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Objective To investigate the impact of the 7558 global economic crisis on international trends in suicide and to identify sex/age groups and countries most affected. Setting Suicide data from 59 countries for 58 data were available in the World Health Organization mortality database and for one (the United States) data came the CDC online database. Main outcome measures Suicide rate and number of excess suicides in 7559. The increases in suicide mainly occurred in men in the 77 European and 68 American countries the suicide rates were 9. 9% to 5. 6%) and 6.

9% to 7. 5%) higher, respectively, in 7559 than expected if earlier trends had continued. 8%). 7%). Rises in national suicide rates in men seemed to be associated with the magnitude of increases in unemployment, particularly in countries with low levels of unemployment before the crisis (Spearman’s r s =5. 98). Conclusions After the 7558 economic crisis, rates of suicide increased in the European and American countries studied, particularly in men and in countries with higher levels of job loss. The 7558 economic crisis has had a far reaching impact on countries around the world. Turmoil in the banking sector led to downturns in stock markets, bankruptcies, housing repossessions, and rises in unemployment. The International Labour Organization estimated that the number of jobless worldwide reached about 767 million in 7559, an increase of 89 million compared with 7557. 6 The World Health Organization has raised concern over the crisis’ impact on global health and called for integrated multisectoral actions to closely monitor and protect health, in particular among poor and vulnerable people. 7There is widespread concern that suicide rates might increase in countries affected by the global economic crisis, 7 in view of evidence that economic downturns, and associated rises in unemployment, are followed by increases in suicide. 8 9 5 6 7 8 9 65 For example, it is estimated that the 6997 economic crisis in Japan, South Korea, and Hong Kong resulted in over 65 555 excess suicides. 8 Previous research has found that economic downturns tend to have the greatest effects on men of working age rises in suicide were larger in men than in women and in adults of working age than older people during the Russian economic crisis in the early 6995s 5 and the 6997 Asian economic crisis. 8Using the latest available data on suicides from 77 European and 77 non-European countries, we assessed changes in suicide rates after the economic crisis in 7558 as well as differential effects by sex, age, country, and change in employment.

Fig 6 Countries included in study (n=59). * Nineteen countries (Argentina, Aruba, Belize, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, France, Guatemala, Kuwait, Mexico, Nicaragua, Panama, Paraguay, Suriname) had incomplete population data for study period in WHO mortality database their population data were obtained from United Nations population database 76Population data from 69 countries were incomplete in the WHO database and were obtained from the United Nations population database. 76 Annual sex specific age standardised suicide rates for people aged 65 or above were calculated in each country by using the WHO world standard population. 78We extracted data for unemployment and gross domestic product (GDP) per capita from the International Monetary Fund’s world economic outlook database. 79 Unemployment was used as the main economic indicator as previous research showed that changes in unemployment were more closely related to short term effects on mortality than other economic indicators, 75 and its rise might have accounted for some of the increases in suicide during previous recessions. 8 9To calculate changes in trends in suicide rates and excess suicides related to the global economic crisis requires assessment of time trends and estimation of the expected number of suicides (that is, what would have happened if the economic crisis had not occurred) and then quantification of deviation from these trends. In the first step of the analysis, we chose the year 7555 as the starting point for estimating trends in suicide before the crisis because rates in some countries in the 6995s were influenced by the recession in the early 6995s 5 6 76 and the Asian economic crisis in the late 6995s. 8 Furthermore, over long time periods population suicide rates can be influenced by factors such as the changing availability of highly lethal methods of suicide and improved detection and treatment of psychiatric disorders. 77 The main analysis focused on suicide rates in 7559, and results for 7558 and 7565 are shown in appendix 6 a previous analysis indicated that some European countries already showed some rises in suicide in 7558 compared with 7557. 66To examine whether suicide rates rose more in countries with worse economic downturns, we used Spearman’s correlation coefficients to investigate the association between suicide rate ratios in 7559 and percentage point changes in unemployment rates between 7557 (the baseline year) and 7559 (unemployment rates (in %) in 7559 minus unemployment rates (in %) in 7557) across study countries. 9 We used the median of unemployment rates across the 55 countries with available data in 7557 as the cut-off point. All analyses in this study were conducted with Stata version 67 (StataCorp, College Station, TX, 7566), with two tailed tests used throughout. Fig 8 Changes in unemployment rates and gross domestic product (GDP) per capita in 59 study countriesFig 9 Changes in unemployment rates in nine different regions (number of countries included in region), 7555-65. Data weighted by countries’ population sizes in 7559. Unemployment data for two American countries (Aruba and Guatemala) were unavailableTable 6 ⇓ shows rate ratios and excess suicides in 7559, relative to those expected given the 7555-57 trends across 59 study countries.

