As with many negative health outcomes, suicide rates are consistently found to be higher among the unemployed than among the employed. Unemployment may increase the likelihood of suicide because (a) it precipitates increased risk for problems such as mental illness, marital stress, or financial strain, which can then lead to suicide; (b) it heightens vulnerability to suicidal tendencies by magnifying the impact of other stressful life events; or (c) it is confounded by a third variable that independently predicts both unemployment and suicide risk. Distinguishingamong these effects has posed a challenge for researchers dating to Durkheim in the late nineteenth century.
Individual-level studies
Longitudinal cohorts have been assembled in a variety of countries (including the United States, New Zealand, the United Kingdom, Denmark, Italy, and Pakistan) to assess the role of individual-level economic factors in suicide risk. Such cohorts are frequently drawn from random samples of government vital statistics records; the accumulated body of results therefore includes highly representative samples from diverse populations. Typically, these individual-level data sets include information on participants’ sex, age, socio-economic factors, marital status, and employment status, and more infrequently, history of mental health problems and exposure to stressful life events. Because multiple measurements of the various risk factors are only rarely available, competing tests of the three hypotheses previously discussed are generally impossible.
These studies find that unemployment is a moderate but significant risk factor for suicide, with reported relative risk magnitudes varying between 1.35 and 3.0. We identify just three individual-level studies that adjust for previous mental health status. In a population-based case-control study of suicide victims in Denmark, Mortensen, Agerbo, Erikson, Qin, and Westergaard-Nielsen found that unemployment increased the risk of suicide by 35 percent, after controlling for previous mental illness serious enough to necessitate hospital admission, as well as for education, family structure, and income. The authors concluded that unemployment accounts for 3 percent of suicides, but given that the analyses could not control for the impact of milder mental health problems, this percentage may be an overestimate. Blakely, Collings, and Atkinson employed sensitivity analyses to assess the extent of confounding by mental illness in their populationbased cohort of New Zealand adults. Their best estimate of the relative risk of suicide for unemployed persons, controlling for mental health, marital status, and socioeconomic variables, was 1.88. This figure represented a 47 percent reduction in excess relative risk from the unadjusted estimate. Likewise, results from a longitudinal study of psychiatric outpatients showed that unemployment was significantly associated with suicide (adjusted hazard ratio [HR] = 2.56). Findings from several other studies support the idea that unemployment significantly increases risk for suicide, but did not adjust for the mental health status of study participants.
Ecological-Level Studies
Aggregate time-series research on suicide and parasuicide (i.e., apparent attempts to commit suicide that are intentionally or unintentionally unsuccessful) has increased greatly since 1990 and now includes analyses conducted in a wide range of populations. Improvements in data quality and statistical methods have resulted in a number of highly rigorous studies. Most of this work adjusts for multiple confounding variables, including rates of divorce, marriage, birth, alcohol use, and labor force participation. The research also includes analyses assessing effects spanning both normal economic cycles and sharp, unexpected economic shocks. These factors—along with the diversity of the populations examined—strengthen the validity and generalizability of the findings.
Suicide rates have been found to correlate positively with the unemployment rate or other markers of economic contraction in the United Kingdom, the United States, Russia, Japan, and other Asian countries. Increases in the suicide rate have been particularly striking in the aftermath of severe economic crises. In Japan, Hong Kong, and Korea, suicide rates jumped between 39 percent and 45 percent after the financial crisis of 1998, apparently due in large part to the resulting steep rise in unemployment rather than to changes in the divorce rate or other factors. Suicide rates in Russia also sharply increased in the aftermath of the 1998 economic collapse. This research did not specifically analyze the unemployment rate, instead hypothesizing that the increase in suicides and other deaths was due in part to the general economic chaos, including loss of job security, rapid currency devaluation, hyperinflation, and political and economic uncertainty. Coefficients for the effect size of unemployment on suicide across normal economic cycles tend to be smaller but remain significant. Some studies have, however, reported negative findings as well. Platt, Micciolo, and Tansella found that change in the suicide rate across 18 regions of Italy was unrelated to change in the unemployment rate, and Hintikka, Saarinen, and Viinamaki reported that suicide mortality in both men and women was negatively related to unemployment in Finland from 1985–1990. However, unemployment in the Italian study consistently increased over the study period, leaving no empirical experimentation with which to assess the effects of declining unemployment. Likewise, the Finnish study period may not have been long enough to draw firm conclusions about the nature of the unemployment–suicide relation in that population. All other studies reviewed used data spanning at least 21 years.
