of depressive symptoms in the elderly was 8.9%. Women had significantly higher prevalence of depressive symptoms than men (13.3% vs.4.6%, P<0.001). Individuals consuming soybeans ≥4times/week had statically lower possibility to have depressive symptoms than those rarely consuming (3.6%vs. 12.5%, P<0.05). In addition to some conventional risk factors like sex, annual income, educational status, current smoking and chronic diseases status were associated with depressive symptoms, proper sleep duration (7-8h/d) [OR(95%CI):0.28(0.15,0.53)] and frequently consumption of soybeans or soybean products [OR (95%CI): 0.36 (0.15,0.87) for 2-3times/week and OR (95%CI):0.50 (0.34,0.74) for ≥4times/week] significantly decreased the risk of depressive symptoms among elderly in rural Northeast China.

CONCLUSION

Women had significantly higher prevalence of depressive symptoms than men in rural China. Individuals who rarely consume soybeans or soybean products are more likely to suffer depressive symptoms. Rural elderly residents should be cautiously screened to prevent or treat depression.

Trade liberalization, social policies and health: an empirical case study

BACKGROUND

This study investigates the health impacts of a major liberalization episode in the textile and clothing (T&C) sector. This episode triggered substantial shifts in employment across a wide range of countries. It is the first study to empirically link trade liberalization to health via changes in employment and offers some of the first empirical insights on how trade liberalization interacts with social policies to influence health.

METHODS

Data from 32 T&C reliant countries were analysed in reference to the pre- and post-liberalization periods of 2000-2004 and 2005-2009. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the association between countries' a) level of development b) labour market and welfare state protections c) T&C employment changes and d) changes in adult female and infant mortality rates. Process tracing was used to further investigate these associations through twelve in-depth country studies.

RESULTS

Results from the fsQCA relate changes in employment after the phase-out to both changing adult female and infant mortality rates. Findings from the in-depth country studies suggest that the worsening of adult female mortality rates is related to workers' lack of social protection, both in the context of T&C employment growth and loss.

CONCLUSIONS

Overall, it is found that social protection is often inaccessible to the type of workers who may be the most vulnerable to processes of liberalization and that many workers are particularly vulnerable due to the structure of social protection policies. Social policies are therefore found to both moderate pathways to health and influence the type of health-related pathways resulting from trade liberalizing policies.

Job Loss, Unemployment and the Incidence of Hazardous Drinking during the Late 2000s Recession in Europe among Adults Aged 50-64 Years

BACKGROUND

To estimate the incidence of hazardous drinking in middle-aged people during an economic recession and ascertain whether individual job loss and contextual changes in unemployment influence the incidence rate in that period.

METHODS

Longitudinal study based on two waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe). Individuals aged 50-64 years from 11 European countries, who were not hazardous drinkers at baseline (n = 7,615), were selected for this study. We estimated the cumulative incidence of hazardous drinking (≥40g and ≥20g of pure alcohol on average in men and women, respectively) between 2006 and 2012. Furthermore, in the statistical analysis, multilevel Poisson regression models with robust variance were fitted and obtained Risk Ratios (RR) and their 95% Confidence Intervals (95%CI).

RESULTS

Over a 6-year period, 505 subjects became hazardous drinkers, with cumulative incidence of 6.6 per 100 persons between 2006 and 2012 (95%CI:6.1-7.2). Age [RR = 1.02 (95%CI:1.00-1.04)] and becoming unemployed [RR = 1.55 (95%CI:1.08-2.23)] were independently associated with higher risk of becoming a hazardous drinker. Conversely, having poorer self-perceived health was associated with lower risk of becoming a hazardous drinker [RR = 0.75 (95%CI:0.60-0.95)]. At country-level, an increase in the unemployment rate during the study period [RR = 1.32 (95%CI:1.17-1.50)] and greater increases in the household disposable income [RR = 0.97 (95%CI:0.95-0.99)] were associated with risk of becoming a hazardous drinker.

CONCLUSIONS

Job loss among middle-aged individuals during the economic recession was positively associated with becoming a hazardous drinker. Changes in country-level variables were also related to this drinking pattern.

RETROSPECTIVE STUDY OF MEASURING TUBERCULOSIS THERAPY COMPLIANCE: GREECE AS A HOST COUNTRY FOR VULNERABLE POPULATIONS BEFORE AND DURING THE FINANCIAL CRISIS

BACKGROUND

For the realization of "2015 UN Millennium Development Goals", a question arises pertaining to the course of tuberculosis in Greece and its relationship to patient adherence to treatment, given the fact that the country is undergoing a financial crisis and is a gateway for economic migrants.

