Inequalities in suicide mortality rates and the economic recession in the municipalities of Catalonia, Spain

International Journal for Equity in Health

Marc Saez²  Manel Marzo¹  Carme Saurina² 

[1] Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain;CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain

关键词: Hierarchical mixed models;    Unemployment rate;    Economic recession;    Suicides rates;   

Others  :  1231450
DOI  :  10.1186/s12939-015-0192-9

 received in 2015-01-19, accepted in 2015-07-17,  发布年份 2015

【 摘 要 】

Introduction

While previous research already exists on the impact of the current economic crisis and whether it leads to an increase in mortality by suicide, our objective in this paper is to determine if the increase in the suicide rate in Catalonia, Spain from 2010 onwards has been statistically significant and whether it is associated with rising unemployment.

Methods

We used hierarchical mixed models, separately considering the crude death rate of suicides for municipalities with more than and less than 10,000 inhabitants as dependent variables both unstratified and stratified according to gender and/or age group.

Results

In municipalities with 10,000 or more inhabitants there was an increase in the relative risk of suicide from 2009 onwards. This increase was only statistically significant for working-aged women (16–64 years). In municipalities with less than 10,000 inhabitants the relative risk showed a decreasing trend even after 2009. In no case did we find the unemployment rate to be associated (statistically significant) with the suicide rate.

Conclusions

The increase in the suicide rate from 2010 in Catalonia was not statistically significant as a whole, with the exception of working-aged women (16–64 years) living in municipalities with 10,000 or more inhabitants. We have not found this increase to be associated with rising unemployment in any of the cases. Future research into the effects of economic recessions on suicide mortality should take into account inequalities by age, sex and size of municipalities.

