Cunningham R, Milner A, Gibb S, Rijnberg V, Disney G, Kavanagh A M
Department of Public Health, University of Otago Wellington, Newtown Wellington, New Zealand.
Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
Psychol Med. 2021 Apr 20:1-9. doi: 10.1017/S0033291721000994.
Unemployment and being not in the labour force (NILF) are risk factors for suicide, but their association with self-harm is unclear, and there is continuing debate about the role of confounding by prior mental health conditions. We examine associations between employment status and self-harm and suicide in a prospective cohort, taking into account prior mental-health-related factors.
We used linked data from the New Zealand Integrated Data Infrastructure. The outcomes were chosen to be hospital presentation for self-harm and death by suicide. The exposure was employment status, defined as employed, unemployed, or NILF, measured at the 2013 Census. Confounders included demographic factors and mental health history (use of antidepressant medication, use of mental health services, and prior self-harm). Logistic regression was used to model effects. Analyses were stratified by gender.
For males, unemployment was associated with an increased risk of suicide [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.20-1.84] and self-harm (OR: 1.55, 95% CI: 1.45-1.68) after full adjustment for confounders. NILF was associated with an increased risk of self-harm (OR: 1.43, 95% CI: 1.32-1.55), but less of an association was seen with suicide (OR: 1.19, 95% CI: 0.94-1.49). For females, unemployment was associated with an increased risk of suicide (OR: 1.30, 95% CI: 0.93-1.80) and of self-harm (OR: 1.52, 95% CI: 1.43-1.62), and NILF was associated with a similar increase in risk for suicide (OR: 1.31, 95% CI: 0.98-1.75) and self-harm (OR: 1.32, 95% CI: 1.26-1.40).
Exclusion from employment is associated with a considerably heightened risk of suicide and self-harm for both men and women, even among those without prior mental health problems.
失业和未就业（不在劳动力队伍中）是自杀的风险因素，但它们与自我伤害的关联尚不清楚，并且对于既往心理健康状况造成的混杂作用的角色仍存在持续的争论。我们在一个前瞻性队列中研究就业状况与自我伤害及自杀之间的关联，同时考虑既往与心理健康相关的因素。
我们使用了来自新西兰综合数据基础设施的关联数据。结局指标选为因自我伤害而住院治疗以及自杀死亡。暴露因素为就业状况，定义为就业、失业或未就业，于2013年人口普查时测量。混杂因素包括人口统计学因素和心理健康史（使用抗抑郁药物、使用心理健康服务以及既往自我伤害情况）。采用逻辑回归对效应进行建模。分析按性别分层。
对于男性，在对混杂因素进行完全调整后，失业与自杀风险增加相关[比值比（OR）：1.48，95%置信区间（CI）：1.20 - 1.84]以及自我伤害风险增加相关（OR：1.55，95% CI：1.45 - 1.68）。未就业与自我伤害风险增加相关（OR：1.43，95% CI：1.32 - 1.55），但与自杀的关联较弱（OR：1.19，95% CI：0.94 - 1.49）。对于女性，失业与自杀风险增加相关（OR：1.30，95% CI：0.93 - 1.80）以及自我伤害风险增加相关（OR：1.52，95% CI：1.43 - 1.62），并且未就业与自杀风险（OR：1.31，95% CI：0.98 - 1.75）和自我伤害风险（OR：1.32，95% CI：1.26 - 1.40）的类似增加相关。
被排除在就业之外与男性和女性自杀及自我伤害风险显著升高相关，即使在那些既往没有心理健康问题的人群中也是如此。
