Research report
Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis Chee Hon Chan,1,2 Eric D Caine,3,4 Sungeun You,5 King Wa Fu,6 Shu Sen Chang,1,2 Paul Siu Fai Yip1,2 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/jech2013-202759). 1
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong 2 Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, Hong Kong 3 Injury Control Research Center for Suicide Prevention and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA 4 VA Center of Excellence for Suicide Prevention, Canandaigua, New York, USA 5 Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea 6 Journalism and Media Studies Centre, University of Hong Kong, Hong Kong, Hong Kong Correspondence to Professor Paul Yip, Centre for Suicide Research and Prevention, HKJC Multidisciplinary Research Building, 2nd Floor, No. 5 Sassoon Road, Pokfulam Received 18 April 2013 Revised 24 October 2013 Accepted 25 October 2013 Published Online First 18 November 2013
ABSTRACT Background Multiple studies have shown that macroeconomic factors are associated with changes in suicide rates. We investigated how changes in economic conditions associated with the recent economic crisis in South Korea influenced suicide rates among working-age adults. Methods Time-series analyses were performed to examine the temporal associations of national unemployment rates and sex-employment-specific suicide rates in South Korea from 2003 to 2011, with particular attention to the increases of suicides that occurred during the recessionary period that began in 2008. We also compared the relative risk of suicide among different occupations. Results National unemployment rates were positively associated with suicide rates among employed and unemployed men and women, with a 2-month to 3 month lagged period. Significant increases of suicide rates among working-age adults during the recession were detected in most of the subgroups stratified by age, sex and employment status. Forty-three per cent of the increase of suicides was derived from the employed population. Compared with workers in elementary occupations, the relative risk of suicide for mangers increased by threefold during the recessionary period. Among those who were employed, half of the increases in suicides occurred among clerks and workers involved in sales and services. Conclusions Changes in macroeconomic conditions are tied to population-level suicide risks for employed and unemployed persons. However, these associations vary depending on sex, employment status and occupational roles. In advance of future economic crises, it is important to develop prevention initiatives intended to reach the diverse populations potentially exposed to the adverse effects of sudden economic disruptions.
INTRODUCTION
To cite: Chan CH, Caine ED, You S, et al. J Epidemiol Community Health 2014;68:246–252. 246
Macroeconomic factors have been shown repeatedly to be associated with significant changes in suicide rates when measured at a population level. Multiple studies have tied rising unemployment rates to short-term increases in suicide rates.1–5 At the individual level, job loss or insecurity has also been viewed as key contributors to increased suicide risk.6 A recent study from Hong Kong found that, at a time when unemployment increased, a greater proportion of suicides were from employed adults rather than the unemployed.5 Those findings underscored, as well, the need to separate population-level indicators and individual employment status. Among the employed, suicide risk has been shown to differ across occupations.7 Recent investigations
have further highlighted that fluctuating labour market conditions may disproportionally influence suicide rates in different occupational groups.8 Following the recovery from the 1997 Asian financial economic crisis, South Korea experienced sustained economic growth until 2008. Its economy shrank beginning in late 2008, continuing for three consecutive quarters; the unemployment rate began to rise during the first quarter of 2009, which continued into 2010. While the suicide rate of South Korea had declined from 2005 to 2008, it increased sharply to 33.8 per 100 000 people in 2009.9 By 2012, the suicide rate remained at a historic high level, 31.7 per 100 000 people, the highest level among the Organisation for Economic Co-operation and Development countries and above neighbouring regional countries (eg, China, Japan). In light of previous studies that described a link between macroeconomic forces and suicide rates in South Korea,10–12 we decided to explore in greater depth the timing and impact of changing unemployment rates on workers—employed and unemployed, and stratified by sex, age and occupation.
