Association between the 2009-2014 economic crisis, suicide and self-harm in Portugal: time series analysis

• Autor(a) principal: Pinheiro, Vera
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10362/135190
• topic: suicide; suicide attempts; suicidal behavior; self-inflicted injury; hospitalizations; mental health; economic crisis; unemployment; suicídio; tentativa de suicídio; comportamento suicidário; lesão autoinfligida; hospitalizações; saúde mental; crise económica; desemprego; Domínio/Área Científica::Ciências Sociais::Outras Ciências Sociais

ABSTRACT - Background: It is well established that the health of a population is highly influenced by its socioeconomic context, welfare systems, labour markets, public policies, and demographic characteristics. Thus, changes in these key determinants may be reflected in the mental health and wellbeing of a population, through risk factors such as unemployment, financial strain, debts and job-related issues, as people posed with these challenges are usually more susceptible to mental ill-health. Following the worldwide economic crisis of 2008, several studies have found contradicting results in regards to this association, with some showing an increased risk for self-harm and suicidal behaviour, be it in the form of suicides or suicide attempts (many requiring urgent hospitalization), worldwide and in Europe, and others finding the opposite association. There is no research in Portugal on the matter. Therefore, our goal was to estimate the impact of the Portuguese economic crisis of 2009-2014 on the deaths and hospitalization rates trends by suicide and self-inflicted injury in Portugal. Methods: A retrospective ecological study, with an interrupted time series analysis of hospitalizations and deaths by suicide and self-inflicted injury (data from the national Hospital Morbidity Database) in mainland Portugal, between 2003 and 2014, was performed. Resident population data aged 15 years old or older was retrieved from the National Statistics Institute. Binomial negative generalized linear models were used to compare rates and trends before (2003-2008) and during (2009-2014) the Portuguese economic crisis. Regression coefficients were calculated (p<0.05) along with 95% Confidence Intervals. All rates were stratified and adjusted for seasonality. Results: Globally, for the whole mainland population, the 2009-2014 economic crisis in Portugal was associated with an increase in the hospitalization and death rate trends due to suicide and self-inflicted injury, with unemployment playing a significant albeit mixed mediating role. However, in line with previous results in the literature, many differences exist in different subgroups, with males, working-age groups (25-44 and 45- 64) and the North and Centre regions being the most impacted, globally. Conclusions: Economic downturns pose considerable risks for suicidal behavior. This should be a priority area for urgent intervention, especially in the context of the COVID- 19 pandemic crisis and the economic crisis it provoked, with a potentially tremendous impact in mental health.