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Suicide by occupation: Systematic review and meta-analysis

  • Allison Milner (a1), Matthew J. Spittal (a2), Jane Pirkis (a2) and Anthony D. LaMontagne (a3)

Abstract

Background

Previous research has shown that those employed in certain occupations, such as doctors and farmers, have an elevated risk of suicide, yet little research has sought to synthesise these findings across working-age populations.

Aims

To summarise published research in this area through systematic review and meta-analysis.

Method

Random effects meta-analyses were used to calculate a pooled risk of suicide across occupational skill-level groups.

Results

Thirty-four studies were included in the meta-analysis. Elementary professions (e.g. labourers and cleaners) were at elevated risk compared with the working-age population (rate ratio (RR) = 1.84, 95% CI 1.46–2.33), followed by machine operators and deck crew (RR = 1.78, 95% CI 1.22–2.60) and agricultural workers (RR = 1.64, 95% CI 1.19–2.28). Results suggested a stepwise gradient in risk, with the lowest skilled occupations being at greater risk of suicide than the highest skill-level group.

Conclusions

This is the first comprehensive meta-analytical review of suicide and occupation. There is a need for future studies to investigate explanations for the observed skill-level differences, particularly in people employed in lower skill-level groups.

Declaration on interest

None.

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Copyright

Corresponding author

Allison Milner, The McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Melbourne, VIC 3010, Australia. Email: allison.milner@unimelb.edu.au

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Suicide by occupation: Systematic review and meta-analysis

  • Allison Milner (a1), Matthew J. Spittal (a2), Jane Pirkis (a2) and Anthony D. LaMontagne (a3)
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eLetters

Suicide by Occupation

Manjeet S. Bhatia
06 January 2014

The article by Allison Milner and his clleagues is an excellent meta-analysis. There are few lacunae in the interpretation of results. Firstly,the suicide rates differ from country to country. Secondly, the causes differ in age- groups and also in different countries e.g. in India,2012 analysis (1) revealed that self employed category accounted for 38.7% of victims out of which 11.4% of victims were engaged in farming/agriculture activities, 4.7% were engaged in business and 2.9% were professionals. Students and un-employed victims accounted for 5.5% and 7.4% respectively.18% suicides were by housewives.Thirdly, educational status also affects suicide rate. In India, majority of suicides were by middle or primary level educated people (46%).These categories have been relatively constant for a long time (1,2). Fouthly, the causes differ fromculture to culture e.g. in India, family problems constituted the majority(26%) followed by illness (21%). So, drawing and applying the conclusionsfrom meta-analysis to different cultures and countries is difficult.

References1.http://ncrb.nic.in/CD-ADSI2011/suicides-11.pdf2.Bhatia MS, Aggarwal NK, Aggarwal BB.Psychosocial profile of suicide ideators, attempters and completers in India.Int J Soc Psychiatry. 2000;46(3):155-63.

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Conflict of interest: None declared

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Gender Remains Major Confounder

Alasdair D Forrest, CT1 in Psychiatry
06 January 2014

Milner et al. (1) make a commendable analysis of the effect of occupation on suicide risk, drawing on an imperfect field of research. Their work does not, however, allow for the effects of the differential demographic - particularly gender - profiles of those employed in each occupational category. This is particularly important when, in the UK in 2011, there was an 18.2 per 100,000 suicide rate in males compared with a 5.6 per 100,000 in females.(2)

If an occupation were almost entirely filled with men aged 30 to 44, with their suicide rate of 22.2 per 100,000 (2), it would not be surprising that it was significantly higher against all reference groups.

The United Nations Statistics Division figures show a striking difference in the gender balance of the ISCO categories in the UK from 2009 census data. In ISCO 9, with its high suicide rate ratio of 1.8 (95% CI 1.5 - 2.3) in Milner et al., 60.4% were male.(3) In ISCO 4, with its rate ratio of 0.8 (95% CI 0.6 - 0.9), only 22.5% are male.(3)

This relationship does not correlate across the ISCO categories, but it is enough of a confounder to be of interest. Despite the advantages of the rate ratio, it does not correct for sex, while the Proportionate Mortality Ratio does. It may be premature to dismiss its utility, until wehave better datasets that are more amenable to correction for demographic factors.

(1) Milner A, Spittal MJ, Pirkis J, LaMontagne AD. Suicide by occupation: systematic review and meta-analysis BJP December 2013 203:409-416; doi:10.1192/bjp.bp.113.128405

(2) Office for National Statistics. Suicides in the United Kingdom, 2011. Gwent: Office for National Statistics. 2011.

(3) United Nations Statistics Division. UNdata 2013 [Internet]. New York: UN Statistics Division; 2013 [cited 2013 Dec 26]. Available from: http://data.un.org/Default.aspx

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Conflict of interest: None declared

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