METHOD Sample and data analyses We collected South Korean mortality data coded X60 to X84 (intentional self-harm) and Y10 to Y34 (event of undetermined intent) in the ICD-10 from January 2003 through December 2011 from the National Statistical Office of Korea (NSO). Within this period, there were 117 300 suicides and 19 452 undetermined deaths. For each death, we obtained information on the date of death, age, sex, employment status and the type of occupation. The categorisation of occupation obtained from NSO includes: manager and senior officials; professionals; clerks; sales and service workers; agriculture, fishery, forestry; craft and related trades; process, plant, and machine operatives; and elementary workers. South Korean national unemployment, population and occupation statistics were obtained from the NSO website. NSO conducts the census for the South Korean population every 5 years (ie, 2005 and 2010), and it is the official government body to collect employment statistics. Given the nature of the information used, based on analyses of deidentified data and population statistics, this study was exempted from ethical review by the Human Research Ethics Committee for Non-Clinical Faculties, The University of Hong Kong.
Statistical analyses The analysis was organised in three parts. First, we used autoregressive (AR) time-series
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
Research report modelling to ascertain whether there was a temporal association between the Korean monthly national unemployment rates and Korean monthly suicide rates, specific to sex and employment status. Since changes of economic conditions may have a lagged effect on suicide rates, we explored the association with a 0-month to 6 month lagged unit. Given that previous research had described that three high profile celebrity suicides were related to increases in the suicide rate in March 2005, February 2007, October 2008 and December 2008,13 we used a dummy variable in the AR models to adjust for these effects. Also, seasonality of the series was adjusted. Second, we performed an interrupted time-series analysis to investigate whether there was significant increase of Korean sex×age×employment suicide rates after the onset of the 2008 global financial crisis. Similar to previous studies,1 2 we decided to use the national unemployment rate as the indicator of the economic environment; as expected, the Korean unemployment rate modestly lagged the start and the finish of the period of gross domestic product contraction (typical of its status as a ‘lagging indicator’). The period between January 2003 and December 2008 in which the unemployment rate remained relatively stable was marked as the ‘precrisis period,’ whereas the period with an abrupt increase of unemployment, between January 2009 and December 2010, was considered as the ‘recessionary period.’ In all models, we used step functions taking the precrisis period as reference to assess the increase of the suicide rate during the recessionary period. The effect of celebrity suicides and seasonality of the series were adjusted. To determine the numerical increase of suicides during the recessionary period, we used this equation DSijk ¼ rijk Pijk DSijk ¼ rijk Pijk for estimation; where ΔSijk denotes the numerical increase of suicides in a specific age(i), sex ( j) and employment status (k) group, r is the estimated increase of suicide rate of an age-sex-employment-specific group from the AR model, and P is the size of the corresponding population. Estimates of the increased suicide rate (r) from the AR models take into account the autocorrelation of the residual in the series. Hence, using it to proxy the numerical increase should be more stringent than direct computation from count data based on simple ordinary least-square extrapolation. Third, we stratified suicide counts based on occupation types, and computed the relative risks (RRs) for each occupation during the precrisis and the recessionary periods. Also, we assessed the numerical increases of suicides stratified by occupation during the latter period. In both time-series analyses, we focused on the working-age population, defined as ages 20–59 years. Individuals younger than 20 years or 60 years old and above were considered as students and retirees, respectively. Based on the employment statistics from NSO, approximately 90% of the employed population in the study period fell in the 20–59 year-old age range. The adequacy of all time-series models was checked by visual inspection of the autocorrelation function and partial autocorrelation function to ascertain absence of autocorrelation in the residuals. Box’s test with multiple lag time was performed. For the exploration of occupation-specific suicide risk, we included populations who were labelled as employed by the NSO. Crude age-sex-employment-specific or occupation-specific suicide rates are calculated by dividing the number of suicides of the specific group by the corresponding population. All analyses were performed in R. Statistical significance was set at 0.05.
