Unemployment, suicide andCOVID‐19: using the evidence to plan for prevention

• DOI: 10.5694/mja2.50715
• Publication Date: 2020-07-30T07:45:14Z
• Authors: Mark Deady; Leona Tan; Nathasha Kugenthiran; Daniel Collins; Helen Christensen; Samuel B Harvey
• Keywords: Treasury; Depression; Pandemic

COVID-19-related unemployment may significantly increase suicide rates; implementation of appropriate preventive measures is critical In response to the coronavirus disease 2019 (COVID-19) pandemic, imposition social distancing policies and related labour market impacts have resulted in extensive job losses. Globally, International Monetary Fund has predicted steepest economic downturn since Great Depression.1 May 2020, 2.3 million Australians (one five employed people) were either unemployed or had work hours reduced for reasons, resulting rise rates on record — a change from 5.2% March 7.1%2 with Treasury predicting rate 8% by September 2020. Unemployment alone associated two- threefold increased relative risk death compared being employed,3 sudden spikes are corresponding surges population suicide.4 The global financial crisis, which led deepest recession 1930s loss 30 jobs worldwide, estimated at least 10 000 additional suicides between 2008 2010 Europe North America.5 Projections using historical data suggest 3.3–8.4% over 2020–2021 period United States6 up 27% Canada.7 Of course, all this speculative although links recessions well documented, what less clear how relationship plays out context larger sociocultural health events such as COVID-19. 1918–1920 influenza pandemic caused around 39 deaths worldwide governments implementing quarantine, public hygiene policies, but evidence regarding its impact world economies limited. severe acute respiratory syndrome (SARS) epidemic 2003 came height Asian so disentangling two difficult. However, during period, number nations tandem unemployment, reaching peaks 2003.8 As situation continues daily, an accurate estimate likely COVID-19 Even current estimates under-represent impact, individuals who still discounted. This particular concern when considering saw Australian take comparatively minor 4.0% 5.8% coincided 22% 12% men women respectively.9 present crisis potentially double rate, one can extrapolate alarming conclusions, some (albeit unpublished) modelling reflecting projection.10 Despite grim forecast, not whole story. There marked differences those that come before. For instance, supply (rather than demand) driven, prospect recovery, slow, conceivable bolter optimism. Although major industries will be severely affected, there potential local spending borders remain closed. addition, hope found resilience shown civilians times unrest often cited "Blitz spirit"11 possibility shared experience might bring sense cohesion, prove life-preserving. Notwithstanding considerable psychosocial mass we argue far predetermined, early sustained action prevent many other adverse mental outcomes. During prior recessions, Austria, Sweden Finland each displayed face substantially unemployment.5 fact, despite sizeable rises 1990s, decreased.4 We that, based available literature, several factors moderate widespread unemployment. These include both prevention care: welfare spending; programs protections; adequate funding of, access to, services, including engaging new technologies reporting care response. Firstly, countries increases cut search initiatives unemployed.12 Robust ensure benefits people low income thought central offsetting suicide.13 Where expand wake disasters, good reduction suicide. federal government's introduction JobKeeper JobSeeker payment schemes mitigate while simultaneously stimulating economy require long term investment. Secondly, active programs, assist find retrain, protections lower unemployment-related do not.12 It been European periods past 50 years, US$100 per capita investment association 0.4%.4 Thirdly, it made immediately health, just terms treatment also evidence-based programs. Different approaches required reduce attempts, deaths, involving clinical services. direct interventions, increasing multilevel systems components ranging individual-level (eg, assertive aftercare, interventions) interventions general practitioner gatekeeper training),14 addition indirect (targeting factors). Critical effectiveness degree penetration these modelling, types differentially affect communities, indigenous communities. Improving quality, availability support services vital preventing suicide,14 creating challenges compounding pre-existing systemic issues. While sector rapidly mobilising improve government quick revise Medicare rebate regard, resource allocation innovation beyond span physical measures. telehealth critical, professionals them unlikely meet need, blended automatised digital more efficient solution. $48.1 announced 2020 positive step; however, further important ever alleviate demand prevention, hold utility at-risk actively suicidal individuals, especially where lacking.15 undergoing their very nature significant constraints, inevitably review across limited funds directed toward most viable cost-effective Importantly, groups affected equally, subgroup consideration vital. periods, disadvantaged disproportionately marginalised populations specific attention. consider consequences loss, house repossession, mounting debt, problems strain, delayed and, therefore, required.16 Finally, fight against valuable tool. includes information technology-enabled coordinated dynamic immediate real-time developing hotspots identified shut down mobilised. field study infancy, concepts integrated, geospatial mapping, hotspot surveillance, could lead advancements intervening behaviour.17 Ultimately, fallout represents threat, requiring urgent mobilisation planning. certain steps programs; in, services; aid regional responses means restriction. presents opportunity implement would only incidentally national burden presented emotional distress any cycle. doing so, ability emerge stronger resilient nation. Mark Deady, Leona Tan Samuel Harvey funded icare Foundation grant. supported National Health Medical Research Council (NHMRC) investigator grant (No. 1178666). authors additionally NHMRC Centre Excellence Suicide Prevention. institutions no role planning, writing publication work. No relevant disclosures. Not commissioned; externally peer reviewed.