Impact of the economic crises on suicide in Italy: the moderating role of active labor market programs.

Giorgio Mattei,Roberto De Vogli,Barbara Pistoresi

doi:10.1007/s00127-018-1625-8

Abstract

To analyze the association between unemployment and suicide in Italy during the years 1990-2014, with a peculiar focus on the great recession (GR) and the role played by social protection as buffering mechanism against the negative effect on health outcomes. Fixed effects panel regressions were used to assess the association between changes in unemployment rate and suicide rates. Additional models investigated the role of active labor market programs (ALMPs) as possible moderators of the association. Analyses were carried out for both males and females, stratified by age and region. The negative time-trend displayed by suicide rate in Italy until 2007 was slowed down by changes in unemployment at the beginning of the GR, when this trend reversed and the rate of suicide started increasing. Male workers aged 25-64 and women aged 55-64years were affected by both "normal" unemployment rate fluctuations as well as severe economic crises. Women aged 35-44 were only influenced by the latter. Men benefit from ALMPs mainly in Central Italy, while women did not benefit significantly from ALMPs. In Italy, economic downturns were associated with increased suicides mainly among men, while severe economic crises were associated with increased suicides among both men and women. ALMPs showed to be effective in moderating the association between unemployment and suicide among men aged 45-54 only in Central Italy. The overall small effectiveness of such programs may be due to lack of sufficient funding.

Highlights

In 2008 the world was hit by the Great Recession (GR), the worst economic crisis since the 1929 Great Depression [1]
We are aware that other indicators may be influenced by economic downturns, such as alcohol consumption, traffic fatalities, all-cause mortality and homicides [4, 22]; yet, in the present study we focus on the relation between unemployment and suicide, and the possible moderating effect played by social protection, since suicide may be considered a gross indicator of mental health within a population
Our analysis confirmed the well-known relation between economic crises and suicides, and pointed out a significant, though small effect of active labor market programs (ALMPs) on mental health outcomes, confined to Central Italy

Summary

Introduction

In 2008 the world was hit by the Great Recession (GR), the worst economic crisis since the 1929 Great Depression [1]. Stuckler et al [4] measured the impact of governmental policies as possible buffering mechanisms for the negative health effect of economic crises They focused on the role of welfare and social safety nets, indicating that the relationship between suicide and economic fluctuations may vary according to level of expenditure in social protection, with particular reference to active labor market programs (ALMPs). According to these authors, recessions do not hurt per se; rather, it is the governments’ choice to implement economic policies of stimulus or austerity (favoring or reducing social safety nets) that matter the most for understanding the effect of economic downturns on population health. A case in point is Greece, where social and health indicators (all-cause mortality, cardiovascular mortality, homicides and crime, HIV and tuberculosis infections, anxiety and mood disorders, suicide, alcohol abuse, attendance of public healthcare services) worsened after the implementation of severe austerity measures [5]

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