Fernández-Navarro P, Barrigón M L, Lopez-Castroman J, Sanchez-Alonso M, Páramo M, Serrano M, Arrojo M, Baca-García E
Cancer and Environmental Epidemiology Unit,National Centre for Epidemiology,Carlos III Institute of Health,Avda. Monforte de Lemos,5,28029 Madrid,Spain.
Department of Psychiatry,IIS-Jimenez Diaz Foundation,Autonoma University,CIBERSAM,Madrid,Spain.
Epidemiol Psychiatr Sci. 2016 Oct;25(5):475-484. doi: 10.1017/S2045796015000773. Epub 2015 Sep 2.
Recent research has shown an association between unemployment and suicide, but the mediating factors in this relationship are still unknown. In this study, we investigated the effect of unemployment and economic recession on suicide rates in the Spanish region of Galicia between 1975 and 2012 Method. We analysed age-standardised suicide rates in men and women and in four age groups: less than 25 years, 25-45 years, 45-65 years and more than 65 years and performed a joinpoint analysis to determine trend changes throughout 1975-2012 period. Also we analysed the association between suicide, recession and unemployment by means of a temporal trend model with a Generalised Additive Model.
Suicide rates increased from 145 suicides in 1975 to a high in 1993, with 377 deaths by suicide, representing 1.38% of all causes of death, and thereafter they tend to decrease to 335 suicides in 2012. Joinpoint analyses revealed that suicide rates changed differently across sex and age groups. For men, the annual percentage of change (APC) between 1975 and 1988 (CI 95% 1986-1994) was 5.45 (CI 95% = 3.5, -7.2) but from 1988 the APC became negative [-0.66 (CI 95% = -1.3, -0.1)]. For women, APC between 1974 and 1990 (CI 95% 1986-1992) was 4.86 (CI 95% = 3.2, -6.4) and -1.46 subsequently (CI 95% = -2.2, -0.5). Women aged 24 years or less showed stable suicide rates while men from 45-65 years showed two incidence peaks. When we studied the independent correlation between unemployment, recession and suicide, we found a significant association between unemployment and suicide, but not between recession and suicide for both sexes together and for men while for women there was no significant correlation between suicide and unemployment or recession. Finally, when we studied the effect of the interaction between unemployment and recession on suicide we found economic recession and unemployment interacted with regards to suicide rates (F = 5.902; df = 4.167; p = 0.00098) and after adjusting by sex, the effect was confirmed among men (F = 4.827; df = 2.823; p = 0.0087), but not among women (F = 0.001; df = 1.000; p = 0.979).
Although suicide rates in Galicia are gradually decreasing in the last decades, there are important sex and age differences. Unemployment was related with suicide during economic recession periods according to our results.
近期研究表明失业与自杀之间存在关联，但这种关系中的中介因素仍不明确。在本研究中，我们调查了1975年至2012年间西班牙加利西亚地区失业和经济衰退对自杀率的影响。方法：我们分析了男性和女性以及四个年龄组（小于25岁、25 - 45岁、45 - 65岁和大于65岁）的年龄标准化自杀率，并进行了连接点分析以确定1975 - 2012年期间的趋势变化。此外，我们通过广义相加模型的时间趋势模型分析了自杀、衰退和失业之间的关联。
自杀率从1975年的145例自杀增加到1993年的高位，有377例自杀死亡，占所有死因的1.38%，此后趋于下降，到2012年为335例自杀。连接点分析显示，自杀率在不同性别和年龄组中的变化不同。对于男性，1975年至1988年（95%置信区间1986 - 1994）的年变化百分比（APC）为5.45（95%置信区间 = 3.5， - 7.2），但从1988年起APC变为负数[-0.66（95%置信区间 = - 1.3， - 0.1）]。对于女性，1974年至1990年（95%置信区间1986 - 1992）的APC为4.86（95%置信区间 = 3.2， - 6.4），随后为 - 1.46（95%置信区间 = - 2.2， - 0.5）。24岁及以下的女性自杀率稳定，而45 - 65岁的男性有两个发病高峰。当我们研究失业、衰退与自杀之间的独立相关性时，我们发现失业与自杀之间存在显著关联，但对于男女总体以及男性而言，衰退与自杀之间不存在显著关联，而对于女性，自杀与失业或衰退之间不存在显著相关性。最后，当我们研究失业与衰退之间的相互作用对自杀的影响时，我们发现经济衰退和失业在自杀率方面存在相互作用（F = 5.902；自由度 = 4.167；p = 0.00098），在按性别调整后，这种影响在男性中得到证实（F = 4.827；自由度 = 2.823；p = 0.0087），但在女性中未得到证实（F = 0.001；自由度 = 1.000；p = 0.979）。
尽管加利西亚地区的自杀率在过去几十年中逐渐下降，但存在重要的性别和年龄差异。根据我们的研究结果，在经济衰退时期，失业与自杀有关。