METHODS

The study concerned 1179 patients of the anti-TBdepartment, "Sotiria" General Chest Diseases Hospital, Athens, Greece collaborating with the National Reference Centre of Mycobacteria, covering a year before the financial crisis, 2007 and 2010-11, the first years of the crisis. A special recording form was used, on the basis of a specific protocol.

RESULTS

Out of 954 patients were diagnosed with tuberculosis disease, 657 of which were foreigners. Out of 791 patients residing in the same area, 632 were foreigners. Of the patients who proceeded to a first self-discontinuation of the medication, only 38.3% (n=18) completed the treatment, while 40.4% of them self-discontinued within the first month. Duration of treatment was 6.68±3.54 months for those (n=805) with no discontinuation and 7.48±3.68 months for those (n=149) with at least one discontinuation, regardless of the etiology p= 0,032. Cases increased during financial crisis, with gradual decrease in mean treatment duration for patients with first line treatment to 7.77±3.81 months in 2007, and 6.53±3.47 and 6.40±3.31 months in 2010 and 2011, respectively.

CONCLUSIONS

Since the beginning of treatment measurable signs of either adherent/non-adherent behavior appeared, affecting mean treatment duration and completion. Duration of treatment decreased in the years of financial crisis. Migrants ghettoization calls for implementation of DOTS.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain

Background

Spain’s financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period.

Methods

An ecological longitudinal study was carried out in Spain’s 17 regions. Two study periods were defined: pre-crisis period (2005–2007) and crisis period (2008–2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design.

Results

Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008.

Discussion

The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates.

Conclusions

The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

The health effects of the global financial crisis: can we reconcile the differing views? A network analysis of literature across disciplines

Why are researchers studying the health effects of economic change reaching markedly varying conclusions? To understand these differences, we first systematically searched Web of Science for the literature on recessions and health yielding 461 articles and 14,401 cited documents. We then undertook a network analysis of co-citation pattern by disciplines, journals and backgrounds of the authors, followed by a chronological review of the literature, to trace the evolution of ideas. We then examined the extent to which earlier literature predicted what has happened in the 2007-2012 crisis. Our analysis finds the literature is dominated by disciplinary silos, with economics studies predominantly citing each other and relative isolation of psychiatry and substance abuse journals. Different philosophical approaches to assessing causality appear to contribute to varying interpretations, a tendency that is unlikely to be resolved without a shift in research norms. We conclude by calling for more inter-disciplinary research that combines empirical findings with a search for plausible mechanisms. This approach would evaluate not only the effects of economic shocks but also the mechanisms that offer protection against them.

Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001-2012)

BACKGROUND

The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender.

METHODS

We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy "Great Recession" for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups.

RESULTS

The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by -12.1 %), and among both men (-21.8 %) and women with the lowest educational level (-15.1 %).

CONCLUSIONS

Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.

Unemployment transitions and self-rated health in Europe: A longitudinal analysis of EU-SILC from 2008 to 2011

The Great Recession of 2008 has led to elevated unemployment in Europe and thereby revitalised the question of causal health effects of unemployment. This article applies fixed effects regression models to longitudinal panel data drawn from the European Union Statistics on Income and Living Conditions for 28 European countries from 2008 to 2011, in order to investigate changes in self-rated health around the event of becoming unemployed. The results show that the correlation between unemployment and health is partly due to a decrease in self-rated health as people enter unemployment. Such health changes vary by country of domicile, and by individual age; older workers have a steeper decline than younger workers. Health changes after the unemployment spell reveal no indication of adverse health effects of unemployment duration. Overall, this study indicates some adverse health effects of unemployment in Europe--predominantly among older workers.

Racial/ethnic disparities in children's emergency mental health after economic downturns

African American children-more than other race/ethnicities-rely on emergency psychiatric care. One hypothesized cause of this overrepresentation involves heightened sensitivity to economic downturns. We test whether the African American/white difference in psychiatric emergency visits increases in months when the regional economy contracts. We applied time-series methods to California Medicaid claims (1999-2008; N = 7.1 million visits). One month following mass layoffs, African American youths use more emergency mental health services than do non-Hispanic whites. Economic downturns may provoke or uncover mental disorder especially among African American youth who by and large do not participate in the labor force.

