title: Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, southern Spain.
abstract: BACKGROUND
  Although suicide rates have increased in some European countries in relation to the current economic crisis and austerity policies, that trend has not been observed in Spain. This study examines the impact of the economic crisis on suicide attempts, the previously neglected endpoint of the suicidal process, and its relation to unemployment, age and sex.
  
  
  METHODS
  The study was carried out in Andalusia, the most populated region of Spain, and which has a high level of unemployment. Information on suicide attempts attended by emergency services was extracted from the Health Emergencies Public Enterprise Information System (SIEPES). Suicide attempts occurring between 2003 and 2012 were included, in order to cover five years prior to the crisis (2003-2007) and five years after its onset (2008-2012). Information was retrieved from 24,380 cases (11,494 men and 12,886 women) on sex, age, address, and type of attention provided. Age-adjusted suicide attempt rates were calculated. Excess numbers of attempts from 2008 to 2012 were estimated for each sex using historical trends of the five previous years, through time regression models using negative binomial regression analysis. To assess the association between unemployment and suicide attempts rates, linear regression models with fixed effects were performed.
  
  
  RESULTS
  A sharp increase in suicide attempt rates in Andalusia was detected after the onset of the crisis, both in men and in women. Adults aged 35 to 54 years were the most affected in both sexes. Suicide attempt rates were associated with unemployment rates in men, accounting for almost half of the cases during the five initial years of the crisis. Women were also affected during the recession period but this association could not be specifically attributed to unemployment.
  
  
  CONCLUSIONS
  This study enhances our understanding of the potential effects of the economic crisis on the rapidly increasing suicide attempt rates in women and men, and the association of unemployment with growing suicidal behaviour in men. Research on the suicide effects of the economic crisis may need to take into account earlier stages of the suicidal process, and that this effect may differ by age and sex.
authors: Delegación Territorial de Igualdad, Salud y Políticas Sociales de Cádiz, Cádiz, Spain. jantonio.cordoba@juntadeandalucia.es.
authors: Juan Antonio
authors: JA
authors: Córdoba-Doña
authors: Miguel
authors: M
authors: San Sebastián
authors: Antonio
authors: A
authors: Escolar-Pujolar
authors: Jesús Enrique
authors: JE
authors: Martínez-Faure
authors: Per E
authors: PE
authors: Gustafsson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D057172:Economic Recession; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D017678:Sex Distribution; D013030:Spain; D013406:Suicide, Attempted / Q000706:statistics & numerical data* / Q000639:trends; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult