Unemployment and Suicide Mortality
Transcription
Unemployment and Suicide Mortality
Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe Christian Breuer GFS Working Papers No. 2 February 2014 Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe Christian Breuer Ifo Institute for Economic Research at the University of Munich1 Abstract This paper addresses the influence of economic activity on suicide mortality in Europe. To this end, it employs a new panel dataset of 275 regions in 29 countries over the period 1999 2010. The results suggest that unemployment does have a significantly positive influence on suicides. In-line with economic theory, this influence varies among gender- and age groups. Males of working age (younger than 65 years) are particularly sensitive, while old-age suicide mortality (older than 65 years) does not respond to unemployment. Moreover, real economic growth negatively affects the suicide rates of working-age males. The results withstand tests for robustness, such as sample variations, and after controlling for serial and spatial autocorrelation. Keywords: Panel data, unemployment, suicide JEL Classification: C 33 · E 24 · I 10 1 Ifo Institute, Poschinger Str. 5, 81679, Munich, Germany, Email: [email protected]. Phone: +49 (0) 89 9224 1265. 2 1. Introduction Recent studies debate on the health consequences of the financial and economic crisis in Europe. According to an increasing number of studies, health outcomes worsened and suicide rates rose in the aftermath of the financial crisis.2 According to McKee et al. (2012), Antonakakis (2013), and Karanikolos et al. (2013), European countries with large fiscal adjustments are notably affected by increasing suicide rates.3 The situation of Greece is therefore particularly controversial.4 The question of whether or not the recent phenomenon of increasing suicide rates can be attributed to regional economic contractions in the Eurozone has been controversially debated recently5. According to economic theory, social living conditions, such as income, unemployment and life expectancy, are rational determinants of suicide behaviour (Hamermesh and Soss, 1974).6 Empirical research, however, remains ambiguous as to whether unemployment affects suicides.7 A number of studies find evidence supporting the hypothesis that unemployment increases suicide rates.8 Other studies, however, do not share this view and criticise that the 2 See Stuckler et al. (2011a), Reeves et al. (2012), and Sullivan et al. (2013) on the effect of the economic recession on suicide rates in the United States, and Stuckler et al. (2011b), for a first look at European data. 3 See also Krugman (2012) and Stiglitz (2012) on the negative consequences of fiscal adjustments in Europe. 4 Econoumou et al. (2011), Kentikelenis et al. (2011), Econoumou et al. (2012), and Karanikolos et al. (2013) suggest that suicide rates in Greece have been causally affected by the economic downturn, while Fountoulakis et al. (2012), Polyzos (2012) and Fountoulakis et al. (2013) do not share this view. 5 According to Eurostat (2013), unemployment rates in the Eurozone rose from 7.3 % in early 2008 to 11.7 % in December, 2012 (seasonally adjusted), with large regional differences. While unemployment in Germany fell from 8.1 % to 5.3 % in this period, for some countries the sharp rise in unemployment led to extraordinary high rates of 26.7 % (Spain) and 30.4 % (Greece) at the end of 2012. 6 Di Tella et al. (2003) show how macroeconomic fluctuations affect happiness in Europe. According to their results, unemployment does have a negative effect on happiness. Winkelmann and Winkelmann (2003) show that the non-pecuniary effect of unemployment on life-satisfaction even exceeds the effect that stems from the associated loss of income. 7 See Platt (1984) for a review of earlier empirical work on the connection between unemployment and suicidal behaviour. 8 Ruhm (2000), Stuckler et al, (2011a), and Luo et al. (2011) provide evidence for the United States, Koo and Cox (2008), Chen et al. (2010), Kuroki (2010), and Andrés et al. (2011), for Japan, Virén (1996) for Finland, Tapia Granados (2005) for Spain, Brainerd (2001) for East European countries in the 1990s, Walsh and Walsh (2011) for Ireland, and Stuckler et al. (2009), for a panel of European countries. Using micro-data, Gerdtham and Johannesson (2003) as well as Browning and Heinesen (2012) find a positive relationship between unemployment and suicide in Denmark and Sweden respectively. 