RESULTS Temporal associations between unemployment rate and sex-employment specific suicide rate Figure 1 displays the temporal association between the Korean national unemployment rate and the sex-employment-specific suicide rates with 0-month to 6 month lagged units. Among the unemployed population, the Korean national unemployment rate was positively and significantly associated with the unemployed suicide rate of men and women, with a 2-month and a 3-month lagged unit (unemployed men: 2-month lagged β=1.21, 95% CI 0.14 to 2.29; 3-month lagged β=2.54, 95% CI 1.68 to 3.40; unemployed women: 2-month lagged β=0.44, 95% CI 0.06 to 0.83; 3-month lagged β=0.61, 95% CI 0.21 to 1.01). For the employed population, although the associations were somewhat weaker, significant associations also were noted between the national unemployment rate and the employed suicide rate of men and women, with a 2-month lagged unit (employed men: β=0.26, 95% CI 0.06 to 0.46; employed women: β=0.15, 95% CI 0.02 to 0.28) and a 3-month lagged unit (employed men: β=0.33, 95% CI 0.13 to 0.53; employed women: β=0.20, 95% CI 0.06 to 0.35). Examining the association of sex-specific unemployment rates and sex×employment specific suicide rates, we detected that the sex-specific unemployment rate was significantly tied to employed-sex-specific and unemployed-sex-specific suicide rates, with either a 2-month lagged unit or a 3-month lagged unit (see online supplementary appendix 1). The increase in the male unemployment rate was associated with a larger increase in suicide rates for men and women in the employed and unemployed groups, as compared with increased unemployment among women.
Increase of suicide in the recessionary period after financial crisis Table 1 summarises the increase of suicide rates and the numerical increases of suicides during the recessionary period ( January 2009 to December 2010). Suicide rate increases were relatively higher among unemployed than employed groups. Nonetheless, significant increases were detected among all subgroups, except for employed men and women in their 50s, and unemployed men in their 30s. Among women of all age groups, suicide rate increases were relatively higher among the unemployed than the employed, and the numerical increases of suicides among unemployed women were greater than the employed. Among men, the increase of suicide rates was also higher in unemployed groups than the employed groups. Although the increase in suicide rates among men aged 30–49 years was higher among unemployed persons, the absolute numerical contribution to the suicide burden was greater among the employed in these age groups. For the entire group ages 20–59 years, the increase of suicides among men was greater among the employed (n=1431, 51%) than the unemployed (n=1376, 49%); for women, the increase in suicides reflected a greater contribution from members of the unemployed group (n=1525, 67%) than the employed (n=768, 33%). Combining suicides of both sex, the employed group accounted for 43% of the increase in deaths.
Occupation-specific suicide trends among the employed Occupational stratified suicide trends for the employed population are shown in figure 2. The suicide trends of all occupation groups during the precrisis period appeared to be either stable or steadily decreasing. Table 2 summarises findings of the differential occupational suicide risk and the annual
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
247
Research report Figure 1 Temporal association of the national unemployment rate and the (lagged) sex-employment-specific suicide rate. The x-axis denotes the lagged unit of the association. The y-axis shows the beta of the association between the national unemployment rate and the sex-employment-specific suicide rate. The upper and lower bounds of the error bars show the 95% CI of the association.
suicide cases of each occupation during the precrisis and the recessionary period. In both periods, the suicide risks for workers in elementary occupations were used as the reference. We observed a relatively greater suicide risk among agriculture, fishery and forestry workers (RR=5.52, 95% CI 4.93 to 6.18), and among clerks (RR=1.35, 95% CI 1.19 to 1.53), and sales and service workers (RR=1.34, 95% CI 1.19 to 1.51) during the precrisis period. The RR of suicide for the 248
latter two groups increased during the recessionary period, and their numerical increase of suicides was greatest among all occupational groups, accounting for 53% of the total increase. In contrast, the suicide risk of the agriculture, fishery and forestry decreased during the recessionary period (accounting for 5% decrease of total suicides), although these groups continue to present the greatest risks across all occupations Managers and senior officials (RR=0.75, 95% CI 0.57
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
Research report Table 1 Increase of suicide rates and numerical increase of suicides during the recessionary period ( January 2009 to December 2010) Numerical increase of suicides
Men 20 to 29 years 30 to 39 years 40 to 49 years 50 to 59 years Women 20 to 29 years 30 to 39 years 40 to 49 years 50 to 59 years
Increase of suicide rates Employed
Unemployed
Employed n (95% CI)
Unemployed n (95% CI)
Beta (95% CI)
p Value
Beta (95% CI)
p Value
old old old old
205 482 456 288
(133 to 283) (268 to 697) (84 to 828) (−60 to 636)
315 136 284 641
(217 to 416) (−85 to 357) (190 to 605) (158 to 1125)
0.48 0.54 0.49 0.43
(0.31 to 0.66) (0.30 to 0.78) (0.09 to 0.89) (−0. 09 to 0.95)
Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis Chee Hon Chan,1,2 Eric D Caine,3,4 Sungeun You,5 King Wa Fu,6 Shu Sen Chang,1,2 Paul Siu Fai Yip1,2 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/jech2013-202759). 1
