The role of unemployment in parasuicide

Socio-economic, health and environmental factors influencing suicide rates: A cross-country study in the Eastern Mediterranean region

BACKGROUND

Suicide is a crucial concern for public health in the world. To date, there is no synthesized evidence about the cross-country impact of suicide risk factors in the Eastern Mediterranean (EMRO). This paper aims to cover the gap and assess socio-economic, health, and environmental (SHE) factors influencing suicide rates among the EMRO countries from 1990 to 2019.

METHODS

This analysis is a cross-sectional time-series design which uses random-effect panel data from 17 EMRO countries. SHE variables are inflation rate, economic growth, unemployment rate, urbanization, and female labor force participation rate, mental disorders prevalence and individuals using the internet.

RESULTS

The models indicate that male suicide rates was positively associated with inflation rate (coefficient = 0.002, p < 0.05) unemployment rate (0.06, p < 0.01), mental disorders prevalence (0.0008, p < 0.01), and urbanization (0.08, p < 0.05). Conversely, individuals using the internet (-0.019, p < 0.01) was related to a reduction in male suicide rates. Variables correlated with an increase in female suicide rates included inflation rate (0.001, p < 0.05), mental disorders prevalence (coefficient = 0.0004, p < 0.01) and urbanization (0.03, p < 0.01). Individuals using the internet (-0.006, p < 0.01) and education index (-4.8, p < 0.01) had negative effect on female suicide rates.

CONCLUSIONS

This research confirms that SHE factors appear to affect suicide. So policymakers should endeavor to control them if the nations are aimed at preventing suicides. Future researches are essential to scrutinize paradoxes in the field.

Predictors of Suicidal Ideation and Attempt among Patients with Major Depressive Disorder at a Tertiary Care Hospital, Puducherry

Objectives  Mental disorders have a large impact on death by suicide. Hence, this study aims to determine the prevalence of suicidal behaviors among major depressive disorder (MDD) patients and the associated factors.

Materials and Methods  This cross-sectional analytical study was conducted among individuals aged 18 to 65 years, diagnosed with MDD in the Psychiatry Outpatient Department of a Tertiary Care Center, Puducherry during March to October 2019. Severity of depression was assessed using Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale was used to find the suicidal behaviors.

Results  For 166 participants in the study, mean (standard deviation) age was 40 (11) years and majority were females (76%). More than one-third (37%) had severe or very severe depression, and the prevalence of suicidal ideation, plan, and attempts were 83, 24, and 35%, respectively. After adjusting the covariates, the severity of depression and unemployment were significantly associated with suicidal attempts (adjusted prevalence ratios [aPR] = 11.4 and 1.9), and very severe depression was associated with suicidal ideation (aPR = 1.6). Among 140 individuals with suicidal ideation, 45 (32%) had an ideation frequency of 2 to 3 times/week, 69 (50%) had ideation for 1 hour, 36 (26%) could control ideation with little difficulty, and 12% had suicidal ideation mostly to end or stop their pain.

Conclusion  Suicidal ideation and attempts were significantly high in MDD patients, and the severity of depression was significantly associated with it. Early identification of high-risk suicidal behavior and implementation of effective preventive interventions are necessary to reduce death by suicide in these groups.

Suicide attempts and job insecurity: a complex association

Objective:

Since Durkheim, epidemiological studies have revealed a significant, complex association between unemployment and suicidal behaviour. The aim of this study was to analyse the relationship between parasuicide and job instability, including unemployment, French social measures against unemployment and occasional work.

Method:

Demographic data, personal and familial characteristics were collected in 541 suicide attempters.

Results:

Seventy-seven per cent were socially active, with 61.5% in regular employment, and 38.5% in precarious employment. The female-to-male ratio approached 2 in the securely employed sample, and fell to 1 for those with poor social and professional integration. Depression, parasuicide, and alcohol abuse were more common in the families of repeaters in secure employment. The impact of the familial psychiatric background was no longer significant in the job insecurity group. Fostering in childhood was a risk factor for repeat suicidal behaviour in the group with job insecurity.

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.

