There were more than 1,000 excess suicides in England during the 2008-10 economic downturn, a time trend analysis has found.

Annual suicide rates for 93 local areas of England during the period 2000-10 were obtained from the National Clinical and Health Outcomes Database. As the validity of regional suicide rates is influenced by substantial variation in coroners’ use of narrative verdicts,1 deaths from undetermined injuries were counted as suicides. The number of people claiming unemployment benefit was obtained from the Office of National Statistics.

Prior to 2008, the rate of suicides was declining by 83 per annum. Between 2008 and 2010, there were 846 more male suicides and 155 more female suicides than would have occurred if the historical downward trend had continued.

When regional data were compared, a significant association was found between the number of men who experienced job loss and the number of male suicides: for each 10% increase in unemployment there was a 1.4% increase in suicides (95% CI: 0.5-2.3%). However, there was no significant association between job loss and suicide among women. These results suggest that around two fifths (329) of the excess male suicides can be attributed to loss of employment.

The study may have been underpowered to detect a significant association between job loss and suicide among women. However, there is evidence to suggest that married women with family responsibilities are resilient to the effects of job loss, whereas middle-aged men with dependent families are particularly vulnerable.2

Work provides material wellbeing, meets important psychosocial needs and gives a sense of identity and social status. Conversely, unemployment is associated with poor physical health, disability, psychological distress, depression and increased rates of overall mortality, death from cardiovascular disease, cancer and suicide.2 A British study of the health effects of a factory closure observed a significant increase in general practice consultation rates, referrals and hospital attendances.3

It is essential to make and document an assessment of suicidal risk for every patient presenting with depression or emotional distress. This should incorporate a review of long-term risk factors, short-term risk factors e.g. being unemployed, precipitating factors e.g. recent job loss, and protective factors.4

Those who are excessively dependent upon their work for a sense of self-esteem, or who compensate for negative core beliefs through achievement at work will be at particular risk if they are dismissed from their jobs.

Dr Phillip Bland