title: Economic Recession, Alcohol, and Suicide Rates: Comparative Effects of Poverty, Foreclosure, and Job Loss.
abstract: BACKGROUND
  Suicide rates and the proportion of alcohol-involved suicides rose during the 2008-2009 recession. Associations between county-level poverty, foreclosures, and unemployment and suicide rates and proportion of alcohol-involved suicides were investigated.
  
  
  METHODS
  In 2015, National Violent Death Reporting System data from 16 states in 2005-2011 were utilized to calculate suicide rates and a measure of alcohol involvement in suicides at the county level. Panel models with year and state fixed effects included county-level measures of unemployment, foreclosure, and poverty rates.
  
  
  RESULTS
  Poverty rates were strongly associated with suicide rates for both genders and all age groups, were positively associated with alcohol involvement in suicides for men aged 45-64 years, and negatively associated for men aged 20-44 years. Foreclosure rates were negatively associated with suicide rates for women and those aged ≥65 years but positively related for those aged 45-64 years. Unemployment rate effects on suicide rates were mediated by poverty rates in all groups.
  
  
  CONCLUSIONS
  Population risk of suicide was most clearly associated with county-level poverty rates, indicating that programs addressing area poverty should be targeted for reducing suicide risk. Poverty rates were also associated with increased alcohol involvement for men aged 45-64 years, indicating a role for alcohol in suicide for this working-aged group. However, negative associations between economic indicators and alcohol involvement were found for four groups, suggesting that non-economic factors or more general economic effects not captured by these indicators may have played a larger role in alcohol-related suicide increases.
authors.affiliation: Alcohol Research Group, Public Health Institute, Emeryville, California. Electronic address: wkerr@arg.org.
authors.forename: William C
authors.initials: WC
authors.lastname: Kerr
authors.affiliation: Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Kaplan
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Huguet
authors.affiliation: Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
authors.forename: Raul
authors.initials: R
authors.lastname: Caetano
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Norman
authors.initials: N
authors.lastname: Giesbrecht
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D019973:Alcohol-Related Disorders; D057172:Economic Recession; D004651:Employment; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence; D008297:Male; D008875:Middle Aged; D011203:Poverty; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult