Friday July 8 2011
The study did not identify the reason why suicides increased
“Suicide rates have risen sharply across Europe since the banking crisis,” The Independent today reported. The newspaper says a study has found that Britain has been affected particularly hard, experiencing an 8% rise in suicide rates between 2007 and 2009. Ireland and Greece, two of the countries reported to be in greater financial difficulty, have seen suicides rise 13% and 16% respectively.
The news is based on a study by researchers who had previously predicted a rise in suicides at the start of the financial crisis. In this research they aimed to look at whether they were right. They consulted a database of international mortality data for information on 10 EU countries and compared suicides to employment rates. As predicted, there was an association between increased unemployment and increased suicide rates. However, although an association has been found, there is no way to guarantee that the two are directly linked, as other reasons may be behind the rise in suicides. Furthermore, the study referred to selected sources of data but all relevant research in the area has yet to be consulted.
The authors are currently involved in a more detailed analysis of the health effects of the ongoing economic crisis, and now intend to gather data from individuals rather than looking at national trends. It is hoped that this will provide a clearer picture of how unemployment and financial problems may affect suicide risk.
Where did the story come from?
This was a narrative report published in The Lancet and the authors were researchers with associations to various European and US institutions, including the University of Cambridge, the London School of Hygiene and Tropical Medicine and the University of California, San Francisco. This narrative report was not supported by any sources of external funding.
The news stories reflect this narrative report, but do not clearly highlight that there are gaps in the current mortality data and in other relevant information that might help to assess links between financial crises and other health effects. Furthermore, the absolute numbers of British suicide rates were not directly quoted in the research paper, so the news reports generally had to report trends in suicide in terms of percentage increases rather than increases in the numbers of actual deaths.
What kind of research was this?
This was a brief narrative review entitled “Effects of the 2008 recession on health: a first look at European data.” The authors state that this is a preliminary assessment of 2009 mortality data across several European countries. The report cited 13 related data sources but only provided a brief methodology, and it is not clear whether all relevant data and sources have been consulted when producing this review. It should therefore be considered to represent the authors’ interpretation of the evidence rather than a systematic examination of all available research.
There can be particular problems when assessing the causes of suicide. Although researchers can monitor rates, it is difficult to identify the circumstances that made an individual contemplate suicide. While this research assumes that the general increase in suicide rates is likely to be due to the impact of the economic crisis, these increases may have not have been solely due to finances and employment, and in some cases these factors may not have had any influence at all.
What did the research involve?
The authors report that two years ago they published an article in The Lancet reviewing mortality rates in 26 European countries during economic crises across three decades. They say that then they noted increases in unemployment rates were associated with increases in suicide rates among the under 65s. At the time they predicted that the economic crisis commencing in 2008 would have similar consequences, and so carried out this research analysing 2009 European mortality data.
To assess trends in suicide rates the researchers accessed the “European Health for All” database, compiled by the World Health Organization (WHO). They say that complete data for 2000–09 was available for only 10 of the 27 EU countries, including Austria, Finland, Greece, Ireland, the Netherlands and the UK, and from four nations that joined the EU in 2004: the Czech Republic, Hungary, Lithuania and Romania. The authors said that they combined data from countries in each group, weighted by population size. They also looked at adult unemployment trends from EUROSTAT, a database compiled by the European Commission.
What were the basic results?
The authors present figures demonstrating a change in unemployment rates and suicide rates for the under 65s. They say that after the banking crisis official unemployment began to rise, and was associated with a 35% increase in unemployment rates across Europe from 2007 to 2009. This rise in unemployment was observed to occur at the same time as a reversal in suicide trends: suicide rates had been falling in the years prior to the financial crisis but began rising as financial turmoil took hold. There was a very small increase of less than 1% between 2007 and 2008 in the new member states, but a 7% increase over the same period in the older members. There were further increases in 2009.
Of the 10 countries included in the analysis, only Austria had a lower suicide rate in 2009 than 2007, with all other countries experiencing at least a 5% increase over the 2007-09 period. In their earlier 2009 published paper they had predicted that a greater than 3% increase in employment would increase suicide rates by about 4.5%, and these figures seemed therefore as expected. They note that countries with the most severe decline in their financial situations had greater rises in suicide levels (13% rise for Ireland and 17% for Greece). However, they did not say how common suicide was overall for any of the countries.
The researchers also say that in their earlier work they had predicted that social protection systems and strong social support networks could mitigate the predicted increase in suicides, and say that case of Austria supports this theory as the country offers a strong social support network and showed a small decline in suicide rates despite a 0.6% increase in unemployment. However, Finland, also with strong social support, did not fit this model as it saw a rise in suicide rates of just over 5%.
The researchers also noted a substantial fall in road traffic fatalities across European countries over the same time period. This is consistent with findings in other countries: for example, the USA experienced a 10% fall in road traffic fatalities (time period not given). The reason for these falls is uncertain.
This was a narrative review conducted by the authors of a 2009 research article that had examined mortality rates across 26 European countries over three decades and how they respond to economic crises. Their current brief report aimed to review whether their predictions had been fulfilled: that the economic crisis in 2008 would be associated with a rise in suicide rates. As per their prediction they did notice a trend for an overall 5% increase in suicide rates between 2007 and 2009, coupled with increasing unemployment rates.
Although the researchers consulted a WHO database to access mortality data, they were only able to access information from 10 countries. As the authors openly acknowledge, their analysis is limited by many gaps in the mortality data, and they note that governmental collection of health data can lag for many years behind their up-to-the-minute knowledge of the financial situation. They say that when data becomes available from elsewhere their analysis will need to be updated. Given these factors, and that the brief methodology does not indicate this to be a full systematic review of the evidence, there is the possibility that other relevant data and information have been missed.
It is also worth noting that when assessing suicide, although researchers can monitor rates, it is difficult to look at the circumstances surrounding individuals who contemplate suicide. Without a clear way to assess their intent or circumstances it cannot be assumed that a general increase in suicide rates is necessarily due to changes in the economic crisis. There may be many different reasons that might lead an individual to contemplate suicide, which may not include their employment situation or financial difficulties or may only be indirectly linked to one’s financial situation.
The authors say that they are currently involved in a much more detailed analysis of the health effects of the ongoing economic crisis. This will include assessment of individual-level data from European household surveys, in addition to examining policy responses. They hope to understand why certain individuals, communities and societies are more or less vulnerable to economic difficulties. The authors conclude that “there is clearly much more to be written on the health consequences of the events of 2008”, and this research is awaited.
Future studies in this area might focus on the non-fatal health consequences of financial difficulties or compare factors such as the rates of suicide in the employed, the newly unemployed and the long-term unemployed, thereby looking directly at employment status and suicide risk on an individual level rather than a national one.