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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

Methodological barriers to studying the association between the economic crisis and suicide in Spain

Authors: Javier Alvarez-Galvez, Jose A. Salinas-Perez, María Luisa Rodero-Cosano, Luis Salvador-Carulla

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

The hypothetical relationship between economic recession and the increase in suicides in Spain is subject to various arguments. In addition to the inherent complexity of capturing and explaining the underlining mechanisms that could describe this causal link, different points of contention have been be identified. The period of this association and its possible starting points, the socioeconomic determinants that may explain the variation in suicide rate, and the data sources available are the main focus of controversy. The present study aims to identify the phases of association between different periods of economic recession and suicide rates, and compare the effect of different social determinants of health that have been mentioned in previous studies.

Methods

We have used interrupted time series analyses to assess the impact of economic recession on national rates of suicide mortality provided by the Spanish Statistical Office (1980–2014). In an attempt to consider the factors that have affected the study of suicide in Spain, different data sources/periods, predictors, and regions in Spain were analysed.

Results

The analysis revealed a positive and significant relationship between the Great Recession and suicide rates during the second period of economic recession (2011–2014), while appeared to decrease during the first recession period. However, the first decreasing trend was not statistically significant in the global analysis of the evolution of monthly suicide rates for the entire country. Both unemployment and per capita GDP were positively related to suicide trends. Finally, the regional analysis demonstrates a similar pattern in different Spanish areas.

