Excess suicides and attempted suicides in Italy attributable to the great recession.

In early May, widows of men who killed themselves began marching on tax offices in Bologna, Italy. Their protest? Austerity and tax collection put their husbands at risk. This is the first grassroots movement on mental health in Europe responding to what has been recently dubbed ‘suicide by economic crisis’. But not everyone agrees with these widows’ interpretation of events. Although articles recently published in The Lancet 3 provided support for the hypothesis, some commentators have claimed that the suggestion that increases in suicides are linked to the recession is a ‘premature overinterpretation’. Are these recent suicide increases in Italy attributable to the financial crisis or just ‘normal statistical fluctuations’? To address this question, we investigated data on suicides and attempted suicides rates reported to have been due to economic reasons between 2000 and 2010 from the Italian Institute of National Statistics. Figure 1 shows that both suicides and attempted suicides due to economic reasons were rising in Italy, but began to rise at a faster pace starting in the first year of the global financial crisis, 2008. Given small numbers of suicides, as suicide is a rare event, and since trends were following similar patterns, to increase precision of our estimates we next evaluated the average of suicides and attempted suicides to assess the portion attributable to the recession. As shown in figure 2, suicides and attempted suicides were rising at an estimated rate of 10.2 per year before the financial crisis, but after this time the rate accelerated to 53.9 per year. Using a regression model with a dummy variable for the crisis years and correcting for precrisis timetrends, we estimated that there were 290.0 (p1⁄40.006, 95% CI 112.4 to 467.6) excess suicides and attempted suicides due to economic reasons attributable to the recession in Italy. Certainly, data on suicides and their narrative verdicts must be interpreted with caution because of potential biases in the classification and interpretation of the circumstances of suicide. However, methods of reporting and documenting have not significantly changed over time in Italy. One indicator of validity is the observation that suicides and attempted suicides classified as occurring for unknown reasons during this period remained relatively stable during the crisis period (see web appendix 1). Analogous to other European countries, overall suicides were falling in Italy before the economic crisis, but rapidly reversed upon the onset of financial crisis in 2008 (web appendix 2). Data for suicides and attempted suicides for other reasons are presented in web appendix 3. More research is needed to evaluate the effect of the recession on mental health problems across regions. These preliminary findings provide a cautionary note that recession and radical austerity may come with a high human cost.