The current economic crisis has invigorated interest in the relation between the economic environment and suicide rates and prompted some to forewarn of increased rates of economically induced suicides (66
) or “econocide,” a term that was recently coined by American psychologists (67
). Although vital statistics for the period covering the current recession are unavailable, historical data provide an opportunity to predict the influences of current and future recessions on patterns of suicide. Using data on monthly counts of suicides in NYC from 1990 through 2006 to assess the time-series relation between levels of economic activity, stock volatility, and suicide, we found that economic activity was negatively associated with suicide. The relation between economic activity and suicide differed by race/ethnicity and sex.
A growing body of international research has shown that rates of suicide in particular and mental health in general are associated with economic activity. With the exception of Finland, which experienced an increase in suicide during an economic upswing between 1985 and 1990 and a decline during a subsequent period of recession (42
), there are few empirical examples of suicide increasing during times of economic prosperity, challenging theories that posit curvilinear or procyclical associations between the economy and suicide rates. Although research from Ireland showed no association between socioeconomic factors and suicide after accounting for time trends (68
), most studies have suggested that suicide rates tend to decline during times of economic prosperity and increase during periods of recession (29
). In a recent review of the population-level mental health effects of economic downturns, Zivin et al. (69
) inferred a positive association between economic crises and the onset of psychopathology, including suicide and mood disorders.
Parametric techniques for assessing the relation between economic conditions and suicide rates may not adequately account for time-varying confounding by seasonal, long-term secular (e.g., provision of emergency services that may influence survival conditional on a suicide attempt), or long-term demographic (e.g., changes in age or racial composition) trends. Our work, in which we aimed to improve on extant research by applying GAMs with smoothing functions to handle time-varying confounding, corroborated prior work that showed a negative relation between economic activity and suicide rate in an urban context. On average, rates of suicide in NYC were lower when economic activity was greater. Specifically, there was a difference of 0.12 per 100,000 persons in the average predicted monthly rate of suicide when economic activity was at its peak (ICEI = 115.5) compared with when it was at its nadir (ICEI = 99.8).
The overall pattern between economic activity and suicide rates was driven primarily by whites, men, and older adults, who accounted for both a consistently higher incidence of suicide and a stronger negative association between the ICEI and suicide than did nonwhites, women, and younger adults, respectively. In studies as early as 1951 (70
), researchers showed a stronger association between economic conditions and suicide rates in men relative to women, with more recent work from Australia indicating that suicide rates increased with levels of economic adversity among men but had the opposite pattern among women (45
). Fewer studies have been conducted to assess whether the relation between economic conditions and suicide is moderated by race/ethnicity or age. In general, our analyses suggested that the association between the ICEI and suicide is more nonlinear for groups, particularly nonwhites and women, that might have fewer socioeconomic resources to buffer them from adverse macroeconomic conditions.
A number of questions remain unanswered and warrant further research. First, it is plausible that individual or contextual (i.e., neighborhood) measures of socioeconomic status moderate the relation between the economic environment and suicide rates (71
); however, we are unaware of any work that has investigated these associations. Second, the lag between fluctuations in the economic environment and rates of suicide is undetermined. Some work has suggested that the economic environment has an acute effect on suicide rates. During the Great Depression, for example, suicide rates peaked when gross domestic product growth was at its lowest point (72
). However, data from the Asian financial crisis showed inconsistent patterns (35
). Our results suggested an acute association between economic activity and suicide, with levels of economic activity associated with rates of suicide within the same month. Third, the mechanisms that link the economic environment to suicide have not been elucidated. Changes in the economic cycle might shift the distribution of factors that predispose persons to suicide and reduce access to salutary resources, such as mental health services and social supports. For example, periods of recession may be associated with increased levels of job insecurity and psychological distress (73
). Further work is needed to clarify the pathways that link changes in the economic environment to suicide rates.
Despite numerous reports of suicide induced by losses in stock market wealth, our findings suggested that fluctuations in the stock market, represented by stock market volatility, do not influence rates of violent suicide at the population level. One potential explanation is that there are not enough people invested in the stock market to detect fluctuations in incidence rates; as Durkheim noted in Suicide,
“Many of the individual conditions are not general enough to affect the relation between the total number of voluntary deaths and the population. They may perhaps cause this or that separate individual to kill himself, but not give society as a whole a greater or lesser tendency to suicide” (19, p. 71). Alternatively, a sufficient causal mechanism for suicide may be multifactorial and losses in wealth, including financial assets, may represent one component of a sufficient cause for suicide. According to a qualitative analysis of 62 cases of suicide involving economic strains, the reason for suicide frequently involved multiple comorbid stressors, such as economic losses and strain in a relationship with a significant other (75
). Finally, it is possible that fluctuations in the stock market are decoupled from changes in wealth at the individual or ecologic level through, for example, practices such as short sales of stocks and bonds.
There were a number of limitations to the present analysis. First, although we used smoothing functions of time to account for time-varying confounders that were not explicitly modeled, it is possible that residual confounding due to unmeasured covariates biased our estimates. However, it is unlikely that potential confounders, such as firearm availability (7
), varied temporally with levels of economic activity and confounded results between the ICEI and suicide. Second, it is possible that individuals with underlying psychiatric conditions might be more likely to experience job loss or unemployment and commit suicide (71
). However, this is unlikely to explain ecologic associations between the economic cycle and suicide. Third, we assessed the relations between 2 measures of the economic environment, the ICEI and a measure of stock market volatility, and suicide. It is possible that these measures do not best capture the economic insecurity or confidence experienced by individuals during economic downturns or upswings, respectively. A sensitivity analysis in which we replaced the ICEI with the unemployment rate showed that the unemployment rate was positively associated with suicide in unadjusted models but not after accounting for seasonal and long-term time trends; these results suggest that prior studies that found a significant positive association between unemployment and suicide may have been confounded, and furthermore, that studies of economic conditions and suicide are sensitive to the measurement of economic conditions used. Fourth, we used the ICEI for New York State, whereas suicide rates were calculated among NYC residents. Although a substantial proportion of NYC residents may have been exposed to the broader economic conditions of the state, our selection of a state-level indicator could have introduced error in the measurement of economic conditions. Fifth, although minimizing the potential for spatial ecologic fallacy, investigations at smaller levels of aggregation, such as urban areas, may have limited external validity. Sixth, we interpolated and extrapolated yearly population estimates stratified by age, sex, and race/ethnicity using estimates from the years 1990 and 2000 and assumed a linear trend.
In summary, macroeconomic forces might influence population mental health. However, additional work is necessary to address several unanswered questions, including which mechanisms link economic conditions to suicide.