L'associazione tra fumo di tabacco e crisi economiche in Italia.

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.

Impact of Antidepressant Prescriptions on Suicidal Behavior in Times of Severe Financial Strain.

ABSTRACT: This descriptive study observes the relationship between antidepressant prescriptions and the suicide rate in Italy in the 2000s to the mid-2010s, which includes a period of severe economic crisis. The observation period was from 2000 to 2015. Suicide and unemployment rates disaggregated by age and sex were collected from the Italian Institute of Statistics. Statistical analyses were performed using correlations between suicide rates and the defined daily dose, with reference to selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other types of antidepressants. Fixed-effects panel regressions were also run. Increases in SSRIs prescriptions were associated with decreases in suicide rates among both men and women. However, when the analyses were adjusted for the rate of growth of the unemployment rate and for gross domestic product, the associations were weaker. The potential protective factor of SSRIs with respect to suicidal behavior may be reduced by severe recessions, especially when unemployment increases.

The relationship between credit and suicide in Italy.

OBJECTIVES: to analyse the association between suicide rates and credit to the economy in Italy, and the potential role of social protection measures (SPMs) as buffering mechanism. DESIGN: descriptive study. SETTING AND PARTICIPANTS: data were derived from the Italian National Institute of Statistics and from the Organisation for Economic Co-operation and Development. Fixed-effects panel regressions were run to test the association between male and female suicide rates and the rate of growth of the credit-to-GDP (CTG) ratio. The buffering role of social protection measures was investigated. The observation period was from 1990 to 2014. MAIN OUTCOME MEASURES: regional male and female rates of suicide. RESULTS: male suicide rate is influenced by the rate of growth of the CTG ratio: a one-unit decrease in the latter is associated with 1.26 more suicides every 10,000 people. This marginal effect was significant at 1% for men, but not significant for women. Unemployment rate and periods of mass job loss were not associated with the outcome. With respect to SPMs, only public unemployment spending was able to moderate the association between suicide rate and rate of growth of the CTG ratio. A one-unit increase in the rate of growth of public unemployment spending was associated with 0.12 less suicides every 10,000 people, but only among men. Younger and older men were more affected by credit reduction, namely those aged 15-44 years and 75 years or more. Differently, women were not influenced by credit reduction, but only by increased UR in the group aged 55-64 years. CONCLUSIONS: access to credit is a major determinant of psychological well-being for men, but not for women. The rate of growth of the CTG ratio may be more useful than other macroeconomic indicators at identifying the mental health outcomes of economic crises.

Unemployment and suicide in Italy: evidence of a long-run association mitigated by public unemployment spending.

From the mid-1990s on, the suicide rate in Italy declined steadily, then apparently rose again after the onset of the Great Recession, along with a sharp increase in unemployment. The aim of this study is to test the association between the suicide rate and unemployment (i.e., the unemployment rate for males and females in the period 1977-2015, and the long-term unemployment rate in the period 1983-2012) in Italy, by means of cointegration techniques. The analysis was adjusted for public unemployment spending (referring to the period 1980-2012). The study identified a long-run relationship between the suicide rate and long-term unemployment. On the other hand, an association between suicide and unemployment rate emerged, though statistically weaker. A 1% increase in long-term unemployment increases the suicide rate by 0.83%, with a long-term effect lasting up to 18 years. Public unemployment spending (as percentage of the Italian gross domestic product) may mitigate this association: when its annual growth rate is higher than 0.18%, no impact of unemployment on suicide in detectable. A decrease in the suicide rate is expected for higher amounts of social spending, which may be able to compensate for the reduced level of social integration resulting from unemployment, helping the individual to continue to integrate into society. A corollary of this is that austerity in times of economic recession may exacerbate the impact of the economic downturn on mental health. However, a specific "flexicurity" system (intended as a combination of high employment protection, job satisfaction and labour-market policies) may have a positive impact on health.

Impact of the economic crises on suicide in Italy: the moderating role of active labor market programs.

