Socioeconomic factors are major contributors to the increase in suicide deaths, study shows

A new study highlights the connection between socioeconomic factors and suicide rates. According to the study, unemployment, inequality in education and inadequate access to medical care were among the identified correlates of the increase in suicide deaths.

The study, led by Shannon Lange at the Institute for Mental Health Policy Research in Ontario, Canada, was published in The Lancet Regional Health: Americas.

The research team looked at two decades of data and identified several social and economic factors that played a role in the region’s suicide death rates. They write:

Specifically, using 20 years of data, we identified the following contextual factors that contributed to suicide death rates in the region, namely: alcohol consumption, educational inequality, health care expenditure, homicide rate, drug use intravenously, number of doctors employed, population density and unemployment rate.

Age-standardized male and female suicide mortality rate and trend over time in the Americas region, 2000-2019.  Diamonds indicate identified turning points.  AAPC: annual average percentage change;  PCA: annual percentage change.
The age-standardized male and female suicide death rate and trend over time in the Americas region, 2000-2019. Diamonds indicate identified turning points. AAPC: annual average percentage change; PCA: annual percentage change.

The researchers wanted to determine why the Americas (North, South, and Central America) have experienced an increase in suicide deaths over the past few decades, while other parts of the world have experienced a decline in suicide death rates.

To conduct the study, they collected suicide death rates, by age and gender, for 33 countries in the Americas from 2000 to 2019. A wide variety of contextual factors were included in the analysis, taken from organizations such as the World Bank and surveys such as the Global Burden of Disease (GBD) study. This allowed the researchers to compare changes over time while also looking at how different factors applied in other countries.

Low population density, high unemployment, and poor access to medical care have been associated with increased suicide rates for both men and women. However, the researchers noted that suicide involves sociocultural factors that are influenced by sex and gender, so they also determined specific factors unique to men and women.

For men alone, suicide increased if there were more homicides and if alcohol and drug abuse was more prevalent. For women alone, suicide was increased by higher rates of educational inequality.

While most of the contextual factors identified seem relatively intuitive and are supported by the current literature, the authors write, the proportion of the country with a moderate population density is less so at first glance.
However, recently, Steelesmith et al. found that between 1999 and 2016, suicide rates were higher and increased faster in rural areas than in large metropolitan counties in the United States; suggesting that rural areas may be more sensitive to the impact of social deprivation than more metropolitan counties. While increasing a country’s population density is not a realistic public health strategy for reducing the suicide death rate, enhancing social connectedness and civic opportunity may be worth exploring as potential suicide prevention strategies. suicide.

Current suicide prevention efforts focus primarily on the individual and are primarily concerned with providing psychiatric care to those considered to be at risk. However, it is unclear how effective this strategy has been as suicide rates continue to rise despite significantly increased rates of mental health treatment in the United States.

In some cases, the same treatments provided for suicide prevention can do more harm than good. For example, antidepressants, often prescribed in the United States for even mild emotional distress, have been shown to double the risk of suicide. Studies have also found that the involuntary (forced) hospitalization common for those expressing suicidal thoughts leads to an increase in suicide and discourages young people from reaching out in the future as well. Nor does screening adolescents for depression improve outcomes.

Although suicide is often viewed as part of a theoretical neurobiological illness (such as depression), the most consistent predictors of suicide are intense feelings of grief, hopelessness, and loneliness, which are effects of many of the correlates found in this study: inequality, lack of medical care, low population density, unemployment, etc.

Thus, the researchers write that instead of focusing on the individual, the most effective means of preventing suicide is societal change:

Multisectoral measures targeting health and social well-being in society, which are informed and developed using evidence on local contextual factors, should be emphasized in suicide prevention initiatives.

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Lange, S., Cayetano, C., Jiang, H., Tausch, A., & Oliveira and Souza, R. (2023). Contextual factors associated with nationwide suicide mortality in the Americas, 2000-2019: A cross-sectional ecological study. The Lancet Regional Health: Americas, 20(100450). https://doi.org/10.1016/j.lana.2023.100450 (Link)

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