3 evidence presented in the case of Europe suffers from methodological issues (Kunce and Anderson, 2002, Andrés, 2005). Kunce and Anderson (2002), as well as Maag (2008) criticise that an analysis of aggregated data at a national level may fail to identify the socio-economic determinants of suicides and suggest analysing more disaggregated data. Only a few studies have analysed the determinants of suicide at the subnational level to date. Ruhm (2000) identifies a negative relationship between death rates and unemployment rates in the United States, whereas suicides as an exception are positively correlated with unemployment. Chen et al. (2010) find that unemployment has a positive effect on suicides for a panel of Japanese prefectures. Using Japanese data at the municipal level, Kuroki (2010) finds evidence of a positive relationship between unemployment and suicides for the male population, while the relationship tends to be negative for females. Neumeyer (2004) examines subnational data for Germany and confirms the finding of Ruhm (2000) that mortality rates are pro-cyclical. Contrary to Ruhm (2000), however, the results of Neumeyer (2004) indicate that unemployment rates and suicide rates in Germany are negatively correlated. In the same vein, Andrés (2005) challenges previous results that unemployment positively affects suicides in a panel of European countries and highlights the application of country-specific linear time trends to account for unobserved country specific factors that are time-varying. According to his findings, unemployment does not significantly affect suicide behaviour in Europe, after controlling for country-specific trends. This article contributes to the debate on how economic activity influences suicide mortality by exploring European regional data at the NUTS-2 level. It applies a new panel dataset of 275 regions in 29 European countries over the period 1999 to 2010. The sample covers the years of the European Monetary Union, including the economic crisis, starting in 2008. The results suggest that unemployment does have a significant positive influence on suicides in Europe. In-line with economic theory, this influence varies among gender- and age groups. Males of working age (younger than 65 years) are particularly sensitive, while old-age suicide mortality 4 (older than 65 years) does not respond to unemployment. Moreover, economic growth negatively affects the suicide behaviour of working-age males. The results withstand tests for robustness, such as sample variations, as well as controls for serial and spatial autocorrelation. 2. Background Since the seminal works of Wagner (1864) and Durkheim (1897), a large body of literature has analysed the cultural, social and economic correlates of suicide. Wagner (1864) pointed to the impact of religion, and found a different pattern of suicide behaviour in protestant and catholic regions in Europe.9 Early contributions, however, pointed to the influence of socioeconomic factors. According to Durkheim (1897), social (dis-) integration and the individual environment affect the incidence of suicides. Modern economic theory suggests that living conditions, such as income, status or unemployment, may explain suicidal behaviour. According to Hamermesh and Soss (1974), an individual i at age a, with a permanent income Y takes his own life when the total discounted lifetime utility Z i plus the individual’s taste for living bi reaches zero: Z i (a, Y ) bi 0, (1) with Z i (a, Y ) = e r ( m a )U m P (m)dm , a 9 (2) Becker and Wössmann (2011) find a significant difference in the suicide behaviour of Protestants and Catholics when looking at historical data on Prussia. Koo and Cox (2008), as well as, Gearing and Lizardi (2009) argue that societies of Christian origin regard suicide as a sin and may, thus, exhibit different suicide behaviour. Based on this, it is possible that suicide behaviour is different in Europe, as compared to other regions. Yang and Lester (1995) argue that unemployment only affects suicide behaviour in the US, while the effect is weak or insignificant in other countries. 