PURPOSE: To analyze the association between unemployment and suicide in Italy during the years 1990-2014, with a peculiar focus on the great recession (GR) and the role played by social protection as buffering mechanism against the negative effect on health outcomes. METHODS: Fixed effects panel regressions were used to assess the association between changes in unemployment rate and suicide rates. Additional models investigated the role of active labor market programs (ALMPs) as possible moderators of the association. Analyses were carried out for both males and females, stratified by age and region. RESULTS: The negative time-trend displayed by suicide rate in Italy until 2007 was slowed down by changes in unemployment at the beginning of the GR, when this trend reversed and the rate of suicide started increasing. Male workers aged 25-64 and women aged 55-64 years were affected by both "normal" unemployment rate fluctuations as well as severe economic crises. Women aged 35-44 were only influenced by the latter. Men benefit from ALMPs mainly in Central Italy, while women did not benefit significantly from ALMPs. CONCLUSIONS: In Italy, economic downturns were associated with increased suicides mainly among men, while severe economic crises were associated with increased suicides among both men and women. ALMPs showed to be effective in moderating the association between unemployment and suicide among men aged 45-54 only in Central Italy. The overall small effectiveness of such programs may be due to lack of sufficient funding.

Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians.

BACKGROUND: The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services. OBJECTIVES: To explore the different points of views of stakeholders (namely, users and professionals) involved in VRPs developed inside an Italian Community Mental Health Center (CMHC). METHODS: A sample of users, psychiatrists, educators and nurses of an Italian CMHC involved in VRPs took part in a focus group. Content analysis was performed with MAXQDA 12, by developing a hierarchical code system a posteriori (i.e., derived from the data). The respondent validation phase was carried out by means of a multiple-choice questionnaire, administered to all participants. RESULTS: A total of 86 emerging issues were coded, divided into two macro-areas: Positive and Negative Reinforcements (48 contributions, 56%, and 38 contributions, 44%, respectively), further subdivided into three areas: professional (service) factors, personal (i.e, user-related) factors, and work environment features (including relationships in the workplace). Some contributions raised issues concerning occupational health protection (e.g. need of information about the rights and duties of the users-workers, as well as the risks they are exposed to in the workplace). CONCLUSIONS: The analysis suggested to address specific issues concerning work and VRPs by means of psycho-education group interventions currently carried out at CMHCs, and pointed to the need to foster collaboration between mental health professionals and the occupational health physician of the company where the VRP is started and where the user might be employed.

Impact of the economic crisis on health-related behaviors in Italy.

BACKGROUND: Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population. AIM: To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy. METHODS: Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models. RESULTS: Increased smokers (ß = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (ß = 2.18, p = .04) or more than 20 cigarettes per day (ß = 1.04, p < .01) and mean number of smoked cigarettes per day (ß = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (ß = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (ß = -812.80, p = .01). Alcohol consumption decreased (ß = -0.60, p < .01), especially in men (ß = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected. CONCLUSION: The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study.

PURPOSE: To report on the effects on health that the 2008 Great Recession is producing in Italy, by comparing the consistency of Italian data with general observations reported in the scientific literature, and by pointing out consequences on the rates of all-cause mortality, cardiovascular mortality, male suicidal behaviours, daytime alcohol drinking and traffic fatalities. METHODS: This is an ecological study in which MEDLINE, PsycINFO and PubMed were searched for the literature with combinations of the following keywords: economic recession, financial crisis, unemployment, health, suicide and mental health. Data from two Italian government agencies (Italian Institute of Statistics, ISTAT, and Italian Agency of Drugs, AIFA) in the years from 2000 to 2010 were obtained and analysed, by producing models of multiple linear regressions. RESULTS: After the recession onset, all-cause mortality remained stable, and was not associated with the economic fluctuations. Differently, cardiovascular mortality was associated with the rate of unemployment, and showed a significant increase in 2010. Alcohol consumption increased in 2009, the year with the worst real GDP decrease (-5.1 %). Though the total rate of suicide was not associated with the economic situation, male completed and attempted suicides due to financial crisis were significantly associated with the rate of unemployment and the real GDP. The increasing diffusion of antidepressants was not associated with a lowering of the rate of suicide. CONCLUSIONS: The data on the Italian situation here discussed are sufficiently reliable to conclude that a link exists between the ongoing economic recession and health and mental health of Italians. Further research is needed to understand more in detail and with stronger reliability such link, to support primary and secondary preventive interventions and orient the development of effective sociopolitical interventions.