Do macroeconomic contractions induce or 'harvest' suicides? A test of competing hypotheses.

BACKGROUND: Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment-induction or displacement. METHODS: We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women. RESULTS: Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later. CONCLUSIONS: Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments.

Twins less frequent than expected among male births in risk averse populations.

Male twin gestations exhibit higher incidence of fetal morbidity and mortality than singleton gestations. From an evolutionary perspective, the relatively high rates of infant and child mortality among male twins born into threatening environments reduce the fitness of these gestations, making them more vulnerable to fetal loss. Women do not perceive choosing to spontaneously abort gestations although the outcome may result from estimates, made without awareness, of the risks of continuing a pregnancy. Here, we examine whether the non-conscious decisional biology of gestation can be linked to conscious risk aversion. We test this speculation by measuring the association between household surveys in Sweden that gauge financial risk aversion in the population and the frequency of twins among live male births. We used time-series regression methods to estimate our suspected associations and Box-Jenkins modeling to ensure that autocorrelation did not confound the estimation or reduce its efficiency. We found, consistent with theory, that financial risk aversion in the population correlates inversely with the odds of a twin among Swedish males born two months later. The odds of a twin among males fell by approximately 3.5% two months after unexpectedly great risk aversion in the population. This work implies that shocks that affect population risk aversion carry implications for fetal loss in vulnerable twin pregnancies.

The association between green space and mental health varies across the lifecourse. A longitudinal study.

BACKGROUND: Epidemiological studies on green space and health have relied almost exclusively on cross-sectional designs, restricting understanding on how this relationship could vary across the lifecourse. METHODS: We used multilevel linear regression to analyse variation in minor psychiatric morbidity over nine annual waves of the British Household Panel Survey (1996-2004). The sample was restricted to residents of urban areas who remained within their neighbourhoods for at least 12 months. The 12-item General Health Questionnaire and confounders were reported for 29 626 male and 35 781 female observations (person-years). This individual-level dataset was linked to a measure of green space availability within each ward of residence. Regression models included age, gender, employment status, household tenure, marital status, education, smoking status and household income. RESULTS: When not considering age, green space was associated with better mental health among men, but not women. Interaction terms fitted between age and green space revealed variation in the association between green space and mental health across the lifecourse and by gender. For men, the benefit of more green space emerged in early to mid-adulthood. Among older women, a curvilinear association materialised wherein those with a moderate availability of green space had better mental health. CONCLUSIONS: These findings illustrate how the relationship between urban green space and health can vary across the lifecourse, and they highlight the need for longitudinal studies to answer why green space may be better for health at some points in the lifecourse than others.

Housing tenure and early retirement for health reasons in Sweden.

AIMS: To assess the association between housing tenure and early retirement for health reasons in Sweden with a view to psychosocial vs. material values of home ownership. METHODS: The data come from linked registers that cover all people resident in Sweden during 1990-2000. The study population consists of 449,233 people aged 40-63 years in 1997. Of these, 19,350 retired early for health reasons in 1998-99. The remaining 429,883 continued their employment without extended sick leave or income decline. None moved during 1990-2000. We calculated the odds of early retirement for four forms of juridical relationship to one's housing (private owner; part owner in a cooperative; private rental; rental from a public housing company), for men and women separately, controlling for age, education, employment income, household disposable income, region, foreign birth, and housing type. RESULTS: Men in cooperative ownership had lower odds of early retirement than those in the three other tenure forms, for which the odds were similar. Among women, public and private renters had similar odds of early retirement, which were higher than those of women in private or cooperative ownership. For both genders, inclusion of housing type in the model after housing tenure explained little additional variance. CONCLUSIONS: The odds of early retirement for health reasons varied across different housing tenure forms in Sweden in 1998-99. The pattern of associations differed as a function of gender. Home ownership appears to involve health resources independent of basic socio-physical factors captured with differences in housing type.

Economic predictors of admissions to inpatient psychiatric treatment in Sweden.

BACKGROUND: The ecological association between contracting labor markets and admissions to inpatient psychiatric treatment has been widely replicated, but little understood, in the United States. Its explanations include the "uncovering mechanism" that assumes a contracting labor market does not increase the incidence of illness, but rather decreases the ability of chronically ill persons or their families to pay the direct and indirect costs of outpatient care. Without such care, some of these persons supposedly become more ill and eventually require inpatient treatment subsidized by the state. This explanation would not apply to a society with universal access to high quality mental health services. The uncovering mechanism, therefore, would be less compelling if the ecological association were found in such a society. We apply time-series methods to data for the 336 months beginning January 1973 to determine if the association appears in Sweden. RESULTS: Consistent with the findings from the United States, inpatient admissions of Swedish men and women move inversely over time with changes in the number of each employed. CONCLUSIONS: The uncovering mechanism cannot explain the Swedish findings. Its rivals, including the argument that economic contraction either increases the incidence of illness or reduces tolerance for the persistently mentally ill, deserve more attention at least in countries with universal access to care. We offer research strategies for discriminating between these remaining rivals.

A time-series analysis of the effect of increased copayments on the prescription of antidepressants, anxiolytics, and sedatives in Sweden from 1990 to 1999.

BACKGROUND: Outpatient prescription medication spending in Sweden has increased sharply since 1974. The Swedish government has raised copayments to reduce medication consumption and limit the growth of medication spending. OBJECTIVE: The aim of this study was to examine the effect of the 1995 and 1997 copayment increases on Swedish consumption of antidepressants, anxiolytics, sedatives. METHODS: Monthly drug-use data for July 1990 through December 1999 for these 3 pharmaceutical classes were obtained from Apoteket AB (Stockholm, Sweden). Data were provided for both sexes in units of defined daily doses per 1000 inhabitants. These series were analyzed with the use of Box-Jenkins autoregressive, integrated, moving-average time-series modeling methods. RESULTS: Dispensing of all 3 drugs classes increased immediately before copayment changes, with the exception of male sedative use at the time of the 1997 reform. Permanent increases in male antidepressant and sedative use occurred before the 1995 copayment reform. Only female antidepressant use was permanently reduced following the 1997 copayment reform. CONCLUSIONS: Our findings suggest that Swedish patients' valuation of mental health medications exceeds the enacted price increases. The permanent increases in male antidepressant and sedative use, beginning in 1995, may have been the result of previous undertreatment. The permanent reduction in female antidepressant use, beginning in 1997, suggests that the price levels reached a threshold that matched or exceeded Swedish women's valuation of these modific