5 where is the highest attainable age, r is the discount rate and U is the expected utility at age m. P(m) is the probability of survival to age m given survival to age a. The expected utility U m is negatively related to the individual’s age m and positively related to his or her permanent income Y. The individual’s taste for living bi is supposed to be normally distributed, so that the age-adjusted aggregate suicide rate, defined as the fraction of individuals in the age group a for whom Z (a, Y ) reaches b , is inversely related to permanent income Y. Based on this framework, Hamermesh and Soss (1974) outline testable hypotheses and argue that an increase in income per capita or life expectancy reduces the likelihood of suicides. They empirically demonstrate a positive relationship between unemployment and suicide mortality in the United States. It is worthwhile to extend the simple economic framework and to include other non-pecuniary factors that may increase lifetime utility. According to Durkheim (1897), social integration may decrease the likelihood of suicides, arguably because it increases expected utility. In this line, a number of factors other than income are likely to influence utility. To control for non-pecuniary factors, empirical studies analysed the effects of demographic, social or environmental variables on suicide mortality, such as income (Noh, 2009), fertility (Andrés, 2005, and Kuroki, 2009), divorce rates (Andrés, 2005), crime rates (Brainerd, 2001), income distribution (Leigh and Jencks, 2007), alcohol consumption (Walsh and Walsh, 2005), civil liberty (Jungeilges and Kirchgässner, 2002), or weather conditions (Neumayer, 2003b). 6 3. Data and descriptive statistics Contrary to previous research, this study relies on regional data at the NUTS-2 level and draws on panel data over the period 1999 – 2010 from the Eurostat regional statistics database. The cross-section includes 275 regions in 29 countries, including all EU-27 and EFTA countries, with the exception of Denmark and Liechtenstein.10 To model suicide behaviour, (age-adjusted) suicide rates per 100,000 inhabitants are used. As for explanatory variables, regional unemployment rates in the population aged 15 years and above are treated as the primary proxy of a region’s (cyclical) economic condition. Eurostat provides data on unemployment at the regional level, starting in 1999. The full sample covers the period 1999-2010. Figure 1 shows aggregated suicide rates, as well as unemployment rates in the EU-27, during the 1999 to 2010 sample period. Figure 1 Unemployment and Suicide Mortality 14 12 10 8 6 4 2 Suicide rate (per 100,000 inhabitants) 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 0 Unemployment rate (%) 10 The total sample for all 31 EU-27 and EFTA countries includes 286 regions. For Denmark and Liechtenstein data is not available at the NUTS-2 level. The panel is unbalanced, due to missing observations for various regions and years. 7 Source: Eurostat. The trend in both rates decreases during 1999 to 2007. Both rates, however, increased substantially after the economic crisis in 2008. This bird’s view suggests a positive relationship between unemployment and suicide mortality for the EU-27. Figure 2 shows the age-adjusted suicide rates of different parts of the population. I distinguish between workingage and old-age groups (< 65 years and > 65 years, respectively), as well as between genderspecific (male and female) suicide rates. With its greater exposure to negative income shocks, theory suggests that unemployment effects on suicide behaviour are particularly strong in the working-age population. In comparison, economic theory predicts no direct unemployment effect on the suicide behaviour of pensioners. This pattern is reflected in Figure 2: the suicide rates of working age males (< 65 years) and unemployment rates exhibit a very similar development, while the suicide rates of other groups are not related to unemployment at first view. Figure 2 Suicide Mortality of Gender- and Age Groups 50 Unemployment rate (%) 45 40 Male suicide rate (less than 65 years), per 100,000 35 30 Male suicide rate (> 65 years), per 100,000 25 20 Female suicide rate (less than 65 years), per 100,000 15 10 Female suicide rate (> 65 years), per 100,000 5 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 0 Source: Eurostat. 