Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study.

BACKGROUND: Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition. METHODS: Data were retrieved on all suicides in Iceland during 2002-14. The study period was divided into a pre-collapse period (2002-08) and a post-collapse period (2008-14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex. RESULTS: A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94-1.35). This was true for both men and women (RR 1.18; CI 0.96-1.46 and RR 0.96; CI 0.67-1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86-1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94-1.79) or balance of trade (RR 1.08; CI 0.96-1.22). CONCLUSION: The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.

The association between different traumatic life events and suicidality.

Background: Traumatic life events have been associated with increased risk of various psychiatric disorders, even suicidality. Our aim was to investigate the association between different traumatic life events and suicidality, by type of event and gender. Methods: Women attending a cancer screening programme in Iceland (n = 689) and a random sample of men from the general population (n = 709) were invited to participate. In a web-based questionnaire, life events were assessed with the Life Stressor Checklist - Revised, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criterion was used to identify traumatic life events. Reports of lifetime suicidal thoughts, self-harm with suicidal intent and suicide attempt were considered as lifetime suicidality. We used Poisson regression, adjusted for demographic factors, to express relative risks (RRs) as a measure of the associations between traumatic events and suicidality. Results: Response rate was 66% (922/1398). The prevalence of lifetime traumatic events was 76% among women and 77% among men. Lifetime suicidality was 11% among women and 16% among men. An overall association of having experienced traumatic life events with suicidality was observed [RR 2.05, 95% confidence interval (CI) 1.21-3.75], with a stronger association for men (RR 3.14, 95% CI 1.25-7.89) than for women (RR 1.45, 95% CI 0.70-2.99). Increased likelihood for suicidality was observed among those who had experienced interpersonal trauma (RR 2.97, 95% CI 1.67-5.67), childhood trauma (RR 4.09, 95% CI 2.27-7.36) and sexual trauma (RR 3.44, 95% CI 1.85-6.37), with a higher likelihood for men. In addition, an association between non-interpersonal trauma and suicidality was noted among men (RR 3.27, 95% CI 1.30-8.25) but not women (RR 1.27, 95% CI 0.59-2.70). Conclusion: Findings indicate that traumatic life events are associated with suicidality, especially among men, with the strongest association for interpersonal trauma.

Antecedentes: Los eventos vitales traumáticos han sido asociados con un riesgo más alto de trastornos mentales, incluso suicidalidad. Nuestro objetivo fue investigar la asociación entre diferentes eventos vitales traumáticos diferentes y suicidalidad, por tipo de evento y género. Método: Fueron invitados a participar las mujeres que se atiendian un programa de detección de cáncer en Islandia (N=698) y una muestra aleatoria de hombres de la población general (N=709) . En un cuestionario online, los eventos vitales fueron evaluados con la Lista de Chequeo de Estresores Vitales-Revisada y se usaron los criterios DSM-5 para identificar eventos vitales traumáticos. Los reportes de pensamientos suicidas, autoflagelación con intención suicida e intento suicida a lo largo de la vida fueron considerados como suicidalidad a lo largo de la vida. Usamos la regresión de Poisson, ajustada por factores demográficos, para mostrar los riesgos relativos como una medida de las asociaciones entre eventos traumáticos y suicidalidad. Resultados: La tasa de respuesta fue de un 66% (922/1398). La prevalencia de eventos traumáticos a lo largo de la vida fue de 76% para mujeres y de 77% para hombres. La suicidalidad a lo largo de la vida fue de 11% para mujeres y de 17% para hombres. Se observó una asociación global entre haber experimentado eventos vitales traumáticos con suicidalidad (RR 2.05, IC 1.21­3.75), con una asociación más fuerte en hombres (RR 3.14, IC 1.25­7.89) que mujeres (RR 1.45, CI 0.70­2.99). Una mayor probabilidad de suicidalidad fue observada entre quienes han experimentado trauma interpersonal (RR 2.97, IC 1.67­5.67), trauma infantil (RR 4.09, IC 2.27­7.36) y trauma sexual (RR 3.44, IC 1.85­6.37), con una más alta probabilidad para hombres. Además, la asociación entre trauma no-interpersonal y suicidalidad fue identificado en hombres (RR 3.27, IC 1.30­8.25) pero no en mujeres (RR 1.27, IC 0.59­2.70). Conclusiones: Los hallazgos indican que los eventos vitales traumáticos están asociados con suicidalidad, especialmente entre hombres, con una asociación más fuerte para el trauma interpersonal.

Suicide attempts and self-harm during a dramatic national economic transition: a population-based study in Iceland.

Background: Macroeconomic downturns have been associated with increased suicide rates. This study examined potential changes in suicide attempts and self-harm in Iceland during a period of major economic transition (2003-12). Methods: Data were retrieved from the National University Hospital in Reykjavik (population size: 204.725), containing all ICD-10 diagnoses connected to potential suicidal behaviour. Poisson regression models were used to compare attendance rates before and after the 2008 economic collapse. Results: During the study period, a total of 4537 attendances of 2816 individuals were recorded due to suicide attempts or self-harm. We noted a significant change in total attendance rates among men, characterized by an annual increase in attendance rate pre-collapse of 1.83 per 100.000 inhabitants and a decrease of 3.06 per 100.000 inhabitants post-collapse ( P = 0.0067). Such pattern was not observed among women. When restricting to first attendances only, we found a reduced incidence post-crisis among both men (RR: 0.85; 0.76-0.96) and women (RR: 0.86; 0.79-0.92). We further found 1% increase in unemployment rate and balance of trade to be associated with reduced attendance rates among men (RR: 0.84; 0.76-0.93 and RR: 0.81; 0.75-0.88, respectively) but not among women. Conclusion: These data suggest no overall increase in attendance rates due to suicide attempts or self-harm following the 2008 Icelandic economic collapse. In fact, a high-point in self-harm and suicide attempts was observed among men at the height of the economic boom and a decrease in new attendances among both men and women after the economic collapse.