Skip to main content Accessibility help
×
Home
Hostname: page-component-888d5979f-8vdwt Total loading time: 0.457 Render date: 2021-10-25T10:15:56.120Z Has data issue: false Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

Published online by Cambridge University Press:  09 July 2013

A. Milner*
Affiliation:
McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
A. Page
Affiliation:
School of Science and Health, University of Western Sydney, Penrith, NSW, Australia
A. D. LaMontagne
Affiliation:
McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
*
* Address for correspondence: A. Milner, Ph.D., McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 207 Bouverie Street, Melbourne, VIC 3010, Australia. (Email: allison.milner@unimelb.edu.au)

Abstract

Background

There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide.

Method

A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained.

Results

Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33–1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00–1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females.

Conclusions

Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agerbo, E (2003). Unemployment and suicide: is the link always causal? Journal of Epidemiology and Community Health 57, 560561.CrossRefGoogle Scholar
Agerbo, E (2005). Effect of psychiatric illness and labour market status on suicide: a healthy worker effect? Journal of Epidemiology and Community Health 59, 598602.CrossRefGoogle ScholarPubMed
Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.CrossRefGoogle ScholarPubMed
Bertolote, JM, Fleischmann, A, De Leo, D, Wasserman, D (2004). Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 25, 147155.CrossRefGoogle ScholarPubMed
Blakely, TA, Collings, SC, Atkinson, J (2003). Unemployment and suicide. Evidence for a causal association? Journal of Epidemiology and Community Health 57, 594600.CrossRefGoogle ScholarPubMed
Brown, J, Demou, E, Tristram, MA, Gilmour, H, Sanati, KA, Macdonald, EB (2012). Employment status and health: understanding the health of the economically inactive population in Scotland. BMC Public Health 12, 327.CrossRefGoogle ScholarPubMed
Butterworth, P, Leach, L, Pirkis, J, Kelaher, M (2012). Poor mental health influences risk and duration of unemployment: a prospective study. Social Psychiatry and Psychiatric Epidemiology 47, 10131021.CrossRefGoogle ScholarPubMed
Corcoran, P, Arensman, E (2011). Suicide and employment status during Ireland's Celtic Tiger economy. European Journal of Public Health 21, 209214.CrossRefGoogle ScholarPubMed
Diez-Roux, AV (1998). Bringing context back into epidemiology: variables and fallacies in multilevel analysis. American Jouurnal of Public Health 88, 216222.CrossRefGoogle ScholarPubMed
Fergusson, DM, Boden, JM, Horwood, LJ (2007). Unemployment and suicidal behavior in a New Zealand birth cohort: a fixed effects regression analysis. Crisis 28, 95101.CrossRefGoogle Scholar
Fergusson, DM, Horwood, LJ, Woodward, LJ (2001). Unemployment and psychosocial adjustment in young adults: causation or selection? Social Science and Medicine 53, 305320.CrossRefGoogle ScholarPubMed
Glymour, MM (2008). Causal diagrams. In Modern Epidemiology, 3rd edn (ed. Rothman, K., Greenland, S. and Lash, T. L.), pp. Lippincott Williams and Wilkins: Philadelphia.Google Scholar
Greenland, S (2003). Quantifying biases in causal models: classical confounding vs collider-stratification bias. Epidemiology 14, 300306.CrossRefGoogle ScholarPubMed
Harbord, RM, Harris, RJ, Sterne, JA (2009). Updated tests for small-study effects in meta-analyses. Stata Journal 9, 197210.Google Scholar
Hudson, CG (2005). Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. American Journal of Orthopsychiatry 75, 318.CrossRefGoogle ScholarPubMed
Kaufman, JS, Maclehose, RF, Kaufman, S (2004). A further critique of the analytic strategy of adjusting for covariates to identify biologic mediation. Epidemiologic Perspectives and Innovations 1, 4.CrossRefGoogle ScholarPubMed
Kraut, A, Walld, R (2003). Influence of lack of full-time employment on attempted suicide in Manitoba, Canada. Scandinavian Journal of Work Environment and Health 29, 1521.CrossRefGoogle ScholarPubMed