The changing relationship between unemployment and suicide

The relationship between unemployment and suicide has changed over time and in particular during the Great Recession. Using state-level panel data covering the years 1979-2010, the study indicates that unemployment's impact was insignificant during the first half of the sample period, but was highly significant during the second half. In addition, while the impact has generally become stronger over recent decades, it fell during the Great Recession although remained significant. Evidence suggesting that increased economic insecurity helps explain the growing sensitivity over time is offered. The models fit the data well, explaining up to 90% of the variation in state suicide rates.

The effect of job loss and unemployment duration on suicide risk in the United States: a new look using mass-layoffs and unemployment duration

We examine the link between employment status and suicide risk using a panel of US states from 1996 to 2005 with monthly data on suicides, the duration of unemployment spells and the number of job losses associated with mass-layoff events. The use of aggregate data at the monthly level along with the distribution of unemployment duration allows us to separate the effect of job loss from the effect of unemployment duration, an important distinction for policy purposes, especially for the timing of potential interventions. Our results are consistent with unemployment duration being the dominant force in the relationship between job loss and suicide. Nevertheless, mass-layoffs may be powerful localized events where suicide risk increases shortly afterward. Implications for the design of unemployment insurance are discussed.

The health effects of economic decline

Political pronouncements and policy statements include much conjecture concerning the health and behavioral effects of economic decline. We both summarize empirical research concerned with those effects and suggest questions for future research priorities. We separate the studies into groups defined by questions asked, mechanisms invoked, and outcomes studied. We conclude that although much research shows that undesirable job and financial experiences increase the risk of psychological and behavioral disorder, many other suspected associations remain poorly studied or unsupported. The intuition that mortality increases when the economy declines, for example, appears wrong. We note that the research informs public health programming by identifying risk factors, such as job loss, made more frequent by economic decline. The promise that the research would identify health costs and benefits of economic policy choices, however, remains unfulfilled and will likely remain so without stronger theory and greater methodological agreement.

Risk factors for suicide attempt in an Arab kindred

OBJECTIVE

This explorative study examines correlates of suicidal behavior in an extended Arab kindred selected because of a high rate of suicidal behavior.

METHODS

Family members (n=468) aged 15 through 55 were assessed using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), which covers a wide range of psychopathology, including a spectrum of suicidal thoughts and behaviors. In addition, self-reported depression, anxiety, hopelessness, impulsivity and hostility, early childhood adversity, and suicidal behavior in first- and second-degree relatives were assessed.

RESULTS

Significant associations were found between suicidal thoughts and behavior, and the presence of family history of suicide, all forms of psychopathology and suicidal behaviors. In addition, impulsivity and hostility were also significantly associated with suicidality.

LIMITATION

The absence of similar assessments in comparison families, makes it difficult to assess why this family appears to be at higher risk for suicidal behavior.

CONCLUSION

Risk correlates of suicidal behavior in the Arab kindred are similar to those reported from other parts of the world. These findings suggest that effective means of suicide prevention used in European populations may be successfully adapted to prevent suicide in this ethnic group as well. Since all forms of suicidal behavior in this population as well as in other Arab populations are increasing rapidly (Karam et al., 2008), these results have important implications for suicide prevention as well as for the understanding of the genetics of suicide.

Impact of business cycles on US suicide rates, 1928-2007

OBJECTIVES

We examined the associations of overall and age-specific suicide rates with business cycles from 1928 to 2007 in the United States.

METHODS

We conducted a graphical analysis of changes in suicide rates during business cycles, used nonparametric analyses to test associations between business cycles and suicide rates, and calculated correlations between the national unemployment rate and suicide rates.

RESULTS

Graphical analyses showed that the overall suicide rate generally rose during recessions and fell during expansions. Age-specific suicide rates responded differently to recessions and expansions. Nonparametric tests indicated that the overall suicide rate and the suicide rates of the groups aged 25 to 34 years, 35 to 44 years, 45 to 54 years, and 55 to 64 years rose during contractions and fell during expansions. Suicide rates of the groups aged 15 to 24 years, 65 to 74 years, and 75 years and older did not exhibit this behavior. Correlation results were concordant with all nonparametric results except for the group aged 65 to 74 years.

CONCLUSIONS

Business cycles may affect suicide rates, although different age groups responded differently. Our findings suggest that public health responses are a necessary component of suicide prevention during recessions.

