Economic crisis 'may explain rise in suicide rates among middle-aged adults'

Among American adults aged 40-64, suicide rates have risen by around 40% since 1999. Now, a new study published in the American Journal of Preventive Medicine says this increase could be down to the recession of 2007-09 - a period that saw a sharp rise in suicide rates among middle-aged adults.

Among individuals aged 40-64, suicides due to external circumstances - such as job loss - rose from 33% in 2005 to 37.5% in 2010, with a sharp increase from 2007 - around the time the economic downturn began.

The study was conducted by a research team at the Robert Wood Johnson Foundation in Princeton, NJ, and the Center for State Health Policy at Rutgers University in New Brunswick, NJ, and the Institute for Health, Health Care Policy and Aging Research in New Brunswick, NJ.

This research comes after another study recently published in The Lancet Psychiatry found that between 2000 and 2011, unemployment was a cause of around 45,000 suicides around the world each year.

Using data from the World Health Organization (WHO) mortality database, the investigators of that study calculated the recession was responsible for an additional 5,000 suicides from 2008.

For this latest study, the researchers set out to determine whether the recession has affected middle-aged adults disproportionately, resulting in higher suicide rates among this age group, while such rates among other age groups have remained relatively stable.

The researchers assessed data from the National Violent Death Reporting System (NVDRS), which provided information on completed suicides between 2005 and 2010.

"These data allow the analysis of how suicide circumstances may have changed in ways that reflect the growing importance of economic crises as a risk factor for suicide," the team explains.

Using this information, the researchers analyzed 17 separate suicide circumstances, which they categorized into three groups: personal circumstances (such as alcohol dependence or mental health problems), interpersonal circumstances (such as the death of a loved one or intimate partner violence) and external circumstances (such as problems with work or financial difficulties).

In addition, the researchers were able to use the data to assess four indicators of suicide planning and intent: history of previous suicide attempts, revealing an intent to commit suicide, leaving a suicide note and experiencing a crisis - such as job loss or a relationship break-up - in the 2 weeks prior to suicidal behavior.

Most middle-aged suicides due to external factors and completed using suffocation

While external circumstances were the least common reasons for suicides among adults overall in 2005-10, it was the only category that saw an increase. External circumstances accounted for around 29.8% of suicides in 2005, but this rose to 32.7% in 2010.

Broken down by age group, the team found that individuals aged 40-64 saw a significant increase in suicides due to external circumstances, rising from 33% in 2005 to 37.5% in 2010, with a sharp increase from 2007 - around the time the economic downturn began.

"By contrast," the authors note, "the relative prevalence of suicides owing to personal and interpersonal circumstances remained stable or declined over the period."

Individuals aged 65 and older also saw a rise in suicides due to external circumstances, from 7.5% in 2005 to 12.4% in 2010, but such suicides among those aged 15-39 fell from 35% to 34.3% during the same period.

The team says the increase in suicides resulting from external circumstances in those aged 65 and over may be explained by financial difficulties linked to the loss of retirement savings due to the stock market crash.

The researchers also found suicide method varied by circumstance. Poisoning was most common in suicides due to personal circumstances, while more lethal methods - such as firearm use or suffocation - were most common in suicides due to external and interpersonal circumstances. In areas where gun ownership was low, suicide by suffocation was more common.

For individuals aged 40-64, there was a 59.5% increase in suicide by suffocation in 2005-10, compared with an 18% rise among those aged 15-39 and a 27.2% increase among those aged 65 and older. The increase in suicide among middle-aged individuals was most prominent among those who took their own lives due to external circumstances.

Commenting on their findings, the researchers say:

"Relative to other age groups, a larger and increasing proportion of middle-aged suicides have circumstances associated with job, financial, or legal distress and are completed using suffocation.

The sharpest increase in external circumstances appears to be temporally related to the worst years of the Great Recession, consistent with other work showing a link between deteriorating economic conditions and suicide."

Based on their findings, the researchers say there needs to be increased awareness that financial factors - such as unemployment, bankruptcy and foreclosure - may increase the risk of suicide, particularly among middle-aged adults.

"Human resource departments, employee assistance programs, state and local employment agencies, credit counselors, and others who interact with those in financial distress should improve their ability to recognize people at risk and make referrals," they add. 

"Increasing access to crisis counseling and other mental health services on an emergency basis, as is often provided at times of natural disaster, should also be considered in the context of economic crises."

References:

1.  Rising suicide among adults aged 40-64 years: the role of job and financial circumstances, Katherine A. Hempstead, Julie A. Phillips,American Journal of Preventive Medicine, doi: http://dx.doi.org/10.1016/j.amepre.2014.11.006, published online 27 February 2015,abstract.
2.  Elsevier news release, accessed 27 February 2015.