The Far-Reaching Impact of Job Loss and Unemployment

Job loss is an involuntary disruptive life event with a far-reaching impact on workers' life trajectories. Its incidence among growing segments of the workforce, alongside the recent era of severe economic upheaval, has increased attention to the effects of job loss and unemployment. As a relatively exogenous labor market shock, the study of displacement enables robust estimates of associations between socioeconomic circumstances and life outcomes. Research suggests that displacement is associated with subsequent unemployment, long-term earnings losses, and lower job quality; declines in psychological and physical well-being; loss of psychosocial assets; social withdrawal; family disruption; and lower levels of children's attainment and well-being. While reemployment mitigates some of the negative effects of job loss, it does not eliminate them. Contexts of widespread unemployment, although associated with larger economic losses, lessen the social-psychological impact of job loss. Future research should attend more fully to how the economic and social-psychological effects of displacement intersect and extend beyond displaced workers themselves.

How Economic Downturns Affect Children's Development: An Interdisciplinary Perspective on Pathways of Influence

To understand how economic downturns affect children's development, scholars have concentrated on how parents' loss of a job affects children's well-being, but have largely ignored the potential effects of downturns on children whose parents remain employed. In this article, we review research across disciplines to demonstrate that economic downturns should be conceptualized as a community-level event that affects all children in a community, not just those whose parents have lost jobs. We focus on three mechanisms linking downturns to children's developmental outcomes: structural changes to communities, the economic and psychological effects on individuals who are continuously employed, and the strain of job loss on social networks. We conclude by discussing ongoing research and looking at implications for public policy.

Do macroeconomic contractions induce or 'harvest' suicides? A test of competing hypotheses

BACKGROUND

Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment-induction or displacement.

METHODS

We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women.

RESULTS

Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later.

CONCLUSIONS

Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.

Systematic review of suicide in economic recession

AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide.

METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycINFO and PsycARTICLES was performed to identify studies that had investigated the association between economic recession and suicide.

RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive.

CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.

Losing jobs and lighting up: Employment experiences and smoking in the Great Recession

The Great Recession produced the highest rates of unemployment observed in decades, in part due to particularly high rates of people losing work involuntarily. The impact of these job losses on health is unknown, due to the length of time required for most disease development, concerns about reverse causation, and limited data that covers this time period. We examine associations between job loss, employment status and smoking, the leading preventable cause of death, among 13,571 individuals participating in the 2001-2011 waves of the U.S.-based Panel Study of Income Dynamics. Results indicate that recent involuntary job loss is associated with an average 1.1 percentage point increase in smoking probability. This risk is strongest when people have returned to work, and appears reversed when they leave the labor market altogether. Although some job loss is associated with changes in household income and psychological distress levels, we find no evidence that these changes explain smoking behavior modifications. Smoking prevention programs and policies targeted at displaced workers or the newly employed may alleviate some negative health effects produced by joblessness during the Great Recession.

The impacts of job loss and job recovery on self-rated health: testing the mediating role of financial strain and income

BACKGROUND

Is regaining a job sufficient to reverse the harmful impacts on health of job loss during the Great Recession? We tested whether unemployed persons who found work within 1 year of job loss experienced a full recovery of their health. Additionally, we tested the mediating role of financial strain and household income.

METHODS

Linear regression models were used to assess the effects of job loss and recovery on self-rated health using the longitudinal EU-SILC, covering individuals from 27 European countries. We constructed a baseline of employed persons (n = 70 611) in year 2007. We evaluated income and financial strain as potential mediating factors.

RESULTS

Job loss was associated with worse self-rated health in both men (β = 0.12, 95%CI: 0.09-0.15) and women (β = 0.13, 95%CI: 0.10-0.16). Financial strain explains about one-third of the association between job loss and health, but income did not mediate this relation. Women who regained employment within 1 year after job loss were found to be similarly healthy to those who did not lose jobs. In contrast, men whose employment recovered had an enduring health disadvantage compared with those who had not lost jobs (β = 0.11, 95%CI: 0.05-0.16). Unemployment cash benefits mitigated financial strain but were too low to substantially reduce perceived financial strain among men.

CONCLUSIONS

Men and women's health appears to suffer equally from job loss but differs in recovery. For men, employment recovery was insufficient to alleviate financial strain and associated health consequences, whereas in women regaining employment leads to health recovery.

