The economic crisis and suicide

The past few years have seen steady progress towards the Department of Health’s target to reduce suicide in England (www.lgbtmind.com/content/suicide-prevention-annual-report-2007.pdf). However, we are now amid a serious financial crisis, with frequent media reports linking the recession to suicides. What is the likely impact of the crisis on suicide and what can be done to offset any adverse effects?

The crisis is expected to lead to a sharp and sustained rise in unemployment, and observational studies indicate that unemployed people are at 2-3 times more risk of suicide.1 Although this high risk is partly because people with psychiatric illness are at greater risk of losing their jobs,2 even in people with no record of serious mental illness unemployment is still associated with about a 70% greater suicide risk.3 Also, prospective studies with repeat measures of employment and mental health show that unemployment has a causal influence on depression and suicidal thinking.4 5

Longitudinal ecological research shows that rises in unemployment in the United Kingdom in the 1920s and ’30s were associated with steep rises in male suicide.6 Similar effects were seen in other Western nations. A recent analysis of the Asian economic crisis (1997-8) indicated that it led to about 10 000 suicides in Hong Kong, Japan, and Korea.7

Improvements in welfare support and other changes since the 1930s may offset the impact of the recession on suicide. Evidence for the benefit of more welfare support comes from the contrasting trends in suicide among male youth in New Zealand and Finland during the recession of the 1980s and ’90s. Although unemployment rose to a greater extent in Finland than New Zealand, increases in male suicide were smaller in Finland where, in contrast to New Zealand, social spending rose as a percentage of gross domestic product.8 Similarly, an analysis of changes in suicide rates in the United States indicated that reductions in welfare spending were associated with rises in suicide.9

Job loss is not the only stress during economic crises. People fear losing their jobs and experience financial difficulties. In a recent meta-analysis job insecurity was associated with 33% more risk of common mental disorder.10 In Hong Kong 24% of all suicides in 2002 concerned people in debt.11 In countries without comprehensive healthcare provision, people most in need of mental health services may be less inclined to access them because of the costs involved.

Several approaches could be taken to offset the likely impact of the recession on suicide. Firstly, and most crucially, are social policy measures to create new jobs, adequate welfare benefits for unemployed people, and provision of alternatives to early entry into the labour market, such as increasing the number of university places. Although these strategies lie outside the health sector’s control, it is nevertheless essential for the royal colleges, representatives of other healthcare organisations, and academics to remind the government of the health impact of recession and its duty of care to the electorate.

Secondly, employers should be reminded of the potential impact of redundancy on mental health and suicide risk and ensure workers are directed to appropriate sources of advice. Likewise, trade unions should be urged to fulfil their duty of protection for members in and out of work. The Department of Health, primary care trusts, and health boards should ensure that information is available for people who lose their jobs and help employers and trade unions to deliver advice. In the US, for example, the Substance Abuse and Mental Health Services Administration has provided helpful advice for affected people and their families on dealing with the impact of financial difficulties on mental health (www.samhsa.gov/economy). Furthermore, the families, friends, and communities of those affected by unemployment should be reminded of its impact on an individual’s emotional wellbeing and encouraged to give support. Special attention should be paid to the mental health needs of people aged 16-24 years: this is the age group whose labour market security is likely to be most affected by the economic downturn.

Thirdly, community support agencies should be adequately resourced to help people with problems arising from job loss, debt, and mortgage arrears. The UK government’s recent £13m (€15m; $20m) investment in services to help unemployed people who have mental health problems, including a plan to further increase the number of psychological therapists, should therefore be welcomed. In a randomised trial, group cognitive behavioural therapy delivered to unemployed people was shown to facilitate return to work and improved mental health,12 but the success of any such approach will depend on job availability. Lastly, the government and primary care trusts should work with the media to prevent overly simplistic and high profile reporting of the suicides of business executives, financiers, and unemployed people. Most people who lose their jobs or whose businesses fail do not kill themselves, and there is convincing evidence that media reporting may provoke copycat suicides.13

The evidence base for the effectiveness of these possible preventive approaches is modest at best. In the absence of such evidence, commonsense approaches are required. Research should be commissioned to investigate measures to support the people affected by the economic crisis while we wait to see the full extent of its impact on the nation’s health.