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Citation
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Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Lancet 2012; 380(9856): 1813-1814. |
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Affiliation
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University of Cambridge, Department of Sociology, Free School Lane, Cambridge CB3 3RQ, UK. Electronic address: asr45@cam.ac.uk. |
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Abstract
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Evidence from European countries indicates a significant rise in suicides from the economic recession, totalling more than 1000 excess deaths in the UK alone. Among the worst affected economies in Europe, such as Greece, suicides have risen by more than 60% since 2007.2 Thus far, there has been little or no analysis of US mental health data, mostly owing to delays in data availability.
Here, we extend our previous analyses of recessions and suicides in Europe to assess trends in all 50 US states. We use data on suicide mortality rates from 1999 to 2010 from the Centers for Disease Control and Prevention. Unemployment data come from the Bureau of Labor Statistics. Time-trend regression models were used to assess excess suicides occurring during the economic crisis -- ie, deaths over and above the level that would be expected if historical trends continued (see appendix for methodological details). Although there are concerns that suicide data are under-reported in the USA, these biases are likely to have been consistent over this relatively short period, although they might lead to a conservative estimate of the mental health effects of the crisis.
Looking across US states between 1999 and 2010, we found that the strongest correlation between unemployment and suicides was in Texas (r=0ยท91), but overall the correlations were statistically indistinguishable between the north, south, east, and west, or when disaggregating states by Democrat and Republican governors (appendix). Small numbers of suicides in small populations limit a state-by-state comparison for all 50 states. Similar patterns were seen if absolute numbers of suicides were used instead of overall rates.
Suicide is a rare outcome of mental illness; these data are likely to be the most visible indicator of major depression and anxiety disorders, as seen in primary-care settings in Spain and in the Greek population. The pattern of accelerating suicides noted in the USA mirrors that recorded for economic reasons in Italy.
Future research should explore other risk factors such as foreclosures and job and income losses, and modifying factors such as gun control policies, access to the means of self-harm, and vulnerable groups, which could explain the remaining portion of the suicide rise observed during the recession.
Our findings have immediate implications for policy. Given that some countries have avoided increases in suicides despite significant economic downturns, there is a clear need to implement policy initiatives that promote the resilience of populations during the ongoing recession. Active labour market programs--projects that immediately help the unemployed find social support and new work opportunities (even part time)--and mental health prevention programs seem to mitigate significantly the negative mental health effects of recessions. The fact that countries such as Sweden have been able to prevent suicide rises despite major recessions reveals opportunities to protect Americans from further risks of suicide during the continued economic downturn.
Language: en |