Economic downturns and suicide mortality in the USA, 1980-2010: observational study

BACKGROUND

Several studies have suggested strong associations between economic downturns and suicide mortality, but are at risk of bias due to unmeasured confounding. The rationale for our study was to provide more robust evidence by using a quasi-experimental design.

METHODS

We analysed 955,561 suicides occurring in the USA from 1980 to 2010 and used a broad index of economic activity in each US state to measure economic conditions. We used a quasi-experimental, fixed-effects design and we also assessed whether the effects were heterogeneous by demographic group and during periods of official recession.

RESULTS

After accounting for secular trends, seasonality and unmeasured fixed characteristics of states, we found that an economic downturn similar in magnitude to the 2007 Great Recession increased suicide mortality by 0.14 deaths per 100,000 population [95% confidence interval (CI) 0.00, 0.28] or around 350 deaths. Effects were stronger for men (0.28, 95% CI 0.07, 0.49) than women and for those with less than 12 years of education (1.22 95% CI 0.83, 1.60) compared with more than 12 years of education. The overall effect did not differ for recessionary (0.11, 95% CI -0.02, 0.25) vs non-recessionary periods (0.15, 95% CI 0.01, 0.29). The main study limitation is the potential for misclassified death certificates and we cannot definitively rule out unmeasured confounding.

CONCLUSIONS

We found limited evidence of a strong, population-wide detrimental effect of economic downturns on suicide mortality. The overall effect hides considerable heterogeneity by gender, socioeconomic position and time period.

Health effects of unemployment benefit program generosity

OBJECTIVES

We assessed the impact of unemployment benefit programs on the health of the unemployed.

METHODS

We linked US state law data on maximum allowable unemployment benefit levels between 1985 and 2008 to individual self-rated health for heads of households in the Panel Study of Income Dynamics and implemented state and year fixed-effect models.

RESULTS

Unemployment was associated with increased risk of reporting poor health among men in both linear probability (b=0.0794; 95% confidence interval [CI]=0.0623, 0.0965) and logistic models (odds ratio=2.777; 95% CI=2.294, 3.362), but this effect is lower when the generosity of state unemployment benefits is high (b for interaction between unemployment and benefits=-0.124; 95% CI=-0.197, -0.0523). A 63% increase in benefits completely offsets the impact of unemployment on self-reported health.

CONCLUSIONS

Results suggest that unemployment benefits may significantly alleviate the adverse health effects of unemployment among men.

A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences

BACKGROUND

This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status.

METHOD

We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample.

RESULTS

Three categories related to the crisis emerged--previous labour experiences, employment consequences and individual consequences--that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession.

CONCLUSION

The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.

Government health care spending and child mortality

BACKGROUND

Government health care spending (GHS) is of increasing importance to child health. Our study determined the relationship between reductions in GHS and child mortality rates in high- and low-income countries.

METHODS

The authors used comparative country-level data for 176 countries covering the years 1981 to 2010, obtained from the World Bank and the Institute for Health Metrics and Evaluation. Multivariate regression analysis was used to determine the association between changes in GHS and child mortality, controlling for differences in infrastructure and demographics.

RESULTS

Data were available for 176 countries, equating to a population of ∼ 5.8 billion as of 2010. A 1% decrease in GHS was associated with a significant increase in 4 child mortality measures: neonatal (regression coefficient [R] 0.0899, P = .0001, 95% confidence interval [CI] 0.0440-0.1358), postneonatal (R = 0.1354, P = .0001, 95% CI 0.0678-0.2030), 1- to 5-year (R = 0.3501, P < .0001, 95% CI 0.2318-0.4685), and under 5-year (R = 0.5207, P < .0001, 95% CI 0.3168-0.7247) mortality rates. The effect was evident up to 5 years after the reduction in GHS (P < .0001). Compared with high-income countries, low-income countries experienced greater deteriorations of ∼ 1.31 times neonatal mortality, 2.81 times postneonatal mortality, 8.08 times 1- to 5-year child mortality, and 2.85 times under 5-year mortality.

CONCLUSIONS

Reductions in GHS are associated with significant increases in child mortality, with the largest increases occurring in low-income countries.

Psychological well-being during the great recession: changes in mental health care utilization in an occupational cohort

OBJECTIVES

We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured.

METHODS

We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects.

