There has been a substantial rise in ‘economic suicides’ in the Great Recessions afflicting Europe and North America. We estimate that the Great Recession is associated with at least 10 000 additional economic suicides between 2008 and 2010. A critical question for policy and psychiatric practice is whether these suicide rises are inevitable. Marked cross-national variations in suicides in the recession offer one clue that they are potentially avoidable. Job loss, debt and foreclosure increase risks of suicidal thinking. A range of interventions, from upstream return-to-work programmes through to antidepressant prescriptions may help mitigate suicide risk during economic downturn.
Internationally comparable suicide data from the World Health Organization (WHO) European Health for All database, shows that following the Great Recession nearly all European societies have experienced rising suicide rates. As shown in Fig. 1, prior to the onset of recession in 2007, suicide rates had been falling in Europe. Subsequently, this downward trend reversed, rising by 6.5% by 2009 and remaining elevated through 2011. This increase corresponds to an additional 7950 suicides above what would be expected on past trends between 2007 and 2010 (see online supplement). Canada too experienced a reversal, as suicides rose by 4.5% (about 240 suicides more than expected) between 2007 and 2009. In the USA, where suicides had been on an upward trajectory, the rate of increase accelerated, with an increase over and above past trends of 4.8%, totalling about 4750 excess suicides between 2007 and 2010. 3 However, those few industrialised countries outside of these regions, such as New Zealand, that have escaped unscathed from the financial crisis have avoided a rise in suicides. These conservative figures suggest that, in total, there have been at least 10 000 more economic suicides than would have been expected in the European Union, Canada and the USA since the Great Recession began in 2007. But are these suicides an inevitable accompaniment of economic hardship?
One clue that, in theory, increased suicides during an economic crisis are avoidable is seen in the marked cross-national variations in countries affected by the current recession. Despite large recessions, some countries experienced no change in suicides, whereas in others suicides rose in step with worsening economies. In general, we observed four main suicide patterns: (a) accelerating rate of previous increase in suicides: USA and Poland; (b) increase from stable trends: Canada; (c) reversal of downward suicide trends: Bulgaria, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, The Netherlands, Portugal, Poland, Romania, Slovenia, Spain and UK; (d) no significant change: Austria and Sweden (missing data and small populations mean that Belgium, Cyprus, Denmark, Luxembourg, Malta, and the Slovak Republic are not reported).
Another clue that increases in such suicides can be averted stems from the observation that not everyone is equally affected. Although underlying suicide rates do vary, it is noteworthy that the scale of the increase associated with an economic crisis does too. Rates rose in both men and women but these increases are about fourfold greater among men, widening the pre-existing gap in suicide rates. Between 2008 and 2010, had the change in the male suicide rate not exceeded that among females there would have been 2380 fewer deaths in Europe (see online supplement). This concentration of the increase in working-age men, which is consistent with an extensive body of theory and previous empirical research, 4 also suggests these findings are not due to data artefacts. Although comparisons of suicide rates among countries must be treated with some caution, albeit often overstated, in part because of cultural factors and coding practices (which may, in fact, understate the rise), any such bias should be non-differential with respect to changes within countries and over short periods of time. 5 Thus, it is implausible that any change in coding rules would selectively affect only one gender and at particular ages.
It is important to check whether these increases are a potential artefact of small numbers. Taking the USA as an example, we found that the acceleration in the suicide rate was a statistically significant departure from the time trend prior to the recession (β = 0.51 (95% CI 0.28-0.75) rise in suicide rate per 100 000 population per year). 3 Thus, these stark variations are likely to be real; revealing the potential of preventing suicides associated with economic crises.
Suicide rates may vary across nations because the depth and nature of recessions also varies. Economic shocks can worsen mental health and, potentially, lead to suicide, through three major pathways. First, job loss is an independent risk factor for increased risk of depression and suicide. 4 Suicide is ∼2.5 times more likely among the unemployed compared with the employed (total odds ratio (OR) = 2.6). 4 Indebtedness, itself a consequence of unemployment, is another, independent risk factor for depression and suicide. Longitudinal data from the UK show that those free from mental health problems at baseline who had financial difficulties were 1.33 times more likely to experience mental illness than those who did not, after controlling for age, gender, marital status, family type, employment status and other socioeconomic measures. 6 Third, debt and unemployment leading to foreclosure on mortgages are associated with depression and anxiety-related disorders. 7 Those who have had their houses repossessed are 1.6 times more likely to experience mental illness than those who have not. 7 Due to the nature of the recession, unemployment, debt and housing insecurity have risen in Europe and North America increasing suicide risk. Yet, some European countries seem to have avoided this association. For example, in Austria the suicide rate has not increased despite rising unemployment during the recession (online Fig. DS1). Further, our analysis of suicides in the USA suggested that unemployment only explained a small proportion of the variance in suicide rates. Consequently, there is still a large residual not explained by economic shocks.
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