Economic recession, mental health and suicide

DGphoto 2014_0052David Gunnell

It’s over seven years since the onset of the 2008 Global Financial Crisis and we’re beginning to get a clear idea of its impact on mental health and suicide.

In keeping with previous economic recessions, the 2008 financial crisis was followed by rises in suicide deaths in many affected countries. As documented in an article published in the British Medical Journal in 2013, younger men appear to have been particularly badly affected.

Recently published research in the International Journal of Epidemiology has provided new insights into the impact of economic down turns on mental health. Using Ireland’s impressive National Registry of Deliberate Self-Harm and national suicide data, Paul Corcoran and colleagues found that there were increases in suicide and self-harm in men and women in Ireland in the years after recession began. The greatest rises were seen in men. There were an estimated 8,800 excess episodes of self-harm (mainly suicide attempts) and 560 suicide deaths in 2008-12 compared to pre-recession trends. 

Sam Harper and colleagues found that suicide deaths increased in the USA in the post-recession years, but to a lesser extent than reported in some earlier studies. People with low levels of education experienced the largest rises in suicide. This adds to previous studies indicating that those most likely to lose their jobs during periods of high unemployment are people with pre-existing mental health problems. Research findings indicate that the vulnerable become more vulnerable during periods of recession.

Most studies have focused on the impact of the economic crisis on suicide deaths, but suicide is the tip of the iceberg of mental illness in populations. Around 20 people present to hospital following self-harm (largely suicidal self-harm / suicide attempts) for every one person dying from suicide, and for every person who self-harms many more experience suicidal thoughts, and still more depression. So Paul Corcoran’s estimate of 560 excess suicides in Ireland in 2008-2010, probably reflects tens of thousands more people experiencing depression and suicidal thoughts.

A number of factors are likely to contribute to the increases in mental illness and suicide during recessions. Whilst rises in job loss are important, they appear to account for less than half of the increases seen in recent years. Debt, low levels of social welfare spending and the effect of austerity measures, such as cuts in welfare and health spending all seem to contribute. A recent study by Ben Barr and colleagues looked at the impact of increases in the number of out-of-work disability claimants re-assessed for continued eligibility for benefits in England. Areas of England experiencing the highest numbers of reassessments experienced the greatest rises in suicide deaths.

Cross national research (see for example Norström and Grönqvist, and Stuckler et al.) has provided important pointers about what might help offset the impact of economic recessions on mental health. Measures include investment in active labour market programmes (e.g. job centres, job clubs and employment subsidies to aid job creation), ensuring austerity measures do not fall on people who are already vulnerable, and provision of generous unemployment benefits.

Whilst it is critical we learn lessons from this recession to inform policy responses to future economic downturns, we should remember that no two recessions are the same and impacts differ from country to country. With increased female labour force participation and changing family structures, it is possible that gender differences in the impact of recession may change. The sections of the population affected by recession may differ, depending on the industries where most job losses occur, the nature of austerity measures and existing welfare provision.

Read more:

P. Corcoran, E. Griffin, E. Arensman, A.P. Fitzgerald and I.J. Perry. Impact of the economic recession and subsequent austerity on suicide and self-harm in Ireland: An interrupted time series analysis. Int J Epidemiol 2015; 44(3): 969-977. [free to access until 31 May 2016]

S. Harper, T.J. Charters, E.C. Strumpf, S. Galea and A. Nandi. Economic downturns and suicide mortality in the USA, 1980-2010: observational study. Int J Epidemiol 2015; 44(3): 956-966. [free to access until 31 May 2016]

S.-S. Chang, D. Stuckler, P. Yip and D. Gunnell. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ 2013; 347: f5239.

B. Barr, D. Taylor-Robinson, D. Stuckler, R. Loopstra, A. Reeves and M. Whitehead. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study. J Epidemiol Community Health 2015; doi: 10.1136/jech-2015-206209.

D. Stuckler, S. Basu, M. Suhrcke, A. Coutts and M. McKee. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009; 374(9686): 315-323.

T. Norstöm and H. Grönqvist. The Great Recession, unemployment and suicide. J Epidemiol Community Health 2014; doi: 10.1136/jech-2014-204602.


David Gunnell is a professor of epidemiology at the University of Bristol. He has a life-long interest in understanding the cause of suicide in populations and developing prevention strategies to prevent suicide (Email: D.J.Gunnell@bristol.ac.uk). Follow David’s research group on Twitter @SASHBristol.

 

 

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