RESULTS

Mental health inpatient and outpatient visits and the yearly supply of mental health-related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs.

CONCLUSIONS

The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress.

The Effects of Unemployment Rate on Health Status of Chinese People

BACKGROUND

The aim of the study was to estimate the short-run and long-run effects of unemployment rate on health outcomes of Chinese population, which is under studied before.

METHODS

The Chinese aggregate data was analyzed (provincial data from 1990-2011). The fixed effect model and infinite distributed lag model (IDL) were applied to analyze the data. It aimed to estimate the short-run and long-run association between unemployment rate and health status of population in China. The mortality was applied as an indicator for health outcomes of entire population.

RESULTS

In the short run, when the unemployment rate was decreased by 1%, mortality will be reduced by approximately 4 % (P<0.01). In the long-run, mortality will be increased by 6.8% with increased unemployment rate of 1% (P <0.05).

CONCLUSION

The result in China demonstrated that the unemployment rate was positively associated with mortality. The result also showed that the increased unemployment rate has been harmful to health outcomes of population. It will be significant to reduce the unemployment rate for improving potential public health benefits in developing countries like China.

The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis

The current study uses six annual waves of the Longitudinal Labor Market Study (LLMS) covering the 2008-2013 period to obtain longitudinal estimations suggesting statistically significant negative effects from unemployment on self-reported health and mental health in Greece. The specifications suggest that unemployment results in lower health and the deterioration of mental health during the 2008-2009 period compared with the 2010-2013 period, i.e., a period in which the country's unemployment doubled as a consequence of the financial crisis. Unemployment seems to be more detrimental to health/mental health in periods of high unemployment, suggesting that the unemployment crisis in Greece is more devastating as it concerns more people. Importantly, in all specifications, comparable qualitative patterns are found by controlling for unemployment due to firm closure, which allows us to minimize potential bias due to unemployment-health related reverse causality. Moreover, in all cases, women are more negatively affected by unemployment in relation to their health and mental health statuses than are men. Greece has been more deeply affected by the financial crisis than any other EU country, and this study contributes by offering estimates for before and during the financial crisis and considering causality issues. Because health and mental health indicators increase more rapidly in a context of higher surrounding unemployment, policy action must place greater emphasis on unemployment reduction and supporting women's employment.

Recessions, job loss, and mortality among older US adults

OBJECTIVES

We analyzed how recessions and job loss jointly shape mortality risks among older US adults.

METHODS

We used data for 50 states from the Health and Retirement Study and selected individuals who were employed at ages 45 to 66 years during 1992 to 2011. We assessed whether job loss affects mortality risks, whether recessions moderate the effect of job loss on mortality, and whether individuals who do and do not experience job loss are differentially affected by recessions.

RESULTS

Compared with individuals not experiencing job loss, mortality risks among individuals losing their job in a recession were strongly elevated (hazard ratio = 1.6; 95% confidence interval = 1.1, 2.3). Job loss during normal times or booms is not associated with mortality. For employed workers, we found a reduction in mortality risks if local labor market conditions were depressed, but this result was not consistent across different model specifications.

CONCLUSIONS

Recessions increase mortality risks among older US adults who experience job loss. Health professionals and policymakers should target resources to this group during recessions. Future research should clarify which health conditions are affected by job loss during recessions and whether access to health care following job loss moderates this relation.

A prescription for unemployment? Recessions and the demand for mental health drugs

We estimate the relationship between mental health drug prescriptions and the level of labor market activity in the USA. Based on monthly data from the National Ambulatory Medical Care Survey of physicians and aggregated by US census regions, we find that the number of mental health drug prescriptions (those aimed at alleviating depression and anxiety) rises by about 10% when employment falls by 1% and when unemployment rises by 100 basis points, but only for patients in the Northeast region. This paper is one of the first to look at compensatory health behavior in response to the business cycle.

The differential impact of the financial crisis on health in Ireland and Greece: a quasi-experimental approach

OBJECTIVES

Greece and Ireland suffered an economic recession of similar magnitude, but whether their health has deteriorated as a result has not yet been well established.

STUDY DESIGN

Based on five waves (2006-2010) of the European Union Statistics of Income and Living Conditions (EU-SILC) survey a (DID) approach was implemented that compared trends in self-rated health in Greece and Ireland before and after the crisis with trends in a 'control' population (Poland) that did not experience a recession and had health trends comparable to both countries before the crisis.

