title: Suicide attempts and self-harm during a dramatic national economic transition: a population-based study in Iceland.
abstract: Macroeconomic downturns have been associated with increased suicide rates. This study examined potential changes in suicide attempts and self-harm in Iceland during a period of major economic transition (2003-12).
  
  
  
  Data were retrieved from the National University Hospital in Reykjavik (population size: 204.725), containing all ICD-10 diagnoses connected to potential suicidal behaviour. Poisson regression models were used to compare attendance rates before and after the 2008 economic collapse.
  
  
  
  During the study period, a total of 4537 attendances of 2816 individuals were recorded due to suicide attempts or self-harm. We noted a significant change in total attendance rates among men, characterized by an annual increase in attendance rate pre-collapse of 1.83 per 100.000 inhabitants and a decrease of 3.06 per 100.000 inhabitants post-collapse ( P = 0.0067). Such pattern was not observed among women. When restricting to first attendances only, we found a reduced incidence post-crisis among both men (RR: 0.85; 0.76-0.96) and women (RR: 0.86; 0.79-0.92). We further found 1% increase in unemployment rate and balance of trade to be associated with reduced attendance rates among men (RR: 0.84; 0.76-0.93 and RR: 0.81; 0.75-0.88, respectively) but not among women.
  
  
  
  These data suggest no overall increase in attendance rates due to suicide attempts or self-harm following the 2008 Icelandic economic collapse. In fact, a high-point in self-harm and suicide attempts was observed among men at the height of the economic boom and a decrease in new attendances among both men and women after the economic collapse.
authors: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Hildur G
authors: HG
authors: Ásgeirsdóttir
authors: Faculty of Economics, University of Iceland, Reykjavik, Iceland.
authors: Tinna L
authors: TL
authors: Ásgeirsdóttir
authors: Department of Clinical Neuroscience, Stockholm Centre for Psychiatric Research and Education, Karolinska Institute, Stockholm, Sweden.
authors: Ullakarin
authors: U
authors: Nyberg
authors: Research Institute in Emergency Care, The National University Hospital of Iceland, Reykjavík, Iceland.|Faculty of Nursing, University of Iceland, Reykjavik, Iceland.
authors: Thordis K
authors: TK
authors: Thorsteinsdottir
authors: Research Institute in Emergency Care, The National University Hospital of Iceland, Reykjavík, Iceland.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Brynjólfur
authors: B
authors: Mogensen
authors: Faculty of Medicine, University of Iceland, Reykjavik, Iceland.|The National University Hospital of Iceland, Reykjavík, Iceland.
authors: Páll
authors: P
authors: Matthíasson
authors: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Sigrún H
authors: SH
authors: Lund
authors: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors: Unnur A
authors: UA
authors: Valdimarsdóttir
authors: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Arna
authors: A
authors: Hauksdóttir
mesh_terms: D000293:Adolescent; D000328:Adult; D057172:Economic Recession / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D012737:Sex Factors; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult