Abstract
Objectives
Suicide became the first cause of death between the ages of 15 and 44 in Spain in the year 2013. Moreover, the suicide rate in Spain went up by more than 9 % with respect to the previous year. This increase could be related to the serious economic recession that Spain has been experiencing in recent years. In this sense, there is a lack of evidence to help assess to what extent these suicides have a social cost in terms of losses in human capital. Firstly, this article examines the relationship between the variables related to the economic cycle and the suicide rates in the 17 Spanish regions. Secondly, an estimate is made of the losses in labour productivity owing to these suicides.
Methodology
In this article, panel data models are used to consider different variables related to the economic cycle. Demographic variables and the suicide rates for regions across Spain from 2002 to 2013 also come into play. The present and future production costs owing to premature death from suicide are calculated using a human capital model. These costs are valued from the gross salary that an individual no longer receives in the future at the very moment he or she leaves the labour market.
Results
The results provide a strong indication that a decrease in economic growth and an increase in unemployment negatively affect suicide rates. Due to suicide, 38,038 potential years of working life were lost in 2013. This has an estimated cost of over 565 million euros.
Conclusions
The economic crisis endured by Spain in recent years has played a role in the higher suicide rates one can observe from the data in official statistics. From a social perspective, suicide is a public health problem with far-reaching consequences.
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Notes
External cause of death relates to cases where the underlying cause of death is determined to be one of a group of causes external to the body (for example suicide, transport accidents, falls or poisoning). These are found in chapter XX of the International Statistical Classification of Diseases and Related Health Problems (ICD 10).
Quantities expressed in euros for 2012.
How long a person can receive benefits is influenced by the amount of time he or she had been paying National Insurance as a worker in the 6 years prior to becoming legally unemployed. The arrangement has a scale that includes 360 days of work leading to 120 days of unemployment benefit. Therefore the maximum payment of National Insurance of 6 years (2160 days) leads to a maximum period of coverage of 720 days.
Since 2004, the EES [72] was carried out on a yearly basis to complement the results from the Four-Yearly Salary Structure Survey. The methodologies and classifications used for both surveys are different. In 2003, the survey had not been carried out; for this reason, there are no data.
References
Instituto Nacional de Estadística-INE: Estadística de Defunciones según la causa de muerte, INE, Madrid (2014)
Alvarez-Galvez, J., Rodero-Cosano, M., Métrico, E., Salinas-Pérez, J., García-Alonso, C., Salvador-Carulla, L.: The impact of socio-economic status on self-rated health: study of 20 countries using European social surveys (2002-2008). Int. J. Environ. Res. Public Health 10(3), 747–761 (2013)
Alvarez-Galvez, J., Rodero-Cosano, M., García-Alonso, C., Salvador-Carulla, L.: Changes in socioeconomic determinants of health: comparing the effect of social and economic indicators through European welfare state regimes. J. Public Health 22(4), 305–311 (2014)
Ruiz-Ramos, M., Córdoba-Doña, J.A., Bacigalupe, A., Juarez, S., Escolar-Pujoral, A.: Crisis económica al inicio del siglo XXI y mortalidad en España. Tendencia e impacto sobre las desigualdade sociales. Informe SESPAS 2014. Gac. Sanit. 28, 89–96 (2014)
