Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

Milner, A, Page, A and LaMontagne, AD 2013, Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review, Psychological medicine, vol. 44, pp. 909-917, doi: 10.1017/S0033291713001621.

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Title Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review
Author(s) Milner, A
Page, A
LaMontagne, ADORCID iD for LaMontagne, AD
Journal name Psychological medicine
Volume number 44
Start page 909
End page 917
Total pages 9
Publisher Cambridge University Press
Place of publication Cambridge, UK
Publication date 2013
ISSN 0033-2917
Keyword(s) Confounders
Directed acyclic graphs
Healthy worker effect
Mental disorders
Summary Background There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide. Method A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained. Results Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33–1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00–1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females. Conclusions Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.
Language eng
DOI 10.1017/S0033291713001621
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C2.1 Other contribution to refereed journal
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Document type: Journal Article
Collections: Faculty of Health
School of Health and Social Development
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