Attempted suicide among Iranian population

Predictors of suicide attempts in Iran, to distinguish any similarities and differences of these predictors between suicide attempts in Iran and other developed and developing countries and to investigate the relation between general psychiatric symptoms and repetition of suicidal attempts were assessed. The validated Farsi version of the General Health Questionnaire-28 (GHQ-28) was used to assess multiple dimensions of quality of life of suicide attempters as depression, anxiety, social dysfunction, and somatic symptoms. Pivotal differences emerged in the clinical profiles of suicide attempters living in a developing country versus developed countries. In developing countries, those who attempt suicides are more likely to have no psychiatric disorder and are less likely to have used alcohol as part of the suicide attempt, but are more likely to have been assaulted physically or verbally. The results on the GHQ-28 indicate that the process through which individuals move from suicidal thought to action may decrease multiple dimensions of quality of life.

Case-control study of unemployment and parasuicide

OBJECTIVE

The objective of the study was to estimate the odds ratio for the association between unemployment and parasuicide, controlling for potential confounding variables.

METHODS

A case-control study was conducted involving 507 cases of parasuicide and 200 age- and sex-matched controls presenting to emergency departments in Edmonton, Canada. Subjects were interviewed using an extensive questionnaire developed for a World Health Organization study of parasuicide. The data were analyzed using conditional logistic regression.

RESULTS

In a crude analysis, the odds ratio for the association between unemployment and parasuicide was 12.0 (95% confidence interval, 6.0-23.9). After controlling for sociodemographic factors, lifetime prevalence of several Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, disorders, previous parasuicide, hopelessness, childhood experiences, and emotional support from family and friends, the odds ratio was 5.2 (95% confidence interval, 2.3-11.4).

CONCLUSIONS

Those who are unemployed have an increased risk of parasuicide, and this association persists after accounting for a wide range of potential confounders.

Unemployment and Suicidal Behavior in a New Zealand Birth Cohort

Abstract. This study examined the association between exposure to unemployment and suicidal behaviors (suicidal ideation and attempted suicide) in a birth cohort of New Zealand young adults using fixed-effects logistic and Poisson regression models. Data were gathered on unemployment and suicidal behaviors at annual periods from ages 16-25 years. At all ages increasing exposure to unemployment was associated with increased risks of suicidal ideation (p < .0001) and number of suicide attempts (p < .0001). Following adjustment for fixed effects and time-dynamic covariates, associations between unemployment and suicidal ideation reduced to marginal significance (p < .10), while the association between unemployment and suicide attempts was not statistically significant (p > .10). After adjustment, those experiencing 6 or more months of unemployment in a given year had odds of suicidal ideation that were 1.43 (95% CI: .96 to 2.16) times higher, and rates of suicide attempts that were 1.72 (95% CI: .89 to 3.32) times higher, than those who were not exposed to unemployment. Although unemployment was associated with moderate increases in risks of suicidal behaviors, much of this association was explained by confounding factors.

Unemployment and suicide. Evidence for a causal association?

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 and psychosocial adjustment in young adults: causation or selection?

This study investigates the relationships between unemployment following school leaving and psychosocial adjustment problems (mental health, substance use, crime, suicidal behaviours and teenage pregnancy) in a birth cohort of over 1000 New Zealand born young people. The data were gathered during the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (NZ) urban region who have been studied from birth to age 21. Data were gathered by personal interview on: (a) exposure to unemployment and (b) personal adjustment over the period from age 16 to age 21. Measures of personal adjustment included mental health (depression, anxiety), substance use, crime, suicidal behaviours and (for females) teenage pregnancy. Data were analysed using a fixed effects regression model that took into account both observed and non-observed sources of confounding and the possibility of reverse causal associations between personal adjustment and unemployment. Before adjustment for confounding and reverse causality there were significant (p < 0.001) associations between exposure to unemployment and measures of mental health, substance use, crime, suicidal behaviours and teenage pregnancy. Adjustment for confounding factors and reverse causality reduced these associations quite substantially and after control for sources of confounding a number of associations became nonsignificant. Nonetheless, after such control, exposure to unemployment remained significantly (p < 0.05) associated with suicidal ideation, substance abuse and criminal behaviours. It is concluded that, in part, the associations between unemployment and personal adjustment are spurious and reflect the presence of confounding factors that are related to both unemployment and adjustment. Nonetheless, the findings suggest that exposure to unemployment may be associated with increased risks of suicidal thoughts, crime and substance use.

