Editorials

Economic recession and suicide

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5612 (Published 17 September 2013) Cite this as: BMJ 2013;347:f5612
  1. Keith Hawton, professor of psychiatry1,
  2. Camilla Haw, professor in mental healthcare2
  1. 1Centre for Suicide Research, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
  2. 2University of Northampton, Northampton, UK
  1. keith.hawton{at}psych.ox.ac.uk

The association is clear but government response may limit its extent

Financial recessions and their socioeconomic sequelae can have diverse consequences for population health, a fact that has attracted considerable attention since the 2008 global financial crisis.1 It has long been known that economic conditions can influence suicide rates.2 The depression of the late 1920s to early 1930s was associated with marked rises in suicide, especially in men, which parallelled increases in unemployment.3 The Asian economic recession of 1997-98 was also followed by rising suicide rates, which reflected financial and unemployment indices.4

In a linked article (doi:10.1136/bmj.f5239), Chang and colleagues identified an impact of the 2008 global economic downturn on suicide by comparing numbers of suicides in 53 countries in 2009 with numbers expected on the basis of 2000-07 trends.5 Excess numbers of suicides occurred in many of the countries, especially in Europe and the United States, particularly in men and young people. The rise in suicides correlated with the extent of increased unemployment, with the effect being greatest in countries with relatively low levels of unemployment before the crisis. Although this study provides more evidence for major economic downturns having an effect on suicide, many important questions are left unanswered.

One question is how long the increase in suicides will persist. Studies including the current one tend to focus on relatively short periods.6 7 Yet evidence suggests that the consequences of long term unemployment may be sustained. Swedish researchers found a “scarring effect” on future earnings in young people whose initial labour market experience was unemployment.8 This is particularly pertinent given that Chang and colleagues found that the biggest effects of unemployment on suicide were in the young.

In the United Kingdom during the recent recession, youth unemployment was three times higher than the overall unemployment rate.9 Even greater effects on youth unemployment occurred in countries such as Greece, Spain, and Ireland. After the economic downturn in many countries during the early 1980s, suicide rates rose substantially in young men for several years afterwards. Suicide statistics for England and Wales suggest that this increased risk may have been carried forward in later years to the next age band—that is, that there was a “cohort effect.”10

Unemployment is probably only one aspect related to recession that affects suicide rates. For example, unemployment was thought to account for only about two fifths of the increase in suicides in England after the recent recession.6 Job insecurity and decreased earnings, together with their effects on families may be important factors, as might increased alcohol consumption.11

In depth qualitative and longitudinal investigations of people severely affected by the recent recession could help further our understanding. This could include clarifying why, as Chang and colleagues found,5 women are less affected in terms of vulnerability to suicide than men, in spite of greater equalisation of work roles between the sexes in recent years. The authors suggest that this may be because men are more likely to be the main earner in the family, may experience shame because of being unemployed, and are less likely to seek help. Other factors may be that social isolation is perhaps a more common consequence of unemployment in men and that men have a greater tendency to misuse alcohol as a result. We currently have no information about the impact of unemployment on women who are single parents, although having responsibility for children is likely to offer some protection against acting on suicidal ideation.

The most important question is how the negative effects of economic downturns on health, especially suicide, can be prevented or at least ameliorated. It seems that where governments choose austerity measures to tackle national financial debt the impact is worse. In contrast, active programmes to keep as many people in work or other meaningful activity and to support community healthcare and benefits can reduce or even fully counter these effects.12

Increased unemployment, together with restriction of access to sickness and disability benefits and housing support may all have contributed to the considerable excess of suicides in England after the onset of the recent recession.6 13 Chang and colleagues show that other European countries that have adopted similar measures also seem to have experienced marked rises in suicide. Reduced funding for mental health services and reduced donations to community charitable support organisations are also likely to have contributed.

Given that the long term effects of the recent recession may last into the period of economic recovery, it is important that governments consider how to reduce the often fatal consequences not only of economic recession but also of policy decisions on tackling such crises. In their book, The Body Economic, Stuckler and Basu used the striking and provocative summary “recessions can hurt, but austerity kills.”1 On the basis of Chang and colleagues’ findings and what we know about likely modifiers of the impact of recessions on suicide, this might be rephrased as: “recessions and their sequelae have wide ranging socioeconomic consequences—how governments respond may determine whether this is translated into despair and suicide.”

Notes

Cite this as: BMJ 2013;347:f5612

Footnotes

  • Research, doi:10.1136/bmj.f5239
  • Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References