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Postrecession increases in suicides not inevitable

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The psychiatrist’s role in addressing mental health effects of recessions

We have known since [Emile] Durkheim that suicide rates rise during times of economic hardship, but we now have evidence that at least three countries – Sweden, Finland, and Austria – experienced the recent Great Recession without additional suicides. Early case finding and antidepressant prescribing to clinically depressed, unemployed people inevitably help to prevent some deaths by suicide, but this is no panacea.

Too many people fall through the cracks or don’t respond to medication or are not adequately monitored. The authors mention the protective effectiveness of active labor market programs assisting the newly unemployed to find work and argue for their economic soundness. Associated with this notion is the beneficial effect of support, which can’t be underestimated as a major force in maintaining resilience.

I agree with the authors of this important paper that "voices of psychiatrists must not remain silent." In addition to the daily ministering to our patients in our clinical settings, we must continue to fight for their rights to state-of-the-art mental health care and our unwavering belief in their self-worth, so shattered with the scourge of un- or underemployment.

Dr. Michael F. Myers is professor of clinical psychiatry at SUNY Downstate Medical Center, Brooklyn, N.Y. He had no disclosures or conflicts of interest.


 

FROM THE BRITISH JOURNAL OF PSYCHIATRY

Increases in suicides after a recession, such as those seen in Europe, Canada, and the United States after the most recent recession, are not inevitable, according to the authors of a report on "economic suicides" in Europe and North America.

"The evidence that some societies have successfully de-coupled economic shocks from adverse mental health outcomes reveals the hope that it will be possible to eliminate the association of economic shocks with a rise in suicidality," said Aaron Reeves, Ph.D., of the University of Oxford (England) and his coauthors, from the London School of Hygiene and Tropical Medicine. Their report, which reviewed suicide data in Europe, the United States, and Canada after the onset of recession in 2007, appears online in the British Journal of Psychiatry (2014 June 11 [doi: 10.1192/bjp.bp.114.144766]).

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Interventions aimed at helping patients whose mental health is adversely affected by recessions might have an effect on reducing the suicide risk.

Using 2007 as the prerecession baseline, they said that after suicide rates had been falling in Europe, the rates started to increase, rising by 6.5% by 2009 and remaining elevated in 2011. The reversal in a prerecession drop in suicide rates also was documented in Canada, with a 4.5% increase in suicides from 2007 to 2009. And in the United States, where suicides had been increasing before the recession, an increase of 4.8% was found between 2007 and 2010.

These increases add up to at least 10,000 more so-called economic suicides than expected in Europe, the United States, and Canada since 2007, the authors pointed out.

But they questioned whether these suicides "are an inevitable accompaniment of economic hardship" and provided several examples of countries where the most recent or previous recessions were not associated with subsequent increases in suicides. For example, in Sweden, suicides declined between 1991 and 1992, during which time a marked rise in unemployment occurred. Also, the authors noted, the prevalence of suicides did not increase in Sweden during the most recent recession.

Factors that can help address the adverse effects of unemployment on suicide include access to secondary prevention, and programs that provide support for unemployed people and help them find work, they said. Noting that the medical community can be advocates of evidence-based prevention measures, they wrote, "recessions will continue to hurt, but need not cause self-harm."

The authors had no disclosures.

emechcatie@frontlinemedcom.com

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