Systematic review of suicide in economic recession

Table 2 Negative Association Studies and studies with inconclusive results

Ref.	Country studied	Study design	Suicide data source	Recession period	Economic indicators	Findings
Hintikka et al[37]	Finland	Time series Study Regression analyses	Causes of death statistics reported by Statistics Finland in 1996	1990-1995	Unemployment Rate and Gross Domestic Product	Female and Male Suicide rates positively associated with increases in GDP (P < 0.05)
Rancans et al[35]	Latvia	Time series study Descriptive statistics	Statistical Yearbooks of the Medical Statistics Bureau of the Latvian Ministry of Health and the Demographic Yearbooks of the Latvian Central Statistical Bureau	1990-1994	Gross Domestic Product and Unemployment rates	Rapid increase in suicide rates after 1989 reaching a maximum in 1993 (42.5 per 100000) The drop in GDP after 1990/1991 and the subsequent rise in unemployment did not correspond strictly with suicide rates changes
Neumayer[40]	Germany	Panel study using regression analyses	The German Federal Statistical Office	Not specified	Unemployment rates for initial analysis and gross domestic product for sensitivity analysis	A decrease in suicides for every percentage point increase in unemployment rate in males (0.98% decrease P < 0.1) and females (1.9% decrease P < 0.05) A decrease in suicides for every percentage point increase in unemployment rate in males (1.22% decrease NS) and females (1.97% decrease in females P < 0.01) Sensitivity analysis found that decreases in suicide rates were not associated with recession
Gonzalez et al[36]	Mexico	Panel study using regression analysis	Administrative records of death certificates	Not Specified	State Gross Domestic Product Per Capita	Decreases in state GDP per capita associated with decreases in the overall suicide rate across all states (P < 0.01)
Mackenbach et al[39]	25 European countries in Western and Eastern Europe	Time series study with regression analysis	International Mortality Data Base of the National Center for Health Statistics of the Centers for Disease Control	Not Specified	Gross Domestic Product	Changes in gross domestic product were not significantly associated with overall suicide rates across all countries in men and women
Saurina et al[41]	England and its sub-regions	Panel study using conditional and hierarchical mixed regression modelling	United Kingdom Office for National Statistics	2008-2010	Unemployment Rates	The increase in suicides between 2008 and 2010 was not statistically significant No significant association between unemployment rates and suicide at the national level, although at the regional level there were statistically significant negative and positive associations
Laanani et al[38]	Austria, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom	Panel Study using regression analysis	Eurostat mortality database	2008-2010	Unemployment Rates	Overall 0.3% increase in suicide rates for every 10% increase in unemployment overall (95%CI: 0.1-0.5) Associations between unemployment and suicide within countries were inconsistent A positive significant association between unemployment and suicide in three countries: Netherlands, United Kingdom and France was found

NS: Non-significant; RR: Rate ratio; GDP: Gross domestic product.