Sharp, sustained increases in suicides closely shadowed austerity events in Greece

Sharp and significant increases in suicides followed select financial crisis events and austerity announcements in Greece, from the start of the country's 2008 recession to steep spending cuts in 2012, Penn Medicine researchers report in a new study published online this week in the British Medical Journal Open, along with colleagues from Greece and the United Kingdom. After one austerity-related announcement in 2011, when the government announced steep spending cuts, suicides surged by over 35 percent, an increase that was then sustained through to the end of the study in 2012.

This is the first multi-decade (from 1983 to 2012) national analysis using monthly data to link the most up-to-date suicide information in Greece to specific austerity and prosperity-related events.

"Suicides closely followed the announcements of specific government economic programs in Greece, and grew to their highest levels in 2012 as economic austerity measures and public outcries accumulated in number and scale," said senior author Charles C. Branas, PhD, a professor of Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. "Tragically, the impact of austerity measures on suicides is more significant and lasting than prosperity?related events, such as the launch of the Euro in Greece, and appears to affect both men and women, though the trend is more pronounced in men."

Using national suicide data from the Hellenic Statistical Authority, the team, which included researchers from the University of Crete and the University of Edinburgh, found that men in Greece experienced a significant, abrupt and sustained 13 percent increase in suicide beginning in October 2008, which marked the beginning of the recession, with a reduction in national gross domestic product and many violent protests. A 36 percent sharp and sustained increase was also observed in June 2011, when the Greek government again passed unpopular austerity measures. Those spending cuts were immediately followed by strikes that halted most public services and closed Greek banks.

At roughly the same time in 2011, the researchers found a 36 percent abrupt and sustained increase in suicides among women, the same month large, organized protests of austerity measures were held. This sustained increase in suicide among women was larger, on a percentage basis, than for men in 2011. This counters previous research showing that economic downturn results in larger increases in suicides among men, not women.

Greek men also demonstrated a large, but temporary, 30 percent increase in suicides in April 2012, following the highly publicized suicide of a male pensioner in the main square of Athens in response to austerity conditions. Many believe that the uptick in suicides was in part triggered by the media's coverage of the incident; recognizing a possible austerity-suicide relationship publically, so often and with such intensity could have arguably contributed to the tragedies that followed, the authors write.

Media coverage, however, helped to guide the researchers in their analyses. They found 12 distinct events between January 1983 and December 2012 by searching media archives and other publications to identify highly publicized events, including acceptance into the EU, the Olympics, and several austerity measure announcements. The team hypothesized those widely-known events would have the most impact on mental health and thereby could potentially lead to an increase or decrease in suicides. The timings of those events were then measured against the timing of suicides over 30 years— a total of 11,505 suicides, 9,079 by men and 2,256 by women were found. The average monthly number of suicides over that time was 25.2 for men and 6.7 for women.

In contrast to the austerity-related events, the authors found that men in Greece experienced an abrupt but temporary 27 percent decrease in suicide with the launch of the Euro currency in January 2002, when Greece was accepted into the Economic and Monetary Union of the European Union. This suggests that a positive, well publicized events can perhaps have a favorable effect on mental health, say the authors.

"This new analysis brings to light the unintended mental health consequences of the public messaging of economic policies, as well as the sometimes sensational and unnecessarily explicit media coverage that can follow in the wake of these consequences," Branas said.

Greece is thought to have been more affected by the economic crisis than any other European country. The past decade in Greece has been riddled with bailouts, strikes, protests, and continual media coverage of the economic crisis. Today, persistently toxic economic conditions, uncertainty, joblessness, and the possibility of further austerity measures continue to put a great strain on the Greek public, the authors say. Despite this, the correlation between austerity measures and suicide has been met with skepticism by some.

Before this study, there had been no large-scale, systematic longitudinal analysis of suicide in Greece, and suicide data were lumped by year, not month, making it harder to test the short?term relationship between specific events and deaths. Speculations about suicides have also been based on government reports, unofficial data or the media, and ranged anywhere from a 17 to 40 percent increase in suicides.

This study, a month-by-month, multi-decade robust statistical analysis of suicide in Greece, more accurately captures the relationship between economic events and suicide.

Anastasia Kastanaki, PhD, study co-author, psychologist, and research associate at the University of Crete in Greece, has conducted several prior studies of suicide in Greece: "In the light of these data, authorities are called upon to play a more important role in educating the public over these events with the ultimate aim of reducing the impact of the financial downturn on suicide. Since efforts to save even one human life are worthwhile and critical, these same authorities, both existing and newly elected, should play a proactive role in the prevention of future suicidal acts by better assessing the needs of the population and of individuals at high risk for suicide."