The Impact of Economic Crisis on Suicide in Asia and other Regions

Hardly could we forget the economic recession in 2008 has brought drastic unemployment and worries to our society, and the upheaval is still affecting countries around the world. With all the observations and statistics collected, in March 28, 2011, the Centre for Suicide Research and Prevention of the University of Hong Kong is honored to have Professor David Gunnell showing us impact of this crisis on suicide in Asia and other regions. Also focusing on Taiwan, especially, Dr Shu-shen Chang presented geographic variations of suicide found in his studies.


The Impact of Economic Crisis on Suicide in Asia and Other Regions
by Prof David Gunnell

The recent economic crisis has led to rises in unemployment and falls in GDP in affected countries around the world. Its impact on mental health and suicide risk is yet to be seen but there are some signals of increases in rates. Prospective studies indicate that unemployed men and women are at 2-3 fold increased risk of suicide, although some of this increased risk is because people with psychiatric illness are at greater risk of losing their jobs. However, even in people with no record of serious mental illness, unemployment is associated with around 70% increase in risk. Cohort studies with repeat measures of employment status and mental health show job loss is associated with an increased risk of depression and self-harm. Evidence of impact of loss of income and bankruptcy on suicide is less clear.

What can be learnt from past recessions? In the great depression of the 1920s-1930s increases in unemployment were closely paralleled by rises in suicide. A recent analysis of the Asian Economic Crisis (1997-8) indicates that the crisis resulted in an excess of >10,000 suicides in 1998 compared to 1997 in Japan, Hong Kong and Korea (Chang S-S et al 2009). But Asian countries were affected to differing degrees; understanding reasons for these differences will shed light on appropriate policy measures to reduce the impact of the crisis on mental health and suicide. Recent work from Europe (Stuckler et al 2009) has begun to clarify such measures. As well as labour market interventions, community support agencies should be adequately resourced to help people with problems arising from job loss, debt, and mortgage arrears and the media should be advised to report suicides related to job loss/financial difficulties responsibly to reduce the risk of copy-cat deaths.

About the speaker

Professor David Gunnell’s research is focused on two main areas: (1) national and international population strategies for preventing suicide and improving mental health; (2) early life influences on adult chronic disease risk – particularly mental illness – and the biological mechanisms underlying these influences. He is a National Institute of Health Research (NIHR) Senior Investigator and leads an NIHR-funded (AWP hosted) programme of research in support of the National Suicide Prevention Strategy for England with colleagues in Bristol, Oxford and Manchester. He is a member of the MHRA’s Pharmacovigillance Expert Advisory Group and the National Suicide Prevention Advisory Group and has acted as an advisor to WHO on their strategy to reduce suicides through pesticide ingestion. Working with Mike Nowers (AWP), he has studied deaths from the Clifton Suspension Bridge and evaluated the impact of the barriers erected on the Bridge in 1998 as a result of this work. Current areas of research: (i) piloting an intervention to reduce suicides following discharge from psychiatric hospitals; (ii) investigating psychiatric adverse drug reactions (suicide / self-harm); (iii) reviewing the reliability of national suicide statistics; (iv) developing a register of attempted suicides in Bristol; (v) developing school based interventions to promote emotional health; (vi) evaluating strategies to reduce the global burden of pesticide poisoning.

Link to presentation slides


Geography of Suicide in Taiwan: Spatial Patterning and Socioeconomic Correlates
by Dr Shu-Sen Chang

In industrialised Western nations suicide rates tend to be high in inner city areas and socially fragmented neighbourhoods. Few studies have investigated spatial variations in suicide in non-Western settings. We estimated smoothed standardised mortality ratios (1999–2007) for suicide for each of the 358 Taiwanese districts (median population aged 15+: 27,000) and investigated their associations with area characteristics using Bayesian hierarchical models. The geographic distribution of suicide was similar in men and women; young people showed the greatest spatial variation in rates. Rates were highest in East Taiwan, a mostly mountainous rural area. There was no evidence of above average rates in large cities. Spatial patterns of method-specific suicide rates varied markedly, with solids/liquids poisonings showing the greatest geographic variation and hangings the least. Factors most strongly associated with area suicide rates were median household income, population density and lone-parent households. Spatial patterning of suicide in Taiwan differed from that observed in Western nations. Suicide prevention strategies should take into account unique local patterns.

About the speaker

Dr. Shu-Sen Chang, M.D. PhD., got his PhD on School of Social and Community Medicine, University of Bristol, Bristol, UK. His thesis title: An investigation into secular trends and geographic variations in suicide in Taiwan and supervisors: was Professors David Gunnell and Jonathan AC Sterne) on 2010. He got the award of Postdoctoral Research Abroad Program, National Science Council in Taiwan at 2010. He is also a Certified psychiatrist & Licensed physician from Department of Health in Taiwan. Currently, he is a Post-doctoral fellow on School of Social and Community Medicine on University of Bristol, in UK now.

Link to presentation slides



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