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong 2 Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, Hong Kong 3 Injury Control Research Center for Suicide Prevention and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA 4 VA Center of Excellence for Suicide Prevention, Canandaigua, New York, USA 5 Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea 6 Journalism and Media Studies Centre, University of Hong Kong, Hong Kong, Hong Kong Correspondence to Professor Paul Yip, Centre for Suicide Research and Prevention, HKJC Multidisciplinary Research Building, 2nd Floor, No. 5 Sassoon Road, Pokfulam Received 18 April 2013 Revised 24 October 2013 Accepted 25 October 2013 Published Online First 18 November 2013
ABSTRACT Background Multiple studies have shown that macroeconomic factors are associated with changes in suicide rates. We investigated how changes in economic conditions associated with the recent economic crisis in South Korea influenced suicide rates among working-age adults. Methods Time-series analyses were performed to examine the temporal associations of national unemployment rates and sex-employment-specific suicide rates in South Korea from 2003 to 2011, with particular attention to the increases of suicides that occurred during the recessionary period that began in 2008. We also compared the relative risk of suicide among different occupations. Results National unemployment rates were positively associated with suicide rates among employed and unemployed men and women, with a 2-month to 3 month lagged period. Significant increases of suicide rates among working-age adults during the recession were detected in most of the subgroups stratified by age, sex and employment status. Forty-three per cent of the increase of suicides was derived from the employed population. Compared with workers in elementary occupations, the relative risk of suicide for mangers increased by threefold during the recessionary period. Among those who were employed, half of the increases in suicides occurred among clerks and workers involved in sales and services. Conclusions Changes in macroeconomic conditions are tied to population-level suicide risks for employed and unemployed persons. However, these associations vary depending on sex, employment status and occupational roles. In advance of future economic crises, it is important to develop prevention initiatives intended to reach the diverse populations potentially exposed to the adverse effects of sudden economic disruptions.
INTRODUCTION
To cite: Chan CH, Caine ED, You S, et al. J Epidemiol Community Health 2014;68:246–252. 246
Macroeconomic factors have been shown repeatedly to be associated with significant changes in suicide rates when measured at a population level. Multiple studies have tied rising unemployment rates to short-term increases in suicide rates.1–5 At the individual level, job loss or insecurity has also been viewed as key contributors to increased suicide risk.6 A recent study from Hong Kong found that, at a time when unemployment increased, a greater proportion of suicides were from employed adults rather than the unemployed.5 Those findings underscored, as well, the need to separate population-level indicators and individual employment status. Among the employed, suicide risk has been shown to differ across occupations.7 Recent investigations
have further highlighted that fluctuating labour market conditions may disproportionally influence suicide rates in different occupational groups.8 Following the recovery from the 1997 Asian financial economic crisis, South Korea experienced sustained economic growth until 2008. Its economy shrank beginning in late 2008, continuing for three consecutive quarters; the unemployment rate began to rise during the first quarter of 2009, which continued into 2010. While the suicide rate of South Korea had declined from 2005 to 2008, it increased sharply to 33.8 per 100 000 people in 2009.9 By 2012, the suicide rate remained at a historic high level, 31.7 per 100 000 people, the highest level among the Organisation for Economic Co-operation and Development countries and above neighbouring regional countries (eg, China, Japan). In light of previous studies that described a link between macroeconomic forces and suicide rates in South Korea,10–12 we decided to explore in greater depth the timing and impact of changing unemployment rates on workers—employed and unemployed, and stratified by sex, age and occupation.
METHOD Sample and data analyses We collected South Korean mortality data coded X60 to X84 (intentional self-harm) and Y10 to Y34 (event of undetermined intent) in the ICD-10 from January 2003 through December 2011 from the National Statistical Office of Korea (NSO). Within this period, there were 117 300 suicides and 19 452 undetermined deaths. For each death, we obtained information on the date of death, age, sex, employment status and the type of occupation. The categorisation of occupation obtained from NSO includes: manager and senior officials; professionals; clerks; sales and service workers; agriculture, fishery, forestry; craft and related trades; process, plant, and machine operatives; and elementary workers. South Korean national unemployment, population and occupation statistics were obtained from the NSO website. NSO conducts the census for the South Korean population every 5 years (ie, 2005 and 2010), and it is the official government body to collect employment statistics. Given the nature of the information used, based on analyses of deidentified data and population statistics, this study was exempted from ethical review by the Human Research Ethics Committee for Non-Clinical Faculties, The University of Hong Kong.