De Vogli, R., Marmot, M., Stuckler, D.: Excess suicides and attempted suicides in Italy attributable to the great recession. J. Epidemiol. Commun. H. 67, 378–379 (2013)
Dávila-Qintana, C.D., Lopez-Valcarcel, B.G.: Secuelas a largo plazo de la crisis económica y desigualdades sociales en salud. Rev. Esp. Salud Pública 88(2), 187–190 (2014)
Kentikelenis, A., Karanikolos, M., Papanicolas, I., Basu, S., McKee, M., Stuckler, D.: Health effects of financial crisis: omens of a Greek tragedy. Lancet 378(9801), 1457–1458 (2011)
World Health Organization- WHO: Impact of economic crisis on mental health. WHO, Copenhagen (2011)
Dooley, D., Fielding, J., Levi, L.: Health and unemployment. Annu. Rev. Public Health 17, 949–965 (1996)
Kasl, S.L., Jones, B.: The impact of job loss and retirement on health. In: Berkman, L., Kawachi, I. (eds.) Social epidemiology, pp. 118–136. Oxford University Press, Oxford (2000)
Lopez, J.A., Gasparrini, A., Artundo, C.M., McKee, M.: The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur. J. Public Health 24(2), 183–184 (2014)
Librero, J., Segura, A., López-Valcarcel, B.: Suicides, hurricanes and economic crisis. Eur. J. Pub. Health 24, 183 (2013)
Masedo-Gutierrez, A.I., Moreno-Kustner, B.: Economic crisis and mortality by suicide: two concepts hard to link. Eur. J. Public Health. Available on line at: http://eurpub.oxfordjournals.org/content/early/2015/05/09eurpub.ckv0
Henriksson, M.M., Aro, H.M., Kuoppasallmi, K.I.: Mental disorders and comorbidity in suicide. Am. J. Psychiatry 150, 935–940 (1993)
Harris, E.C., Barradough, B.: Suicide as an outcome for mental disorders. A meta-analysis. 170, 205–228 (1997)
Hagnell, O., Lanke, J., Rorsman, B.: Suicide rates in the Lundby study: mental illness as a risk factor for suicide. Neuropsychobiology 7, 248–253 (1981)
World Health Organization-WHO: Preventing suicide. A global imperative. WHO, Geneva (2014)
Becker, G.: Human capital: a theoretical and empirical analysis with special reference to education. Columbia University Press, New York (1964)
Grossman, M.: The demand for health: a theoretical and empirical investigation. Columbia University Press, New York (1972)
Grossman, M.: The human capital model. Handb. Health Econ. 1, 347–408 (2000)
Durkheim, E.: Le Suicide. Felix Alcan, Paris (1897)
Dublin, L.I., Bunzel, B.: To be or not to be. Smith&Haas, New York (1933)
Henry, A.F., Short, J.F.: Suicide and homicide. Free Press, New York (1954)
Ginsberg, R.B.: Anomie and aspirations. Diss. Abstr. 27A, 3945–3946 (1966)
Hamermesh, A.S., Soss, N.M.: An economic theory of suicide. J. Polit. Econ. 82, 83–98 (1974)
Yeh, B.Y., Lester, D.: An economic model for suicide. In: Lester, D. (ed.) Suicide as a learned behaviour, pp. 51–57. Springfield, Charles Thomas (1987)
Chang, S.S., Gunnell, D., Sterne, J.A., Lu, T.H., Cheng, A.T.: 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. 68, 1322–1331 (2009)
Chang, S., Stuckler, D., Yip, P., Gunnell, D.: Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ-Brit. Med. J. 347, 5239f (2013)
Stuckler, D., Meissner, C., Fishback, P., Basu, S., McKee, M.: Banking crises and mortality during the great depression: evidence from US urban populations, 1927–1939. J. Epidemiol. Commun. 66, 410–419 (2011)
Economou, M., Madianos, M., Theleritis, C., Peppou, L.E., Stefanis, C.N.: Increased suicidality amid economic crisis in Greece. Lancet 378, 459–460 (2011)
Reeves, A., Stuckler, D., Mckee, M., Gunnell, D., Chang, S., Basu, S.: Increase in state suicide rates in the USA during the economic recession. Lancet 380, 1813–1814 (2012)
Sullivan, E.M., Annest, J.L., Luo, F., Simon, T., Dahlberg, L.L.: Suicide among adults aged 35–64 years—United States, 1999–2010. Morb. Mortal. Wkly Rep. 62, 321–326 (2013)
