The impact of macroeconomic factors on suicide in 175 countries over 27 years

Abstract

Background: Every year, more than 800,000 people die by suicide, three-quarters of which are males. Economic factors influence suicide rates, but a worldwide perspective of their impact according to age and sex is lacking.

Method: We queried publicly available datasets on economic factors and on suicide rates stratified according to sex and age, from 1991 to 2017, for 175 countries. Thus, we analyzed approximately 21 million deaths by suicide using a multivariable regression model approach.

Results: Every 1% increase in global unemployment rates is associated with a 1% upsurge in male deaths by suicide (Relative risk (RR) = 1.01 [CI 95% 1.00-1.01] with respect to females) or 5000 excess male deaths. A 1% higher unemployment rate also exerts age-specific effects on suicide rates, since, among adults aged 30-59, the suicide rate is increased by 2-3%. Lastly, for every 1000 US dollar increase in the GDP per capita, suicide rates are reduced by 2% (RR = 0.98 [0.98-0.98]), corresponding to a reduction of 14,000-15,000 suicide deaths per year globally.

Conclusions: Males who have lost their jobs in adulthood are those at higher risk of suicide and to whom financial support measures should be delivered in a timely manner.

FIGURE 1

Suicide rates in the world, (a) countries considered in our global analysis of suicide rates (in green). (b) suicide rates per sex, year (x‐axis), and age range (y‐axis). The labels of the age ranges representing the second half of each decade (15 to 19, 25 to 29, etc.) are omitted for ease of reading. Each tile color refers to median suicide rates per year and age range across the countries considered. Higher rates correspond to the increasing yellow color of the tile. (c) unemployment rate per year (point range = mean and confidence interval). (d, e) represent the relative risk of death by suicide conveyed by macroeconomic factors. The horizontal red dashed line corresponds to RR = 1, which is the limit for which a variable is either protective (RR < 1) or harmful (RR > 1). For four countries (Burundi, Djibouti, Guinea, and Kuwait), the role of GDP/unemployment rate on suicide deaths could not be reliably estimated, and thus, we excluded these countries from this figure. (d) the relative risk of death by suicide with an increase of 1000 US dollars (USD) in gross domestic product per capita. For ease of reading, the countries for which the risk is reported (in green on the map) are only those for which an increment of 1000 USD in GDP significantly affects suicide rates. (e) the relative risk of death by suicide with a +1% unemployment rate for females and males. For ease of reading, the countries for which the risk is reported (in green on the map) are those where unemployment rates significantly alter suicide rates in females or males or both. For each country, both sexes are reported; the first errorbar (for each country) is referred to females. Sex/sexes for which unemployment rates significantly alter suicide rates are colored in yellow. When considering the role of unemployment rates in determining suicide rates, each interaction of unemployment rate (with age, with sex, or unemployment alone) needs to be considered together with the other interactions involving unemployment, since the relative risk conveyed by a variable is dependent on the relative risks given by all the other interactions of that variable. That is, although for some countries the increase in unemployment rate seems to be protective for males/females or both, this RR has to be weighed against the role of said increase for different age ranges to evince the overall influence of an increase in unemployment. For example, the model reports that a 1% increase in unemployment rates is associated with a 1% decrease in female suicide rates in Brazil. In that case, this reduction has to be weighed against the role of a 1% increase in unemployment rate for individuals belonging to a specific age range, say 45–49, which means that this increase is associated with a 4% increase in suicide rates (thus, evidencing that a 1% percent increase in the unemployment rate is linked to a 3% increase in suicide rates of females aged 45–49)

FIGURE 2

Suicide rates stratified per income classes. (a) high‐income class countries (in 2010, green) considered in our analysis. (b) suicide rates per sex, year (x‐axis), and age range (y‐axis). The labels of the age ranges representing the second half of each decade (15 to 19, 25 to 29, etc.) are omitted for ease of reading. Each tile color refers to median suicide rates per year and age range across the countries considered. Higher rates correspond to the increasing yellow color of the tile. (c) unemployment rate per year (point range = mean and confidence interval). The panels d–l are replicas of the panels described above, for countries of different income classes