Transitions of employment status among suicide attempters during a severe economic recession

Previous studies have shown a positive association between unemployment and attempted suicide. This study investigated transitions of employment status among suicide attempters during the severe economic recession. The main research question was whether inequality in the labour market also prevails among as selected a population as suicide attempters. The material consisted of 2495 persons who attempted suicide during 1989-1994 in Helsinki, Finland. Logistic regression analysis and survival analysis were used. Unemployment rates among suicide attempters were higher than in the general population, male rates being higher than female rates throughout the recession. There were significant changes in the employment status of the entire attempted suicide population from 1989 to 1994, especially in terms of the transition from employment to unemployment. Gender, age and education level predicted exit from the labour market. Among suicide attempters young middle-aged men with low education had the highest risk of unemployment.

Risk factors for suicide and attempted suicide among young people

OBJECTIVE

Suicide rates in young people have increased during the past three decades, particularly among young males, and there is increasing public and policy concern about the issue of youth suicide in Australia and New Zealand. This paper summarises current knowledge about risk factors for suicide and suicide attempts in young people.

METHOD

Evidence about risk factors for suicidal behaviour in young people was gathered by review of relevant English language articles and other papers, published since the mid-1980s.

RESULTS

The international literature yields a generally consistent account of the risk factors and life processes that lead to youth suicide and suicide attempts. Risk factor domains which may contribute to suicidal behaviour include: social and educational disadvantage; childhood and family adversity; psychopathology; individual and personal vulnerabilities; exposure to stressful life events and circumstances; and social, cultural and contextual factors. Frequently, suicidal behaviours in young people appear to be a consequence of adverse life sequences in which multiple risk factors from these domains combine to increase risk of suicidal behaviour.

CONCLUSIONS

Current research evidence suggests that the strongest risk factors for youth suicide are mental disorders (in particular, affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology, indicating that priorities for intervening to reduce youth suicidal behaviours lie with interventions focused upon the improved recognition, treatment and management of young people with mental disorders.

Suicide and unemployment in Italy, 1982-1994

OBJECTIVE

To investigate whether either the condition of being unemployed, or changes in unemployment rates are associated with suicide risk.

DESIGN

Administrative data for suicide according to occupational status have been analysed considering three employment categories: employed, seeking new job (unemployed), seeking first job (never employed). Comparison of suicide rates by economic position and correlation between suicide and unemployment rates have been made.

SUBJECTS AND SETTINGS

20,457 deaths by suicide registered in Italy among economically active people from 1982 to 1994.

MAIN OUTCOME MEASURES

Change over time in suicide rates by economic position; coefficient of aggravation according to occupational status.

RESULTS

Suicide rates among the unemployed are clearly and constantly higher than those among the employed: up to three times higher among men, and twice as high among women. Among the unemployed a clear and significant rise in suicide rates in both sexes took place over the study period; suicide rates among the employed showed a less marked increase. The rise in suicide rates was accompanied by a concurrent rise in unemployment rate percentage. Men seem to be affected most by this change in unemployment rate percentage; women are subject to less evident influences and variations.

CONCLUSION

Different suicidal behaviour trends among unemployed compared with employed people indicate that unemployment (and above all the prospect of not having access to a working role) acts as a contributing factor for suicide. Unemployment, even if symptomatic of a mental disorder, should therefore always be taken into consideration as a risk factor for suicide: the potentially lethal consequences of its negative influence on both self esteem and the ability to use supportive networks in a efficient way is an element to which great attention should be paid.

Overdose among youth in Bahrain: psycho-social characteristics, contact with helping agencies and problems

A one year cohort of 67 overdose attempts among youth (15-24 years) was examined as part of a case control study. The prevalence rate of 105 per 100,000 population is lower than reported rates in the West but higher than those for the region. The majority of attempters were females and nationals who used paracetamol, and their suicide intent was low. Thirteen percent visited a helping agency in the previous week and 18% in the previous month. The most common difficulties preceding the overdoses were problems with parents, school or work, social isolation and problems with boyfriends, or girlfriends respectively. Adjustment disorder was the most common diagnosis followed by depression. A seasonal variation was noted with 46% of the cases occurring in the summer months. The implications of these findings with respect to future policy making and prevention were discussed.