McKee, M., Karanikolos, M., Belcher, P., Stuckler, D.: Austerity: a failed experiment on the people of Europe. Clin. Med. 12, 346–350 (2012)
Antonakakis, N.: Fiscal austerity, unemployment and suicide in Greece. MPRA Paper, 45198 (2013)
Madianos, M.G., Alexiou, T., Patelakis, A., Economou, M.: Suicide, unemployment and other socioeconomic factors: evidence from the economic crisis in Greece. Eur. J. Psychiatry. 28(1), 39–49 (2014)
Muñoz, S., García, P., García de Fernando, S., Portabales, L., Moreno, L., Severino, A., Polo, C.: Conducta suicida y crisis económica. Norte de Salud Mental 12(48), 36–43 (2014)
Breed, W.: Occupational mobility and suicide among white males. Am. Sociol. Rew. 28, 179–188 (1963)
Andrés, A.R., Halicioglu, F., Yamamura, E.: Socio-economic determinants of suicide in Japan. J. Socio-Econ 40, 723–731 (2011)
Tapia Granados, J.A.: Recession and mortality in Spain, 1980–1997. Eur. J. Popul. 21, 393–422 (2005)
Browning, M., Heinesen, E.: Effect of job loss due to plant closure on mortality and hospitalization. J. Health Econ. 31, 599–616 (2012)
Chen, J., Choi, Y., Sawada, Y.: How is suicide different in Japan? Jpn. World Econ. 21(2), 140–150 (2009)
Milner, A., Page, A., LaMontagna, A.: Long-term unemployment and systematic review and meta-analysis. PLoS One 8(1), e51333 (2013)
Chen, J., Choi, Y.C., Mori, K., Sawada, Y., Sugano, S.: Recession, unemployment, and suicide mortality in Japan. Jpn. Labour Rev 9, 75–92 (2012)
Breuer, C.: Unemployment and suicide mortality: evidence from regional panel data in Europe. GFS Working Papers, 2 (2014)
Defina, R., Hannon, L.: The changing relationship between unemployment and suicide. Suicide Life Threat. Behav. (2014). doi:10.1111/sltb.12116
Córdoba-Doña, J.A., San Sebastian, M., Escolar-Pujolar, A., Martínez-Faure, J.E., Gustafsson, E.: Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain. Int J Equity Health 13, 55 (2014)
Urbanos, R.M., Lopez-Valcarcel, B.G.: The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ 16, 175–184 (2015)
Stoudemire, A., Frank, R., Hedemark, N., Kamlet, M., Blazer, D.: The economic burden of depression. Gen. Hosp. Psychiatry 8, 387–394 (1986)
Weinstein, M. C., Saturno, P. J.: Economic impact of youth suicide and suicide attempts. Report of the Secretary’s Task Force on Youth Suicide, 4, 82–93. United States Government Printing Office. Washington D.C. (1989)
Palmer, C.S., Revicki, D.A., Halpern, M.T., Hatziandreu, E.J.: The cost of suicide and suicide attempts in the United States. Clin. Neuropharmacol. 18(Suppl. 3), S25–S33 (1995)
Kennelly, B.: The economic cost of suicide in Ireland. Crisis. 28(2), 89–94 (2007)
Zhou, Y., Baker, T.D., Rao, K., Li, G.: Productivity losses from injury in China. Injury Prev. 9, 124–127 (2003)
O’Dea, D., Tucker, S.: The cost of suicide to society. Ministry of Health, Wellington (2005)
Coggan, C.A., Fanslow, J.L., Norton, R.N.: Intentional injury in New Zealand. Analysis and Monitoring Report 4. Public Health Commission. Wellington: (1995)
Gene-Badia, J., Gallo, P., Hernandez-Quevedo, C., Garcia-Armesto, S.: Spanish health care cuts: penny wise and pound foolish? Health Policy 106, 23–28 (2012)
Houston, M., Day, M., de Lago, M., Zarocostas, J.: Health services across Europe face cuts as debt crisis begins to bite. BMJ Brit. Med. J. 343, d5266 (2011)
Maluquer de montes, J.: La economía española en perspectiva histórica. Pasado&Presente, Barcelona (2014)
Instituto Nacional de Estadística-INE: Encuesta de Población Activa. INE. Madrid (2014)
Instituto Nacional de Estadística-INE.: Encuesta de Condiciones de Vida. INE. Madrid (2014)
Instituto Nacional de Estadística-INE.: Contabilidad Regional de España. INE. Madrid (2014)
Abellán, A.: El suicidio entre las personas de edad. Revista Multidisciplinar de Gerontología. 15(1), 65–67 (2005)
Durkheim, E.: Suicide: a study in sociology. Free Press, New York (1951)