Statistical analyses The analysis was organised in three parts. First, we used autoregressive (AR) time-series
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
Research report modelling to ascertain whether there was a temporal association between the Korean monthly national unemployment rates and Korean monthly suicide rates, specific to sex and employment status. Since changes of economic conditions may have a lagged effect on suicide rates, we explored the association with a 0-month to 6 month lagged unit. Given that previous research had described that three high profile celebrity suicides were related to increases in the suicide rate in March 2005, February 2007, October 2008 and December 2008,13 we used a dummy variable in the AR models to adjust for these effects. Also, seasonality of the series was adjusted. Second, we performed an interrupted time-series analysis to investigate whether there was significant increase of Korean sex×age×employment suicide rates after the onset of the 2008 global financial crisis. Similar to previous studies,1 2 we decided to use the national unemployment rate as the indicator of the economic environment; as expected, the Korean unemployment rate modestly lagged the start and the finish of the period of gross domestic product contraction (typical of its status as a ‘lagging indicator’). The period between January 2003 and December 2008 in which the unemployment rate remained relatively stable was marked as the ‘precrisis period,’ whereas the period with an abrupt increase of unemployment, between January 2009 and December 2010, was considered as the ‘recessionary period.’ In all models, we used step functions taking the precrisis period as reference to assess the increase of the suicide rate during the recessionary period. The effect of celebrity suicides and seasonality of the series were adjusted. To determine the numerical increase of suicides during the recessionary period, we used this equation DSijk ¼ rijk Pijk DSijk ¼ rijk Pijk for estimation; where ΔSijk denotes the numerical increase of suicides in a specific age(i), sex ( j) and employment status (k) group, r is the estimated increase of suicide rate of an age-sex-employment-specific group from the AR model, and P is the size of the corresponding population. Estimates of the increased suicide rate (r) from the AR models take into account the autocorrelation of the residual in the series. Hence, using it to proxy the numerical increase should be more stringent than direct computation from count data based on simple ordinary least-square extrapolation. Third, we stratified suicide counts based on occupation types, and computed the relative risks (RRs) for each occupation during the precrisis and the recessionary periods. Also, we assessed the numerical increases of suicides stratified by occupation during the latter period. In both time-series analyses, we focused on the working-age population, defined as ages 20–59 years. Individuals younger than 20 years or 60 years old and above were considered as students and retirees, respectively. Based on the employment statistics from NSO, approximately 90% of the employed population in the study period fell in the 20–59 year-old age range. The adequacy of all time-series models was checked by visual inspection of the autocorrelation function and partial autocorrelation function to ascertain absence of autocorrelation in the residuals. Box’s test with multiple lag time was performed. For the exploration of occupation-specific suicide risk, we included populations who were labelled as employed by the NSO. Crude age-sex-employment-specific or occupation-specific suicide rates are calculated by dividing the number of suicides of the specific group by the corresponding population. All analyses were performed in R. Statistical significance was set at 0.05.
RESULTS Temporal associations between unemployment rate and sex-employment specific suicide rate Figure 1 displays the temporal association between the Korean national unemployment rate and the sex-employment-specific suicide rates with 0-month to 6 month lagged units. Among the unemployed population, the Korean national unemployment rate was positively and significantly associated with the unemployed suicide rate of men and women, with a 2-month and a 3-month lagged unit (unemployed men: 2-month lagged β=1.21, 95% CI 0.14 to 2.29; 3-month lagged β=2.54, 95% CI 1.68 to 3.40; unemployed women: 2-month lagged β=0.44, 95% CI 0.06 to 0.83; 3-month lagged β=0.61, 95% CI 0.21 to 1.01). For the employed population, although the associations were somewhat weaker, significant associations also were noted between the national unemployment rate and the employed suicide rate of men and women, with a 2-month lagged unit (employed men: β=0.26, 95% CI 0.06 to 0.46; employed women: β=0.15, 95% CI 0.02 to 0.28) and a 3-month lagged unit (employed men: β=0.33, 95% CI 0.13 to 0.53; employed women: β=0.20, 95% CI 0.06 to 0.35). Examining the association of sex-specific unemployment rates and sex×employment specific suicide rates, we detected that the sex-specific unemployment rate was significantly tied to employed-sex-specific and unemployed-sex-specific suicide rates, with either a 2-month lagged unit or a 3-month lagged unit (see online supplementary appendix 1). The increase in the male unemployment rate was associated with a larger increase in suicide rates for men and women in the employed and unemployed groups, as compared with increased unemployment among women.
