Abstract
PurposeThere have been a number of reviews on the association+ between unemployment and suicide, but none have investigated how this relationship is influenced by duration of unemployment.MethodA systematic review and meta-analysis was conducted of those studies that assessed duration of unemployment as a risk factor for suicide. Studies considered as eligible for inclusion were population-based cohort or case-control designs; population-based ecological designs, or hospital based clinical cohort or case-control designs published in the year 1980 or later.ResultsThe review identified 16 eligible studies, out of a possible 10,358 articles resulting from a search of four databases: PubMed, Web of Knowledge, Scopus and Proquest. While all 16 studies measured unemployment duration in different ways, a common finding was that longer duration of unemployment was related to greater risk of suicide and suicide attempt. A random effects meta-analysis on a subsample of six cohort studies indicated that the pooled relative risk of suicide in relation to average follow-up time after unemployment was 1.70 (95% CI 1.22 to 2.18). However, results also suggested a possible habituation effect to unemployment over time, with the greatest risk of suicide occurring within five years of unemployment compared to the employed population (RR = 2.50, 95% CI 1.83 to 3.17). Relative risk appeared to decline in studies of those unemployed between 12 and 16 years compared to those currently employed (RR = 1.21, 95% CI 1.10 to 1.33).ConclusionFindings suggest that long-term unemployment is associated with greater incidence of suicide. Results of the meta-analysis suggest that risk is greatest in the first five years, and persists at a lower but elevated level up to 16 years after unemployment. These findings are limited by the paucity of data on this topic.
Highlights
Past review studies have provided strong evidence of the relationship between unemployment and suicide [1,2,3,4]
The magnitude of the relative and attributable risk associated with unemployment has been contested, as various authors have suggested that the effect of socio-economic factors on suicide tend to be overestimated when the contribution of psychiatric disorders is not taken into account [5]
Over 300 articles were ecological studies, conducted either cross-sectionally or longitudinally, in which unemployment duration and/or suicide were not the primary variables of interest. Restricting studies to those where a measure of duration of unemployment or time since job loss was included resulted in 16 articles relevant to this systematic review (Table S1)
Summary
Past review studies have provided strong evidence of the relationship between unemployment and suicide [1,2,3,4]. The magnitude of the relative and attributable risk associated with unemployment has been contested, as various authors have suggested that the effect of socio-economic factors on suicide tend to be overestimated when the contribution of psychiatric disorders is not taken into account [5]. This assumption is problematic as it assumes that mental illness and unemployment have separate and independent effects on suicide when, mental illness is a likely intermediatory factor between unemployment and suicide [6]. Past meta-analyses on mental health outcomes and all-cause mortality [7,9] suggest a possible amelioration or ‘‘adjustment’’ to the adverse effects of unemployment on mental health and mortality over time
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