Population characteristics. Analyses that stratify by age and sex allow for more in depth investigation and demographic-specific conclusions. In general, women commit suicide less frequently than do men, and evidence from both ecologicallevel and individual-level data suggest that unemployment is a more potent predictor of the suicide among men, perhaps due to men’s greater attachment to the labor force. However, other results from individual-level data are more mixed. In Blakely et al.’s study, effect modification by sex occurred only among adults between the ages of 18 and 24; unemployed men and women between the ages of 25 and 64 demonstrated similar magnitudes of increased risk. Lewis and Sloggett reported no interaction by sex in their estimates of the unemployment–suicide association, whereas Kposowa found that unemployed women were significantly more likely to commit suicide than were unemployed men (although unemployment predicted suicide risk in both groups).
Additionally, theory suggests that losing a job may be more psychologically detrimental for those with heavy financial and familial responsibilities, such as middle-aged adults. Although some research at the ecological level has reported that suicide rates among working-age adults are indeed more adversely affected by unemployment than are rates among younger and elderly group, other studies have found that older adults are more affected. Most individual-level studies reviewed adjusted for age in their statistical models without examining its role as an effect modifier, leaving the evidence inconclusive.
Conclusions and Limitations
Convergence of research at both the individual and ecological levels indicates that economic contraction acts as a moderately sized but important causal risk factor for suicide. The consistency and cross-cultural replication of the findings suggest economic contraction to be nearly universal in its role as a severe psychological stressor. The pathways between unemployment and suicide remain poorly elucidated but implicate mental illness. To what extent such mental illness is newly incident and directly caused by job loss is uncertain, as even the best individual-level data typically use mental health measurements that predate employment status measurements. Future work should aim to identify these mechanisms better and consider potential intervention programs in at-risk populations.
Individual-level studies
Longitudinal cohorts have been assembled in a variety of countries (including the United States, New Zealand, the United Kingdom, Denmark, Italy, and Pakistan) to assess the role of individual-level economic factors in suicide risk. Such cohorts are frequently drawn from random samples of government vital statistics records; the accumulated body of results therefore includes highly representative samples from diverse populations. Typically, these individual-level data sets include information on participants’ sex, age, socio-economic factors, marital status, and employment status, and more infrequently, history of mental health problems and exposure to stressful life events. Because multiple measurements of the various risk factors are only rarely available, competing tests of the three hypotheses previously discussed are generally impossible.
These studies find that unemployment is a moderate but significant risk factor for suicide, with reported relative risk magnitudes varying between 1.35 and 3.0. We identify just three individual-level studies that adjust for previous mental health status. In a population-based case-control study of suicide victims in Denmark, Mortensen, Agerbo, Erikson, Qin, and Westergaard-Nielsen found that unemployment increased the risk of suicide by 35 percent, after controlling for previous mental illness serious enough to necessitate hospital admission, as well as for education, family structure, and income. The authors concluded that unemployment accounts for 3 percent of suicides, but given that the analyses could not control for the impact of milder mental health problems, this percentage may be an overestimate. Blakely, Collings, and Atkinson employed sensitivity analyses to assess the extent of confounding by mental illness in their populationbased cohort of New Zealand adults. Their best estimate of the relative risk of suicide for unemployed persons, controlling for mental health, marital status, and socioeconomic variables, was 1.88. This figure represented a 47 percent reduction in excess relative risk from the unadjusted estimate. Likewise, results from a longitudinal study of psychiatric outpatients showed that unemployment was significantly associated with suicide (adjusted hazard ratio [HR] = 2.56). Findings from several other studies support the idea that unemployment significantly increases risk for suicide, but did not adjust for the mental health status of study participants.