Increase of suicide in the recessionary period after financial crisis Table 1 summarises the increase of suicide rates and the numerical increases of suicides during the recessionary period ( January 2009 to December 2010). Suicide rate increases were relatively higher among unemployed than employed groups. Nonetheless, significant increases were detected among all subgroups, except for employed men and women in their 50s, and unemployed men in their 30s. Among women of all age groups, suicide rate increases were relatively higher among the unemployed than the employed, and the numerical increases of suicides among unemployed women were greater than the employed. Among men, the increase of suicide rates was also higher in unemployed groups than the employed groups. Although the increase in suicide rates among men aged 30–49 years was higher among unemployed persons, the absolute numerical contribution to the suicide burden was greater among the employed in these age groups. For the entire group ages 20–59 years, the increase of suicides among men was greater among the employed (n=1431, 51%) than the unemployed (n=1376, 49%); for women, the increase in suicides reflected a greater contribution from members of the unemployed group (n=1525, 67%) than the employed (n=768, 33%). Combining suicides of both sex, the employed group accounted for 43% of the increase in deaths.
Occupation-specific suicide trends among the employed Occupational stratified suicide trends for the employed population are shown in figure 2. The suicide trends of all occupation groups during the precrisis period appeared to be either stable or steadily decreasing. Table 2 summarises findings of the differential occupational suicide risk and the annual
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
247
Research report Figure 1 Temporal association of the national unemployment rate and the (lagged) sex-employment-specific suicide rate. The x-axis denotes the lagged unit of the association. The y-axis shows the beta of the association between the national unemployment rate and the sex-employment-specific suicide rate. The upper and lower bounds of the error bars show the 95% CI of the association.
suicide cases of each occupation during the precrisis and the recessionary period. In both periods, the suicide risks for workers in elementary occupations were used as the reference. We observed a relatively greater suicide risk among agriculture, fishery and forestry workers (RR=5.52, 95% CI 4.93 to 6.18), and among clerks (RR=1.35, 95% CI 1.19 to 1.53), and sales and service workers (RR=1.34, 95% CI 1.19 to 1.51) during the precrisis period. The RR of suicide for the 248
latter two groups increased during the recessionary period, and their numerical increase of suicides was greatest among all occupational groups, accounting for 53% of the total increase. In contrast, the suicide risk of the agriculture, fishery and forestry decreased during the recessionary period (accounting for 5% decrease of total suicides), although these groups continue to present the greatest risks across all occupations Managers and senior officials (RR=0.75, 95% CI 0.57
Chan CH, et al. J Epidemiol Community Health 2014;68:246–252. doi:10.1136/jech-2013-202759
Research report Table 1 Increase of suicide rates and numerical increase of suicides during the recessionary period ( January 2009 to December 2010) Numerical increase of suicides
Men 20 to 29 years 30 to 39 years 40 to 49 years 50 to 59 years Women 20 to 29 years 30 to 39 years 40 to 49 years 50 to 59 years
Increase of suicide rates Employed
Unemployed
Employed n (95% CI)
Unemployed n (95% CI)
Beta (95% CI)
p Value
Beta (95% CI)
p Value
old old old old
205 482 456 288
(133 to 283) (268 to 697) (84 to 828) (−60 to 636)
315 136 284 641
(217 to 416) (−85 to 357) (190 to 605) (158 to 1125)
0.48 0.54 0.49 0.43
(0.31 to 0.66) (0.30 to 0.78) (0.09 to 0.89) (−0. 09 to 0.95)