8 Table 1 shows descriptive statistics. In addition to suicide and unemployment rates, it includes fertility, heating degree days, and measures of life expectancy, as well as GDP per capita and the regional growth rate of gross value added (GVA). Table 1 Descriptive Statistics Variable Mean Min Max S. D. Obs. Suicide rate Male suicide rate Female suicide rate Suicide rate ( < 65 years) Male suicide rate ( < 65 years) Female suicide rate ( < 65 years) Suicide rate ( > 65 years) Male suicide rate ( > 65 years) Female suicide rate ( > 65 years) Unemployment rate Fertility Weather Life expectancy Male life expectancy Female life expectancy Life expectancy at age 65 Male life expectancy at age 65 Female life expectancy at age 65 GDP per capita (Euro) Economic growth 12.59 19.70 5.81 11.02 17.12 4.92 19.69 34.75 10.01 8.29 1.54 7.54 78.74 75.72 81.70 18.43 16.50 20.03 21,175 2.40 0.70 1.10 0.30 0.40 0.70 0.30 1.00 1.80 0.30 0.80 0.84 0.06 70.40 64.70 74.10 13.70 12.10 14.70 1,100 -15.60 48.00 80.70 30.60 45.00 80.70 18.90 96.70 172.60 81.20 32.80 3.94 18.33 84.00 81.80 87.00 22.40 20.40 24.10 93,900 22.80 6.41 10.44 3.28 5.79 9.48 2.78 12.37 22.26 7.30 4.96 0.32 2.60 2.68 3.18 2.28 1.59 1.63 1.68 11,039 3.31 2,753 2,725 2,700 2,620 2,617 2,574 2,610 2,601 2,479 3,300 3,113 2,926 3,114 3,114 3,114 3,114 3,114 3,114 2,694 1,808 Source: Eurostat. The full sample with 286 regions and 12 years includes 3,432 observations. The panel is unbalanced, due to missing observations for various regions and years. Figure 3 depicts the regional distribution of suicide rates (per 100,000 inhabitants) in Europe for 2010, the last year for which data is available. In this year, countries in South Europe, like Greece and Spain, have already been affected by the economic crisis and have exhibited high levels of unemployment. Suicide rates in this year, however, were low in South European 9 countries, as compared to countries in Central Europe. An analysis of cross-regional differences in crude suicide rates may be inconclusive, because it is likely that unobservable region-specific factors like climate, culture or other determinants, may influence reported suicide rates (Andrés, 2005). It is arguable that unobserved factors may be heterogeneous between regions, but of low volatility over time, as for example alcohol consumption or income distribution (Leigh and Jencks, 2007). Empirical studies on the relationship between suicide rates and socio-economic factors thus often rely on an analysis of fixed-effects panel models to capture the effects of unobserved regional factors that are not time-varying with (cross-section) fixed effects (Neumayer, 2003a and 2003b). Figure 3 Regional Distribution of Suicide Mortality in Europe (2010) Source: Eurostat. 10 4. Empirical strategy To examine the relationship between suicide mortality and regional economic and social determinants, this paper applies two-way fixed effects regressions of the following form: S jt j t j t U jt X jt jt (3) where j and t index regions and years, respectively. S jt denotes the respective agestandardized suicide rate (of the total population and the male and female populations separately) in a region j at time t. j captures region-specific fixed-effects that cannot be attributed to the explanatory variables. t represents time fixed-effects to control for effects that influence the suicide rates of all regions in one year. The application of two-way fixed effects panel estimations is a well-established strategy and similar to the approaches of Ruhm (2000) and Brainerd (2002). According to Andrés (2005), equation (4) contains linear trends ( j t ) for all regions j, with t = 1, …, T to account for the influence of unobserved regional factors that are time-varying. Following Ruhm (2000), S jt denotes either, level-, or the natural logarithm of level values (of suicide rates). U jt denotes the unemployment rate in a certain region and year. X jt is a vector of economic, social, and environmental controls. The baseline equation includes fertility rates, gender specific life expectancy, and a proxy for the influence of weather (heating degree days, divided by 365).11 In the European context, it is conceivable that a cold climate decreases the quality of life and, thus, increases the incidence of suicide, particularly in a cross-section analysis. This paper runs equation (3) for suicide rates of the total population, male and female population and distinguishes between different 11 A number of studies analysed the influence of weather on suicide behaviour, with mixed results (see Breuer et al., 1986; Deisenhammer, 2003; Dixon and Kalkstein, 2009). 