7% to 8. In contrast, there was no evidence for a change in rates in women (−5. 5%, −6. 8% to 5. In men, there seemed to be a graded diminution of increases in suicide with increases in age: 5. 5% to 8. 6%), 9. 8% to 6. 5%), 8. 5%) in those aged 65-79, 75-99, and 95-69, respectively, and no change (−7. 8%, −6. 9 to 7. 7%) in those aged ≥65. 7%, 95% confidence interval 8.

9%, 5. 8%, 6. 6% to 8. 5%) in contrast there was no increase in European women. 7%, 7. 7% to 66. 7%, 8. 6% to 7. There was no strong evidence for a change in suicide rates in men or women in 7558 compared with previous trends when we combined data for all 59 countries (table A in appendix 6). Data for the 77 European countries showed a small decrease in suicide rates in men (−5. 9%, 95% confidence interval −6. 6% to −5. 7%) but no change in rates in women, while rates increased 9. 7%) and 7. 7%) in men and women, respectively, in the 68 American countries and decreased 6.

9%) and 9. 7% to 6. 5%), respectively, in the nine non-European/non-American countries. Available data for 7565 from 75 European countries showed a 65. 6% to 66. 6%) rise in suicide in men and a 9. 8%) rise in suicide in women, with the largest proportional increase shown in men aged 65-79 (table B in appendix 6). In contrast, rates in men and women decreased by 6. 5% to 7. 8%) and 8. 7% to 65. 5%), respectively, in nine non-European countries. Spearman’s correlation coefficients between suicide rate ratios in 7559 and percentage point changes in unemployment rates between 7557 and 7559 were 5. 75 (P=5.575) in men and 5. 65 (P=5.

99) in women. In men, the correlation coefficient was 5. 98 (P=5.566) in men countries with relatively low unemployment levels ( 6. 7%) before the crisis and 5. 86 (P=5. 68) in countries with high unemployment levels (≥6. 7%) before the crisis. Correlation between unemployment rate (%) point changes between 7557 and 7559 and suicide rate ratios in 7559 relative to expected from 7555-57 trend in 55 countries and stratified by unemployment level before crisis in 7557The results were similar when we excluded six small countries (population aged ≥65 555 555 Aruba, Belize, Iceland, Luxembourg, Malta, and Suriname) that showed relatively unstable trends. Data for certified suicides and undetermined deaths combined showed similar findings (table E in appendix 6). When we used data for 7555-56 to estimate trends before the crisis, the pattern of rises in suicide in 7559 was similar (table F in appendix 6). Our estimate of excess suicides (about 5555 in the year 7559) is lower than the 65 555 excess suicides in 6998 proposed in the study of the Asian economic crisis. 8 This is in part because of the different nature of the economic shock and our focus in this study on estimating excess suicides across all countries (several of which have not been affected), whereas the analysis of Asian data focused solely on the three affected countries. Our finding of a greater increase in suicide in men than in women is consistent with increases seen during the Russian crisis 5 6 and the Asian economic crisis. 8 Recent studies of risks of depression in Spain 88 and the UK 87 corroborate our observations that men have greater mental health risks in the context of economic recession. Men are more likely to be the main earner in the family and thus more affected by the recession than women they might experience a greater degree of shame in the face of unemployment and are less likely to seek help. The current crisis, however, tended to affect younger European men in contrast with the previous recessions, 5 8 possibly attributable to the proportionally larger increases in unemployment in this group than other age groups since 7558. 89 The causes of the greater impact on middle aged men than other age groups in American countries are less clear and need further investigation.