Unemployment and suicide. Evidence for a causal association?

OBJECTIVES: To determine the independent associations of labour force status and socioeconomic position with death by suicide. DESIGN: Cohort study assembled by anonymous and probabilistic record linkage of census and mortality records. PARTICIPANTS: 2.04 million respondents to the New Zealand 1991 census aged 18-64 years. MAIN OUTCOME MEASURE: Suicide in the three years after census night. RESULTS: The age adjusted odds ratios (95% confidence intervals) of death by suicide among 25 to 64 year olds who were unemployed compared with employed were 2.46 (1.10 to 5.49) for women and 2.63 (1.87 to 3.70) for men. Similarly increased odds ratios were observed for the non-active labour force compared with the employed. Strong age only adjusted associations of suicide death with the socioeconomic factors of education (men only), car access, and household income were observed. Compared with those who were married on census night, the non-married had odds ratios of suicide of 1.81 (1.22 to 2.69) for women and 2.08 (1.66 to 2.61) for men. In a multivariable model the association of socioeconomic factors with suicide reduced to the null. However, marital status and labour force status remained strong predictors of suicide death. Unemployment was also strongly associated with suicide death among 18-24 year old men. Sensitivity analyses suggested that confounding by mental illness might explain about half, but not all, of the association between unemployment and suicide. CONCLUSIONS: Being unemployed was associated with a twofold to threefold increased relative risk of death by suicide, compared with being employed. About half of this association might be attributable to confounding by mental illness.

Gender and the association between mental disorders and disability.

BACKGROUND: Prior data, especially population data, on gender differences in the association between mental disorders and disability are very sparse and therefore earlier conclusions that women with mental disorders are more disabled than men may be premature. The aim of this study was to determine whether gender moderates the associations between 30 day mood, anxiety and substance use disorders and self-reported 30 day disability in five domains of functioning, in a general population sample. METHODS: Nationally representative face-to-face household survey of New Zealanders (n=7435) aged 16 years and older, with a response rate of 73.3%. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Health-related disability was measured in all participants with a version of the World Health Organisation Disability Assessment Schedule (WHODAS-II). RESULTS: Men with either mood or anxiety disorders (aggregated into one category) reported significantly more Role, Social and Cognitive disability than did women with those disorders. There were no gender differences in the associations between mental disorders and the Mobility or Self-Care disability domains, nor were there gender differences in the associations between substance use disorders and any disability domain. LIMITATIONS: The temporal direction of the association between mental disorders and disability is unknown. Disability is measured by self-report only, which is affected by insight. CONCLUSIONS: Men with emotional disorders experience disproportionately greater role, social and cognitive disability than women with these disorders. More needs to be understood about how to engage and retain men in mental disorder treatment.