By: Katherine A. Hempstead, PhD, Julie A. Phillips, PhD
Since 1999, suicide rates for middle-aged adults in the U.S. have risen approximately 40% but have remained stable for other age groups.1 One explanation for the rising suicide rates focuses on the detrimental effects that the economic downturn of 2007–2009, sometimes called the Great Recession, may have had on those in midlife. 2–4 Evidence suggests that the downturn disproportionately affected the middle-aged in terms of house values, household finances, and hits to retirement accounts.5,6 For example, 27% of workers aged 50–64 years experienced reductions in salaries during the recession, compared with 19% of workers agedo30 years, 22% of those aged 30–49 years, and 20% of those aged 465 years. The hardship and feelings of failure or hopelessness associated with these conditions are compounded by the fact that middle-aged adults are more likely than others to be family breadwinners and supporting dependents.
The great majority of suicidal behavior stems from individual factors, most notably those related to mental illness, health problems, and other personal issues. Access to lethal means also importantly affects suicide risk.7,8 However, there is also evidence that macro context can affect suicide rates. Numerous studies, using both U.S. and cross-national data, provide some support for well-known Durkheimian arguments that levels of social integration and regulation, proxied by, among other measures, unemployment levels, are associated with suicide.9 Exploring the link between business cycles and suicide between 1928 and 2007 in the U.S., Luo and colleagues10 showed that the total suicide rate tends to rise during periods of economic recession and fall during expansions, with the association most pronounced for those aged between 25 and 64 years. In fact, a number of studies link the recent economic crisis to rising suicide rates in a number of different settings using a variety of methodologic approaches.11–15 The effect has been particularly pronounced for the middle-aged and for men.
However, attempts to explore the effect of economic factors on suicide are hampered by lack of information about the circumstances of individual suicides. To the authors’ knowledge, almost all prior studies examining the effects of the Great Recession in the U.S. rely on aggregate-level data and estimate empirical models of the relationship between indicators such as unemployment and suicide rates across U.S. states or countries. Thus, this line of research cannot eliminate the possibility of an ecologic fallacy. A notable exception is a study by McInerney et al.,16 which used individual-level data to show that wealth losses associated with the 2008 stock market crash significantly increased depressive symptoms and the use of antidepressants. Albeit intriguing, this study cannot directly tie changes in external circumstances to suicide deaths.
The current study provides new evidence on this issue by using data from a unique surveillance system, the National Violent Death Reporting System (NVDRS), which contains rich circumstance data at the individual level. Although limited to completed suicides, these data allow the analysis of how suicide circumstances may have changed in ways that reflect the growing importance of economic crises as a risk factor for suicide. This study uses NVDRS data from 2005 to 2010 to examine whether the prevalence of suicide circumstances related to economic distress has increased over the time period, with a focus on those aged 40–64 years. This study also explores the relationship between circumstance and method in this age group as compared with others, in light of findings that the proportion of suicides committed by suffocation relative to other methods has increased for the middle-aged since 1999.1 The study examines whether and how circumstances are related to method and if such a relationship can explain the rise in suffocation observed over the period, and then concludes by considering the implications of these results for prevention efforts.