【 授权许可】

   
2015 Saurina et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

【 参考文献 】

• [1]Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review. Health Policy. 2014; 115(2–3):111-9.
• [2]Stuckler D, Basu S, Suhrcke M, McKee M. The health implications of financial crisis: a review of the evidence. Ulster Med J. 2009; 78(3):142-5.
• [3]Falagas ME, Vouloumanou EK, Mavros MN, Karageorgopoulos DE. Economic crises and mortality: a review of the literature. Int J Clin Pract. 2009; 63(8):1128-35.
• [4]Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet. 2011; 378:1457-8.
• [5]Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, McKee M et al.. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One. 2011; 6(6):e20724.
• [6]Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet. 2011; 378:124-5.
• [7]Nandi A, Charters TJ, Strumpf EC, Heyman J, Harper S. Economic conditions and health behaviours during the ‘Great Recession’. J Epidemiol Community Health. 2013; 67:1038-46.
• [8]Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D et al.. Financial crisis, austerity, and health in Europe. Lancet. 2013; 381(9874):1323-31.
• [9]Regidor E, Barrio G, Bravo MJ, de la Fuente L. Has health in Spain been declining since the economic crisis? J Epidemiol Community Health. 2014; 68:280-2.
• [10]Mattei G, Ferrari S, Pingani L, Rigatelli M. Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study. Soc Psychiatry Psychiatr Epidemiol. 2014 (In press). DOI:10.1007/s00127-014-0818-z.
• [11]Baumbach A, Gulis G. Impact of financial crisis on selected health outcomes in Europe. Eur J Public Health. 2014 (In press). DOI:. 10. 1093/eurpub/cku042 webcite
• [12]Urbanos-Garrido RM, Lopez-Valcarcel BG. The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ. 2014 (In press). DOI:. 10. 1007/s10198-014-0563-y webcite
• [13]Uutela A. Economic crisis and mental Health. Curr Opin Psychiatry. 2010; 23(2):127-30.
• [14]Zivin K, Paczkowski M, Galea S. Economic downturns and population mental health: research findings, gaps, challenges and priorities. Psychol Med. 2011; 41(7):1343-8.
• [15]McInerney M, Mellor JM, Nicholas LH. Recession depression: Mental health effects of the 2008 stock market crash. J Health Econ. 2013; 32(6):1090-104.
• [16]Gili M, García-Campayo J, Roca M. Economic crisis and mental health. SESPAS Report 2014 [in Spanish]. Gac Sanit. 2014;28(suppl 1):104-108.
• [17]McKenzie SK, Imlach Gunasekara F, Richardson K, Carter K. Do changes in socioeconomic factors lead to changes in mental health? Findings from three waves of a population based panel study. J Epidemiol Community Health. 2014; 68(3):253-60.
• [18]Morrell S, Taylor R, Quine S, Kerr C. Suicide and unemployment in Australia 1907–1990. Soc Sci Med. 1993; 36:749-56.
• [19]Gavrilova NS, Semyonova GN, Gavrilov LA. The response of violent mortality to economic crisis in Russia. Popul Rev Policy Rev. 2000; 19:397-419.
• [20]Chang SS, Gunnell D, Sterne JA, Lu TH, Cheng AT. Was the economic crisis 1997–1998 responsible for rising suicide rates in East/Southeast Asia? A time-trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med. 2009; 68:1322-31.
• [21]Luo F, Curtis FS, Quispe-Agnoli M, Ouvang L, Crosby AE. Impact of business cycles on US suicide rates, 1928–2007. Am J Public Health. 2011; 101:1139-46.
• [22]Yip PS, Caine ED. Employment status and suicide: the complex relationships between changing unemployment rates and death rates. J Epidemiol Community Health. 2011; 65:733-6.
• [23]Chang SS, Stuckler D, Yip P, Gunnell D. Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ. 2013; 347:f5239.
• [24]Saurina C, Bragulat B, Saez M, López-Casasnovas G. A conditional model for estimating the increase in suicides associated with the 2008–2010 economic recession in England. J Epidemiol Community Health. 2013; 67(9):779-87.
• [25]López-Bernal JA, Gasparrini A, Artundo CM, McKee M. The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur J Public Health. 2013; 23(5):732-6.
• [26]Ayuso-Mateos JL, Pita-Barros P, Gusmão R. Financial crisis, austerity, and health in Europe. [Comment to: Karanikolos et al. Lancet. 2013; 381(9874):1323–1331]. Lancet. 2013; 382:391-2.
• [27]Thomas K, Chang SS, Gunnell D. Suicide epidemics: the impact of newly emerging methods on overall suicide rates - a time trends study. BMC Public Health. 2011; 11:314. BioMed Central Full Text
• [28]Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008–10 economic recession in England: time trend analysis. BMJ. 2012; 345:e5142.
• [29]Yoon JH, Junger W, Kim BW, Kim YL, Kosh SB. Investigating the time lag effect between economic recession and suicide rates in agriculture, fisheries, and forestry workers in Korea. Saf Health Work. 2012; 3:294-7.
• [30]Garcy AM, Vågerö D. Unemployment and suicide during and after a deep recession: a longitudinal study of 3.4 million Swedish men and women. Am J Public Health. 2013; 103(6):1031-8.
• [31]Kontaxakis V, Papaslanis T, Havaki-Kontaxaki B, Tsouvelas G, Giotakos O, Papadimitriou GΝ. Suicide in Greece: 2001–2011. Psychiatrike. 2013; 24(3):170-4.
• [32]Chan CH, Caine ED, You S, Fu KW, Chang SS, Yip PS. Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis. J Epidemiol Community Health. 2014; 68(3):246-52.
• [33]Pompili M, Vichi M, Innamorati M, Lester D, Yang B, De Leo D, Girardi P. Suicide in Italy during a time of economic recession: some recent data related to age and gender based on a nationwide register study. Health Soc Care Community. 2013 DOI:10.1111/hsc.12086.
• [34]Alameda-Palacios J, Ruiz-Ramos M, García-Robredo B. Suicide, antidepressant prescription and unemployment in Andalusia (Spain) [in Spanish]. Gac Sanit. 2014 (In press). DOI:10.1016/j.gaceta.2013.12.005.
• [35]Breslow NE. Extra-Poisson variation in log-linear models. Appl Stat. 1984; 33:38-44.
• [36]Broek J. A score test for zero inflation in a Poisson distribution. Biometrics. 1995; 51:731-43.
• [37]Rue H, Martino S, Chopin N. Approximate Bayesian inference for latent Gaussian models by using integrated nested Laplace approximations (with discussion). J R Stat Soc Ser B. 2009; 71:319-92.
• [38]Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D et al.. Financial crisis, austerity, and health in Europe. [Authors’ reply]. Lancet. 2013; 382(9890):392.
• [39]Saunderson T, Haynes R, Langford IH. Urban–rural variations in suicides and undetermined deaths in England and Wales. J Public Health Med. 1998; 20:261-7.
• [40]Qin P. Suicide risk in relation to level of urbanicity - a population-based linkage study. Int J Epidemiol. 2005; 34(4):846-52.
• [41]Framework for Action for Sustainable Urban Development in the European Union. Communication from the Commission of the European Communities (COM), 605 final, Brussels; 1998.
• [42]Renes V. Social dimension of poverty and social intervention [in Spanish]. Documentación Social. 2000;119:259-274.
• [43]Ayllón S. Poverty dynamics in Catalonia: a first approximation [in Catalan]. Quaderns d’Acció Social i Ciutadania. 2009; 5:30-2.
• [44]Ayllón S, Mercader M, Ramos X. Characterization of deprivation and poverty in Catalonia. J Appl Econ. 2007; 44:137-75.
• [45]Brunet I, Valls F, Belzunegui N. Female poverty: hidden poverty? An analysis of the risk of poverty by gender in different stages of life. J Int Org. 2009; 3:91-110.