Parasuicide in the county of Sør-Trøndelag, Norway. General epidemiology and psychological factors

During the period 1 October 1988 to 31 December 1993, 2068 episodes of parasuicide involving 1543 persons were registered in the county of Sør-Trøndelag, Norway. Parasuicide rates decreased in the area compared with 1987, more for females than for males. Rates were higher for divorced females and separated males than for those of other marital statuses, but these rates were lower than previously found in the same area. The proportion of unemployed patients remained fairly stable, while the rate of unemployment increased in the general population. Compared to males, female parasuicide patients more often reported family problems and economic inactivity, and more often had been victims of violence or sexual abuse. Male parasuicide patients more often than females were living alone, were unemployed, abused alcohol, had financial problems, and had been engaged in criminal activity. Compared with older parasuicide patients, the young of both sexes were more often unemployed and abused drugs, but had less often been in contact with the health or social services. In addition, young female parasuicide patients more often had experienced family problems and suicidal behaviour among family or friends. The results were generally considered to be consistent with theories of sex role stereotypes, which emphasize expressive traits in an affiliative context for females and instrumental traits in a public or economic context for men.

Unemployment and health

The relationship between unemployment and health continues to be the subject of much debate. Unemployment levels in the UK are high and this has major consequences for both the individual and the nation. This article reviews the current literature, offers some explanations and outlines the main methodological problems with research in this area, which should be considered by nurses when planning health care.

Health consequences of youth unemployment--review from a gender perspective

Current research is classified into different theoretical approaches, mainly economic deprivation theories, stress-related theories, gender theories and different psychological and sociological theories. The correlations between unemployment and ill-health are explained as a result of both selection and exposure. The societal consequences of youth unemployment have been studied in aggregate studies. The familial consequences is a neglected area, but there is evidence of increased illness as well as battering of wives and children. Almost all research has been focused on the individual and mainly on the psychological consequences. Consistent relationships are found between unemployment and minor psychological disorders. Few studies have included somatic health but the results indicate increased physiological illness, especially among unemployed girls. Increased health care consumption has been documented. There are evidence that unemployment is a risk indicator for both increasing alcohol consumption, particularly in young men. Unemployment is also associated with increased tobacco consumption, increased use of illicit drugs as well as deteriorated health behaviour. The mortality rate is significantly higher among unemployed young men and women, especially in suicides and accidents. Social consequences include increased risk of alienation, lack of financial resources, criminality and future exclusion from the labour market. As mediating factors social support, high employment rate, negative attitudes towards work and high possibility of control have been documented to have a protective effect on health. Research should now be directed towards more qualitative methods, based on theoretical models, in order to search for deeper mechanisms, mediating factors and explanatory theories of the unevenly distributed health in society, in which unemployment has been proved to be one important factor.

Mental illness and social integration among suicide attempters in Copenhagen. Comparison with the general population and a four-year follow-up study of 100 patients

In order to describe a population of suicide attempters in an affluent suburb of Copenhagen, 100 patients were interviewed, randomly chosen from a group of 246 patients referred to psychiatric consultation after a suicide attempt. The group consisted of 71 women and 29 men. Single status, abuse, and previous suicide attempts occurred frequently as did suicide among first-degree relatives. The most frequent reason for a suicide attempt was conflict with partners. In comparison with the normal population in the same catchment area, the patients were alone and felt lonely, but no difference was found in the group's relation to the labor market. After a four-year follow-up period, 9 persons had died by suicide. Borderline personality disorder and affective psychosis, no employment, 2 or more previous attempts, violent method and potential lethal attempt proved to be predictors of suicide later on. Alcohol and drug abuse, lack of social support and loneliness did not influence the risk.

Unemployment and health: a review

Unemployment has an adverse effect on health. This effect is still demonstrable when social class, poverty, age and pre-existing morbidity are adjusted for. Unemployed men and their families have increased mortality experience, particularly from suicide and lung cancer. Unemployed men also have a reduction in psychological well-being with a greater incidence of parasuicide, depression and anxiety. Unemployed men are more likely to use general practitioner and hospital services and receive more prescribed medicines. Smoking and alcohol consumption are often increased after the onset of unemployment. Women are less affected by enforced unemployment, but families are put at greater risk of physical illness, psychological stress and family breakdown. Maintaining financial security, providing proactive health care and retraining for re-employment can all reduce the impact of unemployment on health.