Yang, B., Lester, D.: Recalculating the economic cost of suicide. Death Stud. 31(4), 351–361 (2007)
Andrés, A.R.: Income inequality, unemployment, and suicide: a panel data analysis of 15 European countries. Appl. Econ. 3, 439–451 (2005)
Instituto Nacional de Estadística. INE.: Movimiento Natural de la Población.INE, Madrid (2015)
Instituto Nacional de Estadística. INE.: Estadística del Padrón Continuo. INE, Madrid (2015)
Breuer, C.: Unemployment and suicide mortality: evidence from regional panel data in Europe. Health Econ (2014). doi:10.1002/hec.3073
Instituto Nacional de Estadísitica. INE.: Boletín Mensual de Estadística. Climatología, Madrid (2015)
Instituto Nacional de Estadística. INE.: Estadística de nulidades, separaciones y divorcios, Madrid (2015)
Koo, J., Cox, W.M.: An economic interpretation of suicide cycles in Japan. Contemp. Econ. Policy 26(1), 162–174 (2008)
Oliva, J.: Pérdidas laborales ocasionadas por la enfermedades y problemas de salud en España en el año 2005. Papeles de trabajo del Instituto de Estudios Fiscales 5/10 (2010)
Instituto Nacional de Estadística-INE.: Encuesta de Estructura Salarial. INE. Madrid (2014)
Fenoglio, P., Parel, V., Kopp, P.: The social cost of alcohol, tobacco and illicit drugs in France, 1997. Eur. Addict. Res. 9(1), 18–28 (2003)
Pinto, J.L., Sánchez, F.I.: Métodos para la evaluación económica de nuevas prestaciones. Ministerio de Sanidad y Consumo, Madrid (2003)
Oliva, J.: Loss of labour productivity caused by disease and health problems: what is the magnitude of its effect on Spainʼs economy? Eur. J. Health Econ. 13(5), 605–614 (2012)
United Nations.: World Productivity Database. Available online at: http://www.unido.org/data1/wpd/Index.cfm (2007)
Cubí-Molla, P., Peña-Longobardo, L.M., Casal, B., Rivera, B., Oliva, J.: Pérdidas laborales atribuibles a la mortalidad prematura por lesiones de tránsito entre 2002 y 2012. http://dx.doi.org/10.106/gaceta2015.03.004
Rockett, I., McKinley, T.: Reliability and sensitivity on suicide certification in higher-income countries. Suicide Life Threat. Behav. 29, 141 (1999)
Branas, ChC, Kastanaki, A.E., Michaloditrakis, M., Tzougas, J., Kranioti, E.F., Theodorakis, P.N., Carr, B.G., Wiebe, D.J.: The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ Open 5(1), 1–11 (2015)
Alameda-Palacios, J., Ruiz-Ramos, M., García-Robredo, B.: Suicídio, prescripción de antidepresivos y desempleo em Andalucía. Gac. Sanit. 28(4), 309–312 (2014)
Carulla, L.S., Roca, M.: Mental health impact of the economic crisis in Spain. Int. Psychiatry 10(1), 8–10 (2013)
Dávila Quintana, C.D., Gónzalez López-Valcárcel, B.: Crisis económica y salud. Gac. Sanit. 23(4), 261–265 (2009)
Koopmanschap, M.A., Rutten, F.F., van Ineveld, B.M., van Roijen, L.: The friction cost method for measuring indirect cost of disease. J. Health Econ. 14(2), 171–189 (1995)
Johannesson, M., Karlsson, G.: The friction cost method: a comment. J. Health Econ. 16, 249–256 (1997)
Liljas, B.: How to calculate indirect costs in economic evaluations. PharmacoEconomics 13, 1–8 (1998)
Ayala, L., Rodriguez, M.: Health-related effects of welfare-to-work policies. Soc. Sci. Med. 93, 103–112 (2013)
Acknowledgments
The authors would like to acknowledge the support received from the research project ECON2013-48217-C2-2R “Impacto económico, sanitario y social de las enfermedades y los problemas de salud: información y herramientas para la evaluación de políticas públicas”.
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Rivera, B., Casal, B. & Currais, L. Crisis, suicide and labour productivity losses in Spain. Eur J Health Econ 18, 83–96 (2017). https://doi.org/10.1007/s10198-015-0760-3
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DOI: https://doi.org/10.1007/s10198-015-0760-3