Macroeconomic fluctuations and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in 2000–2015: A register-based study

Mall Leinsalu,Aleksei Baburin,Domantas Jasilionis,Juris Krumins,Pekka Martikainen,Andrew Stickley

doi:10.1016/j.jpsychires.2020.09.009

Abstract

IntroductionIn the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. This study aimed to examine changes and educational inequalities in suicide mortality among working-age men in the Baltic countries and Finland in relation to macroeconomic fluctuations. MethodsWe analysed changes in overall suicide mortality and by educational level between the 2000–2003, 2004–2007, 2008–2011 and 2012–2015 periods among men aged 30–64 years using census-linked longitudinal mortality data. We estimated age-standardised mortality rates, mortality rate ratios (Poisson regression), the relative index of inequality and slope index of inequality. ResultsOverall suicide mortality fell markedly from 2000–2003 to 2004–2007. The decline was largest among high educated men in the Baltic countries and among middle and low educated men in Finland. From 2004–2007 to 2008–2011, the positive trend slowed and while suicide mortality continued to fall among middle and low educated men, it increased somewhat among high educated men in all Baltic countries. In Finland, suicide mortality decreased among the high educated and increased slightly among low educated men. ConclusionsIn the Baltic countries, lower educated men had a smaller decline in suicide mortality than higher educated men during a period of rapid economic expansion, however, they were not more disadvantaged during the recession, possibly because of being less exposed to financial loss. Consequently, relative inequalities in suicide mortality may increase during economic booms and decrease during recessions.

Highlights

In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession
We aimed to examine the changes in overall suicide mortality and by educational level among working-age men in the Baltic countries in relation to macroeconomic fluctuations
The age-standardised mortality rates (ASMRs) for overall suicide mortality were higher in the Baltic countries compared with Finland

Summary

Introduction

In the 2000s, the Baltic countries experienced unprecedented economic growth followed by a deep recession. The largest decline occurred in some Eastern Eu ropean countries (Alicandro et al, 2019) which had the highest suicide rates in the world even in 2016 (WHO, 2020) These overall positive trends were interrupted after the onset of the global financial crisis with the 2008 economic recession quickly affecting suicide mortality in many countries. The suicide rate increased throughout the general population (Chang et al, 2013) a larger effect was seen among men at working ages (Reeves et al, 2014), and in countries with less social protection (Norstrom and Gronqvist, 2015). There is only limited evidence on how the recent recession and macroeconomic pro cesses in general have affected suicide mortality in different socioeco nomic groups (Coope et al, 2014; Regidor et al, 2016)

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