Conclusion

Although previous studies have mentioned the double-dip in the suicide rate associated with the corresponding period of double recession, our study only identify a positive relationship during the second recession period. These results points out that the major impact of economic problems might have had a delayed effect due to initial protection policies.
Literature
1.
Saxena S, Krug EG, Chestnov O, World Health Organization, editors. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014. 89 p.
2.
Perry IJ, Corcoran P, Fitzgerald AP, Keeley HS, Reulbach U, Arensman E. The incidence and repetition of hospital-treated deliberate self harm: findings from the World’s first National Registry. PLoS One. 2012;7(2):e31663.CrossRefPubMedPubMedCentral
3.
Reeves A, McKee M, Stuckler D. Economic suicides in the great recession in Europe and North America. Br J Psychiatry J Ment Sci. 2014;205(3):246–7.CrossRef
4.
Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet Lond Engl. 2013;381(9874):1323–31.CrossRef
5.
6.
Falagas ME, Vouloumanou EK, Mavros MN, Karageorgopoulos DE. Economic crises and mortality: a review of the literature. Int J Clin Pract. 2009;63(8):1128–35.CrossRefPubMed
7.
Bosch X, Moreno P, López-Soto A. The painful effects of the financial crisis on Spanish health care. Int J Health Serv Plan Adm Eval. 2014;44(1):25–51.CrossRef
8.
Gallo P, Gene-Badia J. Cuts drive health system reforms in Spain. Health Policy Amst Neth. 2013;113(1–2):1–7.
9.
Lopez Bernal JA, Gasparrini A, Artundo CM, McKee M. The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur J Pub Health. 2013;23(5):732–6.CrossRef
10.
Ruiz-Perez I, Rodriguez-Barranco M, Rojas-Garcia A, Mendoza-Garcia O. Economic crisis and suicides in Spain. Socio-demographic and regional variability. Eur J Health Econ. 2017;18(3):313–20.CrossRef
11.
Alameda-Palacios J, Ruiz-Ramos M, Garcia-Robredo B. Suicide, antidepressant prescription and unemployment in Andalusia (Spain). Gac Sanit SESPAS. 2014;28(4):309–12.CrossRef
12.
Córdoba-Doña JA, San Sebastián M, Escolar-Pujolar A, Martínez-Faure JE, Gustafsson PE. Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain. Int J Equity Health. 2014;13:55.CrossRefPubMedPubMedCentral
13.
Saurina C, Marzo M, Saez M. Inequalities in suicide mortality rates and the economic recession in the municipalities of Catalonia. Spain Int J Equity Health. 2015;14(1):75.CrossRefPubMed
14.
Iglesias-García C, Sáiz PA, Burón P, Sánchez-Lasheras F, Jiménez-Treviño L, Fernández-Artamendi S, et al. Suicide, unemployment, and economic recession in Spain. Rev Psiquiatr Salud Ment Engl Ed. 2017;10(2):70–7.CrossRef
15.
Librero J, Segura A, Beatriz L-V. Suicides, hurricanes and economic crisis. Eur J Public Health. 2014;24(2):183.CrossRefPubMed
16.
Masedo-Gutierrez AI, Moreno-Kustner B. Economic crisis and mortality by suicide: two concepts hard to link. Eur J Public Health. 2015;25(5):900.CrossRefPubMed
17.
Giner L, Guija JA. Number of suicides in Spain: differences between data from the Spanish statistical office and the Institutes of Legal Medicine. Rev Psiquiatr Salud Ment. 2014;7(3):139–46.CrossRefPubMed
18.
Álvaro-Meca A, Kneib T, Gil-Prieto R. Gil de Miguel a. Epidemiology of suicide in Spain, 1981–2008: a spatiotemporal analysis. Public Health. 2013;127(4):380–5.CrossRefPubMed
19.
Chang S-S, Gunnell D, Sterne JAC, Lu T-H, Cheng ATA. Was the economic crisis 1997–1998 responsible for rising suicide rates in east/Southeast Asia? A time–trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Soc Sci Med. 2009;68(7):1322–31.CrossRefPubMed
20.
Salvador-Carulla L, Roca M. Mental health impact of the economic crisis in Spain. Int Psychiatry. 2013;10(1):8–10.
21.
Roca M, Gili M, Garcia-Campayo J, Garcia-Toro M. Economic crisis and mental health in Spain. Lancet. 2013;382:1977–8.CrossRefPubMed
22.
23.
Urbanos-garrido RM, Lopez-valcarcel BG. The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ HEPAC. 2015;16(2):175–84.CrossRefPubMed
24.
Baron RC, Salzer MS. Accounting for unemployment among people with mental illness. Behav Sci Law. 2002;20(6):585–99.CrossRefPubMed
25.
26.
Gotsens M, Marí-Dell’Olmo M, Rodríguez-Sanz M, Martos D, Espelt A, Pérez G, et al. Validación de la causa básica de defunción en las muertes que requieren intervención medicolegal. Rev Esp Salud Pública. 2011;85(2):163–174.
27.
StataCorp. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP; 2015.
28.
Huitema BE, McKean JW. Design specification issues in time-series intervention models. Educ Psychol Meas. 2000;60(1):38–58.CrossRef
29.
Linden A, Adams JL. Applying a propensity score-based weighting model to interrupted time series data: improving causal inference in programme evaluation. J Eval Clin Pract. 2011;17(6):1231–8.CrossRefPubMed
30.
Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J. 2015;15(2):480–500.
31.
Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55.
32.
Glonti K, Gordeev VS, Goryakin Y, Reeves A, Stuckler D, McKee M, et al. A Systematic Review on Health Resilience to Economic Crises. PLoS One. 2015;10(4):e0123117.CrossRefPubMedPubMedCentral
33.
Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, et al. Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys. PLoS Med. 2009;6(8):e1000123.CrossRefPubMedPubMedCentral
34.
Laanani M, Ghosn W, Jougla E, Rey G. Impact of unemployment variations on suicide mortality in western European countries (2000–2010). J Epidemiol Community Health. 2015;69(2):103.CrossRefPubMed
35.
Cordoba-Dona JA, San Sebastian M, Escolar-Pujolar A, Martinez-Faure JE, Gustafsson PE. Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, southern Spain. Int J Equity Health. 2014;13:55.CrossRefPubMedPubMedCentral
36.
Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Pub Health. 2013;23(1):103–8.CrossRef
37.
Bartoll X, Palència L, Malmusi D, Suhrcke M, Borrell C. The evolution of mental health in Spain during the economic crisis. Eur J Pub Health. 2014;24(3):415–8.CrossRef
38.
O’Donoghue B, Lyne JP, Fanning F, Kinsella A, Lane A, Turner N, et al. Social class mobility in first episode psychosis and the association with depression, hopelessness and suicidality. Schizophr Res. 2014;157(1–3):8–11.CrossRefPubMed
39.
Santurtún M, Santurtún A, Zarrabeitia MT. ¿ Afecta el medio a los suicidios que se cometen en España? Análisis descriptivo del patrón temporoespacial. Rev Psiquiatr Salud Ment. 2017. doi:10.​1016/​j.​rpsm.​2017.​05.​001.
40.
Preston S, Heuveline P, Guillot M. Demography: measuring and modeling population processes. New York: Wiley-Blackwell; 2000. p308.
41.
42.
Metadata
Title
Methodological barriers to studying the association between the economic crisis and suicide in Spain
Authors
Javier Alvarez-Galvez
Jose A. Salinas-Perez
María Luisa Rodero-Cosano
Luis Salvador-Carulla
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4702-0

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