METHODS

Logistic regression using a (DID) approach.

RESULTS

A simple examination of trends suggests that there was no significant change in health in Greece or Ireland following the onset of the financial crisis. However, DID estimates that incorporated a control population suggest an increase in the prevalence of poor self-rated health in Greece (OR = 1.216; CI = 1.11-1.32). Effects were most pronounced for older individuals and those living in high-density areas, but effects in Greece were overwhelmingly consistent in different population sub-groups. In contrast, DID estimates revealed no effect of the financial crisis on the prevalence of poor self-rated health in Ireland (OR = 0.97; CI = 0.81-1.16).

CONCLUSIONS

DID estimates suggest that the financial crisis led to higher prevalence of reporting poor health in Greece but not in Ireland. Although the research design does not allow the authors to directly assess the role of specific policies, contextual factors including policy responses may have contributed to the different effect of the crisis on the health of the two countries.

Internet addiction and psychopathology in a community before and during an economic crisis

Background. Internet addiction disorder (IAD) is a novel concept under scrutiny for a definite inclusion in the psychiatric taxonomy, after showing correlations with overt expressions of psychopathology. This study aims to assist the scientific dialogue concerning IAD while presenting comparative data on adolescent psychopathology before and during a major economic crisis that has affected Greece from 2010 onwards. Methods. This is a cross-sectional study of a high school student population, aged 12-18, on IAD which follows-up a 2006 survey, and is carried out 5 years later at the same school classes. A comparison on psychopathological symptoms between the two samples is carried out to confirm any underlying correlations with IAD while providing some first insight on any effects of the economic crisis on adolescent psyche. Results. Results indicate that Internet addiction is increased in this population paralleling the increase in Internet availability at home. Adolescents affected with IAD present with more psychopathological symptoms. A comparison between the 2006 and 2011 samples reveals lower rates of general psychopathology but similar burden of reported symptoms. Conclusions. Those findings are discussed in the framework of adolescent coping to adversity, individual reactions to major crises, as well as the general debate regarding the value of IAD as a distinct diagnosis. The effects of the economic crisis may have triggered an adaptive response in the adolescent population although IAD as a distinct nosological entity is clearly linked to more symptoms of overt psychopathology. Directions are offered for further research in countries affected by crises.

Urban Poverty and Neighborhood Effects on Crime: Incorporating Spatial and Network Perspectives

Research on neighborhoods and crime is on a remarkable growth trajectory. In this article, we survey important recent developments in the scholarship on neighborhood effects and the spatial stratification of poverty and urban crime. We advance the case that, in understanding the impact of neighborhoods and poverty on crime, sociological and criminological research would benefit from expanding the analytical focus from residential neighborhoods to the network of neighborhoods individuals are exposed to during their daily routine activities. This perspective is supported by reemerging scholarship on activity spaces and macro-level research on inter-neighborhood connections. We highlight work indicating that non-residential contexts add variation in criminogenic exposure, which in turn influence offending behavior and victimization risk. Also, we draw on recent insights from research on gang violence, social and institutional connections, and spatial mismatch, and call for advancements in the scholarship on urban poverty that investigates the salience of inter-neighborhood connections in evaluating the spatial stratification of criminogenic risk for individuals and communities.

Does "Out of work" get into the womb? Exploring the relationship between unemployment and adverse birth outcomes

This study uses Texas vital records from 1994 to 2003 to examine the relationship between self-reported maternal unemployment and birth outcomes, including birthweight and infant mortality. In the preferred specification, a sample containing 1,344, 605 sibling births to 604,649 mothers was used. Regression results indicated that within the same women, being unemployed was associated with lower average birthweights and higher rates of infant mortality than being engaged in market work, especially when unemployment preceded market work, and a range of hypothesized mediators did little to attenuate these relationships. Interaction models revealed that the poor average birth outcomes related to unemployment were driven by observations with at least one other indicator of health complication, such as presence of a medical risk factor. These results confirm that the relationship between unemployment and mother-child health varies across individuals, although further research is needed to understand the causal linkages connecting unemployment, health risks, and birth outcomes.

Effects of statewide job losses on adolescent suicide-related behaviors

OBJECTIVES

We investigated the impact of statewide job loss on adolescent suicide-related behaviors.

METHODS

We used 1997 to 2009 data from the Youth Risk Behavior Survey and the Bureau of Labor Statistics to estimate the effects of statewide job loss on adolescents' suicidal ideation, suicide attempts, and suicide plans. Probit regression models controlled for demographic characteristics, state of residence, and year; samples were divided according to gender and race/ethnicity.

