Structural determinants of suicide during the global financial crisis in Spain: Integrating explanations to understand a complex public health problem

Introduction Suicide is a complex public health problem in contemporary societies. Macroeconomic downturns derived from the economic crisis have been found to be associated with growing suicide mortality in the United States and in Europe. The present work is aimed to assess the association between the recent economic downturns and suicide patterns using interrupted time series analysis and, particularly, adjusting this relationship by indicators of social cohesion and community values that might provide additional insights on the complex explanation of suicidal trends. Methods We combined suicide, social and economic data extracted from the National Statistics Institute (INE), the Eurostat database, and the World Values Survey to assess the association between the socio-economic factors and trends in suicide rates. To study the association between the financial crisis and changes in suicide rates in Spain, we used interrupted time series analysis (ITSA). Results Our findings confirm that suicides increased after the 2011 recession, but remained moderately constant after the 2008 economic downturn. Suicides particularly increased after the 2011 recession in the 10-14, and 45-64 years old intervals between males and females, and apparently in older groups. However, during the 2008-2011 time period suicide rates decreased during working years (specifically among 40-44, 45-49, and 55-59 years old groups). Our results highlight the importance of social protection against unemployment and, to a lesser extent, social protection in disability and family, in reducing suicides, as well as the economic prosperity of the country. Conclusion This result corroborates that the economic crisis has possibly impacted the growing suicide rates of the most vulnerable groups, but exclusively during the period characterised by economic cuts after the 2011 recession. This study highlights the need to implement tailored policies that protect these collectives against suicide.