Eccesso di suicidi dovuto alla crisi economica globale in Italia: un aggiornamento

A previous research letter examining the impact of the Great Recession on suicides in Italy showed that, analogous to other high-income Countries, suicides were falling before the economic downturn, but rapidly reversed upon the onset of the crisis in 2008.¹ The analysis, however, presented some limitations, including biases related to the classification and interpretation of the circumstances of suicide in the Italian National Institute of Statistics (Istat) database that relied on narrative verdicts of the local municipal policies. Furthermore, the previous analysis included only a few data points after the onset of the crisis (2008-2010).
This time we investigated excess suicides due to the crisis by gender and age groups including more data points (2011-2015) and using a more reliable and valid outcome measure from the Italian Health for All database.^2,3 As shown in figure 1, before 2007, suicides were decreasing or were relatively stable in both genders for all age groups. However, this time-trend reversed after the onset of the Great Recession in both men and women aged between 45 and 64 years old.

To calculate the number of excess suicides due to the economic crisis in Italy between 2008 and 2015, we considered 2007 as our pre-recession baseline and we then computed the difference between the baseline standardized suicide rate and the standardized suicide rate for each year since the start of the recession. We then multiplied this difference by the population living in Italy in those years. We found that there were 1,251 excess suicides in men and 123 in women, for a total of 1,374 excess suicides. When replicating the same calculation using the absolute number of actual suicides (instead of standardized suicides rates), we found that there were 2,298 and 303 excess deaths among men and women, respectively.
Although these two methods produced different estimates, they both support the hypothesis that since the outbreak of the crisis there have been, indeed, additional suicides that cannot be ascribed to normal fluctuations over time. They are also in line with the conclusions of two systematic reviews that unequivocally showed that the global financial downturn has increased both the number of suicides⁴ and mental health problems not only in Italy, but also in several European Countries and in the United States.⁵ As pointed out by Reeves et al.,⁶ these are rather conservative approaches in estimating excess suicides, especially because background secular trends were declining before the beginning of the crisis in some age groups.
This new analysis corroborates previous evidence in the scientific literature and renews a call to action to intervene with stronger social protection and safety nets5 to avert the human costs of current and future crises and austerity policies.¹

Declared conflict of interest: the authors declare they have no conflict of interest.

References

1. De Vogli R, Marmot M, Stuckler D. Excess suicides and attempted suicides in Italy attributable to the great recession. J Epidemiol Community Health 2013;67(4):378-79.
2. Italian Institute of National Statistics. Health for All – Italia. Available from: http://www.istat.it/it/archivio/14562 (accessed on: December 20, 2018).
3. Istat. Tavole suicidi (1994-2015). https://www.istat.it/it/files//2017/09/Tavole-Suicidi.xlsx (accessed on December 20, 2018).
4. De Vogli R. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection. Int J Equity Health 2014;13:58.
5. Oyesanya M, Lopez-Morinigo J, Dutta R. Systematic review of suicide in economic recession. World J Psychiatry 2015;5(2):234-54.
6. Reeves A, McKee M, Stuckler D. Economic suicides in the Great Recession in Europe and North America. Br J Psychiatry 2014;205(3):246-47.
7. Frasquilho D, Gaspar de Matos M, Salonna F, et al. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health 2016;16:115.