Lewis, G, Sloggett, A (1998). Suicide, deprivation, and unemployment: record linkage study. British Medical Journal 317, 12831386.CrossRefGoogle ScholarPubMed
Li, CY, Sung, FC (1999). A review of the healthy worker effect in occupational epidemiology. Occupational Medicine (London) 49, 225229.CrossRefGoogle ScholarPubMed
Li, Z, Page, A, Martin, G, Taylor, R (2011). Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review. Social Science and Medicine 72, 608616.CrossRefGoogle ScholarPubMed
Lundin, A, Hemmingsson, T (2009). Unemployment and suicide. Lancet 374, 270271.CrossRefGoogle ScholarPubMed
Lundin, A, Lundberg, I, Allebeck, P, Hemmingsson, T (2012). Unemployment and suicide in the Stockholm population: a register-based study on 771,068 men and women. Public Health 126, 371377.CrossRefGoogle ScholarPubMed
Lundin, A, Lundberg, I, Hallsten, L, Ottosson, J, Hemmingsson, T (2010). Unemployment and mortality – a longitudinal prospective study on selection and causation in 49 321 Swedish middle-aged men. Journal of Epidemiology and Community Health 64, 2228.CrossRefGoogle Scholar
Maki, N, Martikainen, P (2012). A register-based study on excess suicide mortality among unemployed men and women during different levels of unemployment in Finland. Journal of Epidemiology and Community Health 66, 302307.CrossRefGoogle ScholarPubMed
Milner, A, Hjelmeland, H, Arensman, E, De Leo, D (2013 a). Social and environmental factors and suicide mortality: a narrative review of over 200 articles. Sociology Mind 3, 137148.CrossRefGoogle Scholar
Milner, A, Page, A, Lamontagne, AD (2012). Duration of unemployment and suicide in Australia over the period 1985–2006: an ecological investigation by sex and age during rising versus declining national unemployment rates. Journal of Epidemiology and Community Health 67, 237244.CrossRefGoogle ScholarPubMed
Milner, A, Page, A, Lamontagne, AD (2013 b). Long-term unemployment and suicide: a systematic review and meta-analysis. PLOS ONE 8, e51333.CrossRefGoogle ScholarPubMed
Morrell, S, Taylor, R, Quine, S, Kerr, C, Western, J (1999). A case–control study of employment status and mortality in a cohort of Australian youth. Social Science and Medicine 49, 383392.CrossRefGoogle Scholar
Mortensen, PB, Agerbo, E, Erikson, T, Qin, P, Westergaard-Nielsen, N (2000). Psychiatric illness and risk factors for suicide in Denmark. Lancet 355, 912.CrossRefGoogle ScholarPubMed
Paul, KI, Moser, K (2009). Unemployment impairs mental health: meta-analyses. Journal of Vocational Behavior 74, 264282.CrossRefGoogle Scholar
Platt, S (1984). Unemployment and suicidal behaviour: a review of the literature. Social Science and Medicine 19, 93115.CrossRefGoogle ScholarPubMed
Qin, P, Agerbo, E, Mortensen, PB (2003). Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry 160, 765772.CrossRefGoogle Scholar
Qin, P, Agerbo, E, Westergard-Nielsen, N, Eriksson, T, Mortensen, PB (2000). Gender differences in risk factors for suicide in Denmark. British Journal of Psychiatry 177, 546550.CrossRefGoogle ScholarPubMed
Roelfs, DJ, Shor, E, Davidson, KW, Schwartz, JE (2011). Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Social Science and Medicine 72, 840854.CrossRefGoogle ScholarPubMed
Sanderson, S, Tatt, ID, Higgins, JP (2007). Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. International Journal of Epidemiology 36, 666676.CrossRefGoogle ScholarPubMed
Shah, D (2009). Healthy worker effect phenomenon. Indian Journal of Occupational and Environmental Medicine 13, 7779.CrossRefGoogle ScholarPubMed
Shrier, I, Platt, R (2008). Reducing bias through directed acyclic graphs. BMC Medical Research Methodology 8, 70.CrossRefGoogle ScholarPubMed
Weich, S, Lewis, G (1998). Poverty, unemployment, and common mental disorders: population based cohort study. British Medical Journal 317, 115119.CrossRefGoogle ScholarPubMed
Yoshimasu, K, Kiyohara, C, Miyashita, K (2008). Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies. Environmental Health and Preventative Medicine 13, 243256.CrossRefGoogle ScholarPubMed
Supplementary material: File

Milner Supplementary Material

Appendix

Download Milner Supplementary Material(File)
File 58 KB
99
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *