Re: Impact of 2008 global economic crisis on suicide: time trend study in 54 countries
The article by Chang et al  and the accompanying editorial by Hawton and Haw  examining the proximal effects of the global economic crisis of 2008 on international trends in suicide adds to the extant literature showing a direct relationship between the macroeconomic environment and mental health outcomes.
Chang et al  found that after the crisis of 2008, rates of suicides increased in European and American countries, particularly in men, where the baseline unemployment rates were low. Stuckler et al  have previously shown that for every 1% increase in unemployment, there was an increase in under-65 suicides of 0.79% in 26 European Union countries between 1970 and 2007. Most interestingly, they found that increased investment in active labour market programmes reduced the effect of unemployment on suicides, demonstrating a possible cause - effect relationship between the two. Hawton and Haw  also rightly point out that restriction of sickness, disability, child and housing benefits may directly contribute to these excess suicides. It should be noted that unemployment affects not just proximal measures like suicide and rates of mental health in adults.
It also has an impact on more distal outcomes, and across generations. For example, Ramanathan et al  using the National Longitudinal Survey of Youth 1997 (NLSY97) cohort found that exposure to a 1% deviation from mean regional unemployment rates during infancy was associated with an increase in the odds ratios of engaging in marijuana use (OR=1.09) smoking (OR=1.07), alcohol use (OR=1.06), arrests (O.R.=1.17), gang affiliation (O.R.=1.09), and petty (O.R.=1.06) and major theft (O.R=1.11) during adolescence (age 12 to 16 years). Unfavourable macroenvironment (particularly high unemployment rates) therefore can have serious immediate as well as long term consequences across the lifespan, and more importantly across generations. The two articles in the most recent issues are most timely and have serious direct implications, particularly pertaining to future financial policies and their consequences on mental health and wellbeing across the life span.[1,2] In addition, they also warrant exploration of potential pathways through which macroeconomic environments may impact long term mental health outcomes, both in children and adults.
1. Chang S-S, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ 2013;347:f5239.
2. Hawton, K., Haw, C., Economic recession and suicide. BMJ 2013;347:f5612
3. Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., McKee, M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis . Lancet 2009; 374: 315–23
4. Ramanathan, S., Balasubramanian, N., Krishnadas, R. Macroeconomic environment during infancy and risk of adolescent behavioural problems. JAMA Psychiatry 2013; 70(2):218-225.
Competing interests: No competing interests