Ecological-Level Studies
Aggregate time-series research on suicide and parasuicide (i.e., apparent attempts to commit suicide that are intentionally or unintentionally unsuccessful) has increased greatly since 1990 and now includes analyses conducted in a wide range of populations. Improvements in data quality and statistical methods have resulted in a number of highly rigorous studies. Most of this work adjusts for multiple confounding variables, including rates of divorce, marriage, birth, alcohol use, and labor force participation. The research also includes analyses assessing effects spanning both normal economic cycles and sharp, unexpected economic shocks. These factors—along with the diversity of the populations examined—strengthen the validity and generalizability of the findings.
Suicide rates have been found to correlate positively with the unemployment rate or other markers of economic contraction in the United Kingdom, the United States, Russia, Japan, and other Asian countries. Increases in the suicide rate have been particularly striking in the aftermath of severe economic crises. In Japan, Hong Kong, and Korea, suicide rates jumped between 39 percent and 45 percent after the financial crisis of 1998, apparently due in large part to the resulting steep rise in unemployment rather than to changes in the divorce rate or other factors. Suicide rates in Russia also sharply increased in the aftermath of the 1998 economic collapse. This research did not specifically analyze the unemployment rate, instead hypothesizing that the increase in suicides and other deaths was due in part to the general economic chaos, including loss of job security, rapid currency devaluation, hyperinflation, and political and economic uncertainty. Coefficients for the effect size of unemployment on suicide across normal economic cycles tend to be smaller but remain significant. Some studies have, however, reported negative findings as well. Platt, Micciolo, and Tansella found that change in the suicide rate across 18 regions of Italy was unrelated to change in the unemployment rate, and Hintikka, Saarinen, and Viinamaki reported that suicide mortality in both men and women was negatively related to unemployment in Finland from 1985–1990. However, unemployment in the Italian study consistently increased over the study period, leaving no empirical experimentation with which to assess the effects of declining unemployment. Likewise, the Finnish study period may not have been long enough to draw firm conclusions about the nature of the unemployment–suicide relation in that population. All other studies reviewed used data spanning at least 21 years.
Population characteristics. Analyses that stratify by age and sex allow for more in depth investigation and demographic-specific conclusions. In general, women commit suicide less frequently than do men, and evidence from both ecologicallevel and individual-level data suggest that unemployment is a more potent predictor of the suicide among men, perhaps due to men’s greater attachment to the labor force. However, other results from individual-level data are more mixed. In Blakely et al.’s study, effect modification by sex occurred only among adults between the ages of 18 and 24; unemployed men and women between the ages of 25 and 64 demonstrated similar magnitudes of increased risk. Lewis and Sloggett reported no interaction by sex in their estimates of the unemployment–suicide association, whereas Kposowa found that unemployed women were significantly more likely to commit suicide than were unemployed men (although unemployment predicted suicide risk in both groups).
Additionally, theory suggests that losing a job may be more psychologically detrimental for those with heavy financial and familial responsibilities, such as middle-aged adults. Although some research at the ecological level has reported that suicide rates among working-age adults are indeed more adversely affected by unemployment than are rates among younger and elderly group, other studies have found that older adults are more affected. Most individual-level studies reviewed adjusted for age in their statistical models without examining its role as an effect modifier, leaving the evidence inconclusive.
Conclusions and Limitations
Convergence of research at both the individual and ecological levels indicates that economic contraction acts as a moderately sized but important causal risk factor for suicide. The consistency and cross-cultural replication of the findings suggest economic contraction to be nearly universal in its role as a severe psychological stressor. The pathways between unemployment and suicide remain poorly elucidated but implicate mental illness. To what extent such mental illness is newly incident and directly caused by job loss is uncertain, as even the best individual-level data typically use mental health measurements that predate employment status measurements. Future work should aim to identify these mechanisms better and consider potential intervention programs in at-risk populations.
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