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LETTER

Excess suicides and attemptedsuicides in Italy attributable tothe great recession

In early May, widows of men who killedthemselves began marching on tax offices inBologna, Italy. Their protest? Austerity andtax collection put their husbands at risk.

This is the first grassroots movement onmental health in Europe responding to whathas been recently dubbed suicide byeconomic crisis.1

But not everyone agrees with thesewidows interpretation of events. Althougharticles recently published in The Lancet2 3

provided support for the hypothesis,some commentators have claimed that thesuggestion that increases in suicides arelinked to the recession is a premature

overinterpretation.4 Are these recentsuicide increases in Italy attributable to thefinancial crisis or just normal statisticalfluctuations?

To address this question, we investigateddata on suicides and attempted suicides ratesreported to have been due to economicreasons between 2000 and 2010 from theItalian Institute of National Statistics.5

Figure 1 shows that both suicides andattempted suicides due to economic reasonswere rising in Italy, but began to rise ata faster pace starting in the first year of theglobal financial crisis, 2008.

Given small numbers of suicides, assuicide is a rare event, and since trends werefollowing similar patterns, to increase preci-sion of our estimates we next evaluated theaverage of suicides and attempted suicides toassess the portion attributable to the reces-sion. As shown in figure 2, suicides andattempted suicides were rising at an esti-mated rate of 10.2 per year before thefinancial crisis, but after this time the rateaccelerated to 53.9 per year. Using a regres-sion model with a dummy variable for thecrisis years and correcting for precrisis time-trends, we estimated that there were 290.0(p0.006, 95% CI 112.4 to 467.6) excesssuicides and attempted suicides due toeconomic reasons attributable to the reces-sion in Italy.

Certainly, data on suicides and theirnarrative verdicts must be interpreted withcaution because of potential biases in theclassification and interpretation of the

circumstances of suicide.

6

However,methods of reporting and documentinghave not significantly changed over time inItaly. One indicator of validity is theobservation that suicides and attemptedsuicides classified as occurring for unknownreasons during this period remained rela-tively stable during the crisis period (seeweb appendix 1). Analogous to otherEuropean countries, overall suicides werefalling in Italy before the economic crisis,but rapidly reversed upon the onset offinancial crisis in 2008 (web appendix 2).Data for suicides and attempted suicidesfor other reasons are presented in web

appendix 3.More research is needed to evaluate theeffect of the recession on mental healthproblems across regions. These preliminaryfindings provide a cautionary note thatrecession and radical austerity may comewith a high human cost.

Roberto De Vogli,1,2 Michael Marmot,1

David Stuckler3,4

1Department of Epidemiology and Public Health, Divisionof Population Health, University College London, London,UK; 2School of Public Health, University of Michigan, AnnArbor, USA; 3Department of Sociology, CambridgeUniversity, Cambridge, UK; 4London School of Hygiene

and Tropical Medicine, University of London, London, UKCorrespondence to Dr Roberto De Vogli, Departmentof Epidemiology and Public Health, University College

Figure 1 Trends in suicides and attempted suicides due to economic reasons in Italy,2000e2010. Data source: Italian National Institute of Statistics (ISTAT), 2000e2010.

Figure 2 Excess suicides and suicide attempts due to economic reasons in Italy, 2000e2010.Data source: Italian National Institute of Statistics (ISTAT), 2000e2010.

De Vogli R, Marmot M, Stuckler D. J Epidemiol Community Health (2012). doi:10.1136/jech-2012-201607 1 of 2

PostScriptJECH Online First, published on August 2, 2012 as 10.1136/jech-2012-201607

Copyright Article author (or their employer) 2012. Produced by BMJ Publishing Group Ltd under licence.

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London, 1-19 Torrington Place, London WC1E 6BT, UK; r.devogli@ucl.ac.uk