Correspondence

Effects of the 2008 recession on health: a first look at European data

Variations in suicide following the initial COVID-19 pandemic outbreak were heterogeneous across space, over time, and across population subgroup. Whether suicide has increased during the pandemic in Spain, a major initial COVID-19 hotspot, remains unclear, and no study has examined differences by sociodemographic group.

We used 2016–2020 data on monthly suicide deaths from Spain's National Institute of Statistics. We implemented Seasonal Autoregressive Integrated Moving Average (SARIMA) models to control seasonality, non-stationarity, and autocorrelation. Using January 2016–March 2020 data, we predicted monthly suicide counts (95 % prediction intervals) between April and December 2020, and then compared observed and predicted monthly suicide counts. All calculations were conducted for the overall study population and by sex and age group.

Between April and December 2020, the number of suicides in Spain was 11 % higher-than-predicted. Monthly suicide counts were lower-than-expected in April 2020 and peaked in August 2020 with 396 observed suicides. Excess suicide counts were particularly salient during the summer of 2020 – largely driven by over 50 % higher-than-expected suicide counts among males aged 65 years and older in June, July, and August 2020.

The number of suicides increased in Spain during the months following the initial COVID-19 pandemic outbreak in Spain, largely driven by increases in suicides among older adults. Potential explanations underlying this phenomenon remain elusive. Important factors to understand these findings may include fear of contagion, isolation, and loss and bereavement – in the context of the particularly high mortality rates of older adults during the initial phases of the pandemic in Spain.

Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.

Between 2008 and 2009 suicide rates in Chile were higher than those observed before and after, increasing more than in other countries in Latin America. The Great Recession has been suggested as an important factor behind this increase. This study assesses the excess of suicide attributable to the crisis in Chile, a “mature” neoliberal society with a precarious social security system, low salaries, and high levels of indebtedness, and identifies the most relevant economic variables that may contribute to this excess. We pooled data since 2000 on monthly suicide rates, unemployment, economic activity and perception of problematic indebtedness for different sex and age groups. We adopted an interrupted time series design with Poisson regressions models adjusted for monthly variations and non-linear pre-crisis trajectories via restricted cubic splines. We then further controlled for economic variables to evaluate their possible contributions to suicide increase attributable to the economic crisis. Suicide mortality during the crisis period was higher than in the previous period in all sex and age groups. Overall, we estimated that 301 suicides (95% CI: 181 to 422) were attributable to the crisis in Chile. This excess was concentrated among men younger than 65 and women 65 and older. Including unemployment and indebtedness perception in the models reduced the excess of suicides. The increase was concentrated in the first half of the crisis and an early pre-crisis effect could be observed when anticipating the crisis beginning by three months. Results suggest that the Great Recession had an impact on suicide mortality in Chile and that increase in unemployment and indebtedness could be related to this increase. Results by sex and age are consistent with the most vulnerable groups in the context of Chilean neoliberalism. For future crises, improving unemployment insurance, and reinforcing suicide prevention attending to the economic context should be a priority.

The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period.

We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender.

There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18–35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed.

A few patients may have received initial care in an emergency department after SA without being referred to psychiatry.

In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.

It is widely believed that during the Great Depression (1929–1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates

The data concerning suicide, homicide, economic and climatic variables for the years 1900–1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed.

The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900–1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922.

The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health

The current work investigates the heterogeneous effect of the 2008 recession on health outcomes in the Italian population across the main geographic areas. Health outcomes were proxied by individual-level information on healthy/risky behaviors, such as individual fruit and vegetable consumption, frequency of bodyweight monitoring, smoking, and alcohol intake. These health outcomes were employed as dependent variables in the empirical model that included some socioeconomic individual aspects (e.g., age, gender, education, and income source), as well as consumer price index data for tobacco products, alcoholic beverages, and fruit and vegetables. In this work, we used twelve years of data (2005–2016) from the Italian Multipurpose Household Survey (MHS), which collects individual self-reported characteristics, augmented with information on unemployment rates at the regional level, as well as with consumer price indexes for the goods analyzed. The results indicated that the 2008 economic crisis lowered the probability that individuals engage in healthy behaviors, such as self-monitoring their bodyweight, mostly among individuals in northern and central areas. Likewise, the economic downturn increased the probability of smoking regardless of the geographic area, with a larger magnitude in individuals in northern and central areas, whose health outcomes were more impacted by the economic downturn than individuals living in the southern and island areas.