RESULTS

Statewide job losses during the year preceding the survey increased girls' probability of suicidal ideation and suicide plans and non-Hispanic Black adolescents' probability of suicidal ideation, suicide plans, and suicide attempts. Job losses among 1% of a state's working-age population increased the probability of girls and Blacks reporting suicide-related behaviors by 2 to 3 percentage points. Job losses did not affect the suicide-related behaviors of boys, non-Hispanic Whites, or Hispanics. The results were robust to the inclusion of other state economic characteristics.

CONCLUSIONS

As are adults, adolescents are affected by economic downturns. Our findings show that statewide job loss increases adolescent girls' and non-Hispanic Blacks' suicide-related behaviors.

Social determinants of mental health

A person's mental health and many common mental disorders are shaped by various social, economic, and physical environments operating at different stages of life. Risk factors for many common mental disorders are heavily associated with social inequalities, whereby the greater the inequality the higher the inequality in risk. The poor and disadvantaged suffer disproportionately, but those in the middle of the social gradient are also affected. It is of major importance that action is taken to improve the conditions of everyday life, beginning before birth and progressing into early childhood, older childhood and adolescence, during family building and working ages, and through to older age. Action throughout these life stages would provide opportunities for both improving population mental health, and for reducing risk of those mental disorders that are associated with social inequalities. As mental disorders are fundamentally linked to a number of other physical health conditions, these actions would also reduce inequalities in physical health and improve health overall. Action needs to be universal: across the whole of society and proportionate to need. Policy-making at all levels of governance and across sectors can make a positive difference.

The impact of economic crises on social inequalities in health: what do we know so far?

Since 2008, Western countries are going through a deep economic crisis whose health impacts seem to be fundamentally counter-cyclical: when economic conditions worsen, so does health, and mortality tends to rise. While a growing number of studies have presented evidence on the effect of crises on the average population health, a largely neglected aspect of research is the impact of crises and the related political responses on social inequalities in health, even if the negative consequences of the crises are primarily borne by the most disadvantaged populations. This commentary will reflect on the results of the studies that have analyzed the effect of economic crises on social inequalities in health up to 2013. With some exceptions, the studies show an increase in health inequalities during crises, especially during the Southeast Asian and Japanese crises and the Soviet Union crisis, although it is not always evident for both sexes or all health or socioeconomic variables. In the Nordic countries during the nineties, a clear worsening of health equity did not occur. Results about the impacts of the current economic recession on health equity are still inconsistent. Some of the factors that could explain this variability in results are the role of welfare state policies, the diversity of time periods used in the analyses, the heterogeneity of socioeconomic and health variables considered, the changes in the socioeconomic profile of the groups under comparison in times of crises, and the type of measures used to analyze the magnitude of social inequalities in health. Social epidemiology should further collaborate with other disciplines to help produce more accurate and useful evidence about the relationship between crises and health equity.

Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System

OBJECTIVES

Although there is a large and growing body of evidence concerning the impact of contracting economies on suicide mortality risk, far less is known about the role alcohol consumption plays in the complex relationship between economic conditions and suicide. The aims were to compare the postmortem alcohol intoxication rates among male and female suicide decedents before (2005-2007), during (2008-2009) and after (2010-2011) the economic contraction in the USA.

METHODS

Data from the restricted National Violent Death Reporting System (2005-2011) for male and female suicide decedents aged 20 years and older were analysed by Poisson regression analysis to test whether there was significant change in the fractions of suicide decedents who were acutely intoxicated at the time of death (defined as blood alcohol content ≥0.08 g/dL) prior, during and after the downturn.

RESULTS

The fraction of all suicide decedents with alcohol intoxication increased by 7% after the onset of the recession from 22.2% in 2005-2007 to 23.9% in 2008-2011. Compared with the years prior to the recession, male suicide decedents showed a 1.09-fold increased risk of alcohol intoxication within the first 2 years of the recession. Surprisingly, there was evidence of a lag effect among female suicide decedents, who had a 1.14-fold (95% CI 1.02 to 1.27) increased risk of intoxication in 2010-2011 compared with 2005-2007.

CONCLUSIONS

These findings suggest that acute alcohol intoxication in suicide interacts with economic conditions, becoming more prevalent during contractions.