Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States of America.
Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States of America.
Prev Med. 2020 Dec;141:106318. doi: 10.1016/j.ypmed.2020.106318. Epub 2020 Nov 4.
Unemployment is a risk factor for suicide. Unemployment insurance is the primary policy tool in the United States for alleviating the burden of unemployment on individuals. Our objective was to estimate the effect of state unemployment insurance accessibility on suicide rates, and effect modification by sociodemographic factors and unemployment rate. We used quarterly data from all 50 U.S. states and Washington, DC from 2000 to 2015, for a total of 3264 state-quarter units of analysis. The exposure was the quarterly unemployment insurance recipiency rate, i.e. the percentage of unemployed persons who received unemployment insurance. The outcome was the state-quarterly suicide rate per 100,000 population. Linear regression models included state, year, and calendar quarter fixed effects, state time trends, and state-level economic covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, educational attainment, age, gender, and race. Based on fully adjusted models, potential protective effects of higher unemployment insurance recipiency rates appear to be small and restricted to demographic groups at higher risk of suicide including men, non-Hispanic White Americans, and those 45-64 years of age. These groups also generally have higher UI recipiency rates, therefore differences in subgroup estimates may reflect variations in eligibility policies and accessibility of UI programs.
失业是自杀的一个风险因素。在美国，失业保险是缓解个人失业负担的主要政策工具。我们的目的是估计州失业保险的可及性对自杀率的影响，以及社会人口因素和失业率的调节作用。我们使用了 2000 年至 2015 年来自美国 50 个州和华盛顿特区的每季度数据，总共分析了 3264 个州季度单位。暴露因素是每季度的失业保险领取率，即领取失业保险的失业人数占比。结果是每 10 万人的州季度自杀率。线性回归模型包括州、年和日历季度固定效应、州时间趋势以及州级经济协变量，以解释州内随时间变化的混杂因素。我们评估了州失业率、教育程度、年龄、性别和种族等因素的调节作用。基于完全调整的模型，较高的失业保险领取率似乎具有较小的潜在保护作用，仅限于自杀风险较高的人群，包括男性、非西班牙裔白人和 45-64 岁的人群。这些人群的失业保险领取率通常也较高，因此亚组估计值的差异可能反映了资格政策和失业保险计划的可及性的差异。