11 age groups (younger than 65 years of age and older than 65 years). To distinguish between unemployment and the influence of other economic phenomena, the full set of controls includes the annual growth rate of real gross value added (GVA), as a proxy for economic growth, and regional log gross domestic product (GDP) per capita. Due to missing observations, the additional economic controls reduce the number of observations, so all equations are run both with and without the economic control variables, economic growth and log GDP per capita. Figure 3 indicates that neighbouring regions, particularly of the same country, might exhibit a similar suicide pattern. To test whether the results are influenced by serial or spatial autocorrelation, equation (4) includes the first lag of (regional) suicide rates, as well as a spatial lag of suicide rates in neighbouring regions: S jt j t j t U jt X jt S jt 1 WS jt jt (4) , where WS jt denotes the (weighted) average suicide rate in neighboring regions of the same country, with WS jt S njt * Pjtn S jt * Pjt P Pjt n jt , where S njt indicate the national suicide rate, Pjtn the national population, and Pjt the regional population.12 12 This procedure is equivalent to an application of a weight matrix based on neighbouring regions, where a neighbour is a region of the same country and neighbouring regions are weighted by their population size. 12 5. Results a) Benchmark results Table 2 reports the results of the benchmark regressions of equation (3). Columns 1 and 2 display the results for total population (both gender types and all age groups). Columns 3 and 4 report the results for male suicide rates, and Columns 5 and 6 show the results for female suicide rates. Regressions in even-numbered columns treat the natural logarithm of suicide rates as endogenous variables, while suicide rates in odd-numbered columns are in levels. According to Ruhm (2000), this paper distinguishes between level and log level values to investigate the functional form of a possible relationship between suicides and their determinants. The tables show Driscoll-Kraay (1998) standard errors that allow correlations of the error term across time and regions. As suggested by Andrés (2005), all regressions contain cross section and year fixed effects, as well as region-specific trends to control for unobserved factors. The benchmark regression shows that the suicide rate of the total population is positively related to unemployment. This relationship is particularly pronounced for males. The coefficient for unemployment displays the estimated quantitative relationship between unemployment and suicide mortality. Columns no. 1, 3 and 5 show the mean reaction of suicide rates to an increase in unemployment rates. If unemployment rises by 1 percentage point, suicide rates increase by 0.09 (per 100.000 inhabitants). Male suicides increase by 0.21 (per 100.000 male inhabitants). The relationship is positive for females too, but statistically not significant. The interpretation of coefficient in column no. 2, 4 and 6 differs from this result: if unemployment rises by 1 percentage point, the suicide rate rises by 0.55 %, and male suicides rise by approximately 1 %. Accordingly, a 1 percentage point increase in unemployment would increase suicide cases of male population by approximately 500 per 13 year in the EU-27. The positive influence of unemployment on female suicide mortality turns out to be insignificant. The effect is little in absolute cases, as compared to male suicides, because the absolute number of female suicides is low on average, as compared to male suicides. Table 2 Fixed Effects Regressions, Benchmark Dependent variable: Suicide mortality rate Expl. variables Unemployment Fertility Weather Life expectancy Total population Men Women level log level log level log 0.092*** (0.021) 0.394 (1.039) 0.188** (0.080) -0.751** (0.334) 0.551* (0.257) 0.069 (0.113) 0.015* (0.008) -0.063*** (0.017) 0.212*** (0.031) 2.747 (1.764) 0.359* (0.175) 1.020*** (0.245) 0.184 (0.150) 0.016 (0.010) 0.021 (0.016) -2.215 (1.809) 0.001 (0.053) 0.464 (0.343) -0.170 (0.238) 0.004 (0.010) -1.528** (0.485) -0.075*** (0.016) L. e.: male -0.500*** -0.099*** (0.098) (0.012) L. e.: female Cross-section FE Period FE Regional trends Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Observations 2,253 2,253 2,252 2,252 2,232 2,232 No. of regions 259 259 259 259 259 259 0.489 0.366 0.440 0.340 0.351 0.295 R² Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days) and life expectancy (at birth). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 14 Column 3 indicates that male suicides respond to weather conditions. Accordingly, the suicide rates increase in particularly cold years. An increase in the number of heating degree days per year of 1 on average increases the suicide rate of males by 0.36. Moreover, the results indicate that male and female suicides are negatively related to life expectancy. This latter result confirms earlier results in literature on this topic (e.g. by Brainerd, 2001). b) Additional controls Table 3 reports the results of equation (3) after additionally including economic controls. The results show that real economic growth (gross value added) is negatively correlated with male suicide rates, while GDP per capita only has a statistically significant negative effect on suicide mortality in row no. 1 and 2. An increase in real GVA of 1 percent would decrease male suicide mortality by 0.5 percent. This result does not, however, diminish the relationship between unemployment and suicide mortality, which remains statistically significant for males in both specifications. Accordingly, two separate factors positively affect male suicides in an economic downturn: firstly, a decrease in growth, and secondly, an increase in unemployment. This finding underlines the economic effects on suicides in the recent economic downturn in Southern Europe. Life expectancy is also negatively correlated with suicide for both gender groups and statistically significant, while the effect of weather and fertility turns out to be insignificant. 15 Table 3 Fixed Effects Regressions, Full Set of Controls Dependent variable: Suicide mortality rate Expl. variables Unemployment Fertility Weather Life expectancy Total population Men Women level log level log level log 0.132** (0.046) -1.574 (1.744) -0.182 (0.259) -0.653 (0.418) 0.773 (0.452) -0.214 (0.208) -0.022 (0.019) -0.057** (0.019) 0.310*** (0.081) -2.423 (1.935) -0.116 (0.350) 1.315*** (0.376) -0.266* (0.140) -0.021 (0.017) 0.038 (0.033) -1.457 (2.689) -0.180 (0.203) 1.082* (0.565) 0.038 (0.455) -0.010 (0.029) -1.568* (0.693) -0.077** (0.025) -0.087*** (0.021) 0.135 (0.212) -0.004 (0.184) L. e.: male -2.192 (2.175) -0.101** (0.031) -0.034 (0.076) -0.495*** (0.108) -0.629* (0.279) -2.087 (1.659) -0.014 (0.026) L. e.: female GDP per capita Economic growth Cross-section FE Period FE Regional trends Observations No. of regions R² -2.965* -0.145** (1.585) (0.051) -0.042*** -0.281** (0.013) (0.091) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,429 212 0.502 1,429 212 0.363 1,429 212 0.449 1,429 212 0.337 1,412 212 0.416 1,412 212 0.313 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), GDP per capita (log), and economic growth (annual growth rate of gross value added). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 16 c) Different age groups Tables 4 and 5 distinguish between age-specific suicide rates. Table 4 reports results for the working-age population (< 65 years), while Table 5 includes results for the old-age population (> 65 years). Note that unemployment has an effect on both, male and female suicide rates at ages below 65, but has no influence on suicide at ages above 65, a result very much in line with the economic theory. If unemployment rises by 1 percentage point, both, male and female suicides (of the working age population) rise by approximately 1 percent. Accordingly, unemployment increases suicides of working-age population (with an elasticity of approximately one for both gender groups), but has no statistically significant effect on suicide behavior in the age above 65. Beside unemployment, the effect of weather does have a statistically significant positive effect on the suicides of working-age males. Furthermore, life expectancy continues to negatively impact suicides in all age and gender groups. d) Serial and spatial autocorrelation To test whether the results are influenced by serial or spatial autocorrelation, equation (4) includes the first lag of the regional suicide rate, as well as a spatial lag, where the suicide rate in neighbouring regions is the population-weighted suicide rate in all regions of the same country. Table 6 shows the results of equation (4). The lagged suicide rate, as well as the suicide rate in neighbouring regions, turns out to be statistically significant. The positive sign of the spatial lag indicates that, beyond regional characteristics, there may be determinants at the national level that simultaneously influence suicide rates in all regions of a country. This influence, however, does not diminish the positive effect of regional unemployment on regional suicide mortality, which turns out to be statistically significant in most of the 17 specifications. The effect of regional weather on suicides now turns out to be negative. It is conceivable that the influence of spatial autocorrelation in weather might influence the results. The negative effect of life expectancy on suicides, however, remains robust. Table 4 F. E. Regressions, Age Group < 65 Years Dependent variable: Suicide mortality rate Expl. variables Unemployment Fertility