WASHINGTON (CBS DC) — One-in-five suicides worldwide, or about 45,000 each year between 2000-2011, have been linked to unemployment.

A new study published in the journal Lancet Psychiatry found that the recent economic downturn caused about 5,000 deaths in 63 countries, but unemployment was responsible for nine times as many suicides — 45,000 — over the course of the same decade. The researchers found that suicide risk among the unemployed was stronger in places where there was less unemployment overall, making their jobless situation more dire and unusual than that of the general population.

Researchers teamed with lead study author Dr. Carlos Nordt of the University of Zurich Psychiatric Hospital in Switzerland to analyze World Health Organization mortality data alongside the International Monetary Fund’s World Economic Outlook database. The researchers found that the rate of suicide associated with unemployment increased by 20-30 percent between 2000-2011.

Estimations showed that around 233,000 suicides took place each year during that decade, and unemployment accounted for around one-in-five of those, or about 45,000.

“Our findings reveal that the suicide rate increases six months before a rise in unemployment. What is more, our data suggests that not all job losses necessarily have an equal impact, as the effect on suicide risk appears to be stronger in countries where being out of work is uncommon,” Dr. Nordt tells The Guardian.

“It is possible that an unexpected increase in the unemployment rate may trigger greater fears and insecurity than in countries with higher pre-crisis unemployment levels…Therefore, suicides associated with unemployment totaled a nine-fold higher number of deaths than excess suicides attributed to the most recent economic crisis,” said Nordt.

One of the most surprising findings was that countries experiencing broad economic crisis weren’t as susceptible to high numbers of suicides as countries in which unemployment was less common – thus singling out those still out of work.

“What is more, our data suggest that not all job losses necessarily have an equal impact, as the effect on suicide risk appears to be stronger in countries where being out of work is uncommon. It is possible that an unexpected increase in the unemployment rate may trigger greater fears and insecurity than in countries with higher pre-crisis unemployment levels,” the researchers wrote.

Nordt and his team say countries should put in place suicide intervention programs that focus on negative health effects affecting people during times of economic prosperity.

An editorial linked to the study suggests that the number of suicides attributable to economic crisis are “just the tip of the iceberg.”

“Many affected individuals who remain in work during these hard times encounter serious psychological stressors due to pernicious economic strains other than un¬employment, including falling income, ‘zero¬-hour’ contracting, job insecurity, bankruptcy, debt and home repossession,” explain Roger Webb and Navneet Kapur of the University of Manchester.

They add that increased understanding of non-fatal self-harming, including alcohol abuse, stress and anxiety, depression and hopelessness can help treat mental health problems that can lead to suicide.

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