Unemployment and suicide in the Stockholm population: A register-based study on 771,068 men and women

doi:10.1016/j.puhe.2012.01.020

Public Health

Volume 126, Issue 5, May 2012, Pages 371-377

https://doi.org/10.1016/j.puhe.2012.01.020 Get rights and content

Summary

Objectives

Several studies have reported a higher risk of suicide among the unemployed. Some individuals may be more prone to both unemployment and suicide due to an underlying health-related factor. In that case, suicide among the unemployed might be a consequence of health-related selection. This study aimed to investigate the relationship between unemployment and suicide, and the importance of previous sickness absence to this relationship.

Study design

The study was based on 771,068 adults aged 25–58 years in Stockholm County in 1990–1991. Data on sickness absence in 1990–1991 and unemployment in 1991–1993 were collected from registers for each individual. Time and cause of death in 1994–1995 were obtained from Sweden’s Cause of Death Register.

Methods

The association between sickness absence in 1990–1991 and unemployment in 1992–1993, and the association between unemployment in 1992–1993 and suicide in 1994–1995 was investigated using logistic regression.

Results

Unemployment lasting for >90 days in 1992–1993 was associated with suicide in men in 1994–1995 [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.38–3.38], while unemployment lasting for ≤90 days in 1992–1993 was associated with suicide in women in 1994–1995 (OR 2.68, 95% CI 1.23–5.85). Higher levels of sickness absence were related to an increased risk of subsequent unemployment in both sexes. The higher prevalence of sickness absence among the unemployed attenuated the association between unemployment and suicide in both men and women.

Conclusions

Unemployment is related to suicide. Individuals in poor health are at increased risk of unemployment and also suicide. The higher relative risk of suicide among the unemployed seems to be, in part, a consequence of exclusion of less healthy individuals from the labour market.

Introduction

Several studies have reported a higher prevalence of ill health1, 2, 3, 4 and excess mortality5, 6, 7, 8, 9 among the unemployed, but the causal relationship between unemployment and health is not clearly understood. People who are ill may be more prone to job loss, and/or less likely to be re-employed, as a consequence of health-related selection. However, several studies have found a strong association between unemployment and suicide,5, 7, 10, 11, 12, 13, 14, 15 even after adjusting for pre-existing illness.10, 14, 15, 16

Recent studies have found an association between sickness absence and subsequent unemployment.17, 18, 19 In a Finnish study of municipal and hospital personnel, sickness absence was found to be related to job termination generally among people in permanent employment, and particularly among older individuals (41–51 years of age).¹⁷ In a Dutch study based on subjects employed in postal and telecommunication companies, those with frequent and long-term absence from work showed an increased risk of involuntary job loss at 4-year follow-up.¹⁸ In a Swedish follow-up of a national sample of 25–53 year olds, sickness absence was found to be associated with unemployment over the subsequent 4 years.¹⁹

In a Finnish study of healthcare workers, hospitalization due to a psychiatric diagnosis predicted subsequent unemployment.²⁰ Studies in French²¹ and Finnish²² settings have also shown that sickness absence predicts suicide. The present authors have previously shown that psychiatric diagnosis antecedent to unemployment confounds the association between unemployment and suicide among Swedish middle-aged men.⁹ However, sickness absence was found to contribute most strongly to reducing the relative risk of suicide associated with unemployment, due to strong associations between sickness absence and mental illness and other risk factors for suicide. That study only covered men born between 1949 and 1951. The population of the present study consisted of 386,885 men and 384,183 women who lived in Stockholm County in 1990 and 1991, and who were between 25 and 58 years of age in 1990.

The present study investigated whether individuals who became unemployed in 1992–1993 were at increased risk of suicide, and if so, to what extent this was due to confounding by ill health, indicated by higher prevalence of sickness absence in 1990–1991, among the unemployed.

Section snippets

Subjects

Information on income from paid employment, sickness allowance and unemployment compensation was obtained from the Longitudinal Register of Education and Labour Market Statistics (LOUISE), a statistical register based on administrative data held by Statistics Sweden, which covers all individuals aged ≥16 years residing in Sweden. Individuals aged <25 years were not included in the study population since, as a group, they are less established on the labour market. People receiving a disability

Results

The entire study population consisted of 771,068 individuals (386,885 men and 384,183 women), of which 766,996 were alive at the start of follow-up (384,243 men and 382,753 women). Of these, 645,121 (84%) had not received a disability pension (in 1990–1991 or 1992–1993) and had an annual income of at least SEK 29,700 in 1990 and SEK 32,200 in 1991 (324,994 men and 320,127 women).

Discussion

This study found that unemployment for >90 days in 1992–1993 was associated with an increased risk of suicide in 1994–1995 in men but not in women before controlling for confounders. Unemployment for ≤90 days was only associated with an increased risk of suicide in women, also before controlling for confounders. Further, individuals in poor health, as indicated by higher levels of sickness absence before unemployment, were found to be at increased risk of becoming unemployed. For men, the

Acknowledgments

Ethical approval

Ethical approval for using the anonymized database was granted by the Karolinska Institutet Research Ethics Committee (Ref. No. 2010/221-31/5).

Funding

This study was financed by the Swedish Council for Working Life and Social Research (Project No ).

Competing interests

None declared.

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Original ResearchUnemployment and suicide in the Stockholm population: A register-based study on 771,068 men and women

Summary

Objectives

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Subjects

Results

Discussion

Acknowledgments

Lancet

J Health Econ

Public Health

J Socio-Econ

J Psychosom Res

Unemployment and serious suicide attempts

Psychol Med

Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men

Int J Epidemiol

Employment status, employment conditions, and limiting illness: prospective evidence from the British household panel survey 1991–2001

J Epidemiol Commun Health

Unemployment, depressiveness and disability retirement: a follow-up study of the Finnish HeSSup population sample

Soc Psychiatry Psychiatr Epidemiol

Unemployment and suicide. Evidence for a causal association?

J Epidemiol Commun Health

Unemployment and mortality in Denmark, 1970–80

BMJ (Clin Res Ed)

Loss of employment and mortality

BMJ

Unemployment and mortality – a longitudinal prospective study on selection and causation in 49 321 Swedish middle aged men

J Epidemiol Commun Health

Unemployment and mortality among Finnish men, 1981–5

BMJ

Unemployment and suicide: a cohort analysis of social factors predicting suicide in the US national longitudinal mortality study

Psychol Med

Original Research
Unemployment and suicide in the Stockholm population: A register-based study on 771,068 men and women