Weather Life expectancy Total population Men Women level log level log level log 0.117*** (0.021) 1.991 (1.403) 0.216** (0.092) -0.796* (0.362) 0.866** (0.286) 0.243* (0.129) 0.019** (0.007) -0.064** (0.021) 0.235*** (0.036) 4.250* (2.287) 0.400** (0.171) 1.184*** (0.281) 0.311** (0.135) 0.019** (0.008) 0.038 (0.022) -0.793 (1.283) 0.003 (0.052) 0.980* (0.523) 0.102 (0.285) 0.001 (0.009) -1.379** (0.447) -0.065*** (0.013) -0.624*** (0.121) -0.130*** (0.032) L. e.: male L. e.: female Cross-section FE Period FE Regional trends Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Observations No. of regions 2,252 259 2,252 259 2,251 259 2,251 259 2,216 259 2,216 259 R² 0.455 0.324 0.428 0.303 0.264 0.237 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days) and life expectancy (at birth). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 18 Table 5 F. E. Regressions, Age Group > 65 Years Dependent variable: Suicide mortality rate Expl. variables Unemployment Fertility Weather L. e. at age 65 Total population Men Women level log level log level log -0.016 (0.071) -4.612 (5.661) 0.082 (0.153) -1.131 (0.668) -0.022 (0.314) 0.040 (0.221) 0.023 (0.020) -0.063 (0.050) 0.007 (0.088) -0.801 (3.524) 0.126 (0.417) 0.137 (0.270) 0.147 (0.187) 0.025 (0.024) 0.040 (0.041) -4.317 (5.345) -0.227 (0.193) 0.566 (0.601) -0.094 (0.268) -0.008 (0.028) -3.505** (1.214) -0.145** (0.050) L. e.: male -1.604** -0.099*** (0.628) (0.025) L. e.: female Cross-section FE Period FE Regional trends Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Observations No. of regions 2,242 259 2,242 259 2,235 259 2,235 259 2,155 259 2,155 259 R² 0.382 0.253 0.265 0.190 0.345 0.244 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days) and life expectancy (at birth). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 19 Table 6 Fixed Effects Regressions, Controlling for Autocorrelation Dependent variable: Suicide mortality rate Expl. variables Total population level Unemployment Fertility Weather Life expectancy log 0.072*** 0.407 (0.019) (0.275) -0.140 -0.089 (0.652) (0.095) -0.284*** -0.024*** (0.057) (0.004) -1.087*** -0.083*** (0.248) (0.015) L. e.: male L. e.: female Lagged suicide rate Spatial lag Cross-section FE Period FE Regional trends Observations No. of regions R² -0.150** (0.048) 0.704*** (0.042) Men Women level log level log 0.135*** (0.018) 0.757 (0.676) -0.368*** (0.098) 0.886** (0.335) 0.010 (0.109) -0.023*** (0.005) 0.033*** (0.010) -0.559 (0.888) -0.152** (0.048) 0.443 (0.394) -0.133 (0.245) -0.025* (0.013) -1.591*** (0.247) -0.064*** (0.016) -0.468*** -0.090*** (0.067) (0.024) -0.194** -0.204*** -0.232** -0.163*** -0.120*** (0.062) (0.052) (0.073) (0.027) (0.029) 0.730*** 0.646*** 0.650*** 0.470*** 0.472*** (0.044) (0.062) (0.087) (0.111) (0.090) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,996 250 0.511 1,996 250 0.400 1,973 250 0.442 1,973 250 0.349 1,944 250 0.420 1,944 250 0.321 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), lagged suicide rate, and the spatial lag of the suicide rate. Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 20 e) Robustness To ensure that the results are robust, the sample size is varied and all regions of one country are consecutively excluded in the benchmark regression. Table 7 contains the results of these sample variations (total population, suicide rates in levels), after excluding country by country. The main finding, namely that unemployment affects suicide mortality, remains robust for all sample adjustments. Furthermore, an increase in life expectancy decreases suicide mortality for every sample. The results are robust to further tests, particularly after including economic controls in agespecific regressions for both young and old-age groups. Moreover, exogenous variables, with the exception of unemployment, are excluded in the benchmark, as well as in age- and gender- specific regressions. Controls for serial and spatial autocorrelation are also included in all regressions for both age groups. The finding that unemployment affects suicide mortality, particularly among young males, remains statistically significant. 21 Table 7 Sensitivity Analysis Country excluded Belgium Bulgaria Czech Republic Germany Estonia Ireland Greece Spain France Italy Cyprus Latvia Lithuania Luxembourg Hungary Malta Netherlands Austria Poland Portugal Romania Slovenia Slovakia Finland Sweden United Kingdom Iceland Norway Switzerland Full Sample unemployment 0.093*** 0.099*** 0.093*** 0.106*** 0.089*** 0.093*** 0.100*** 0.117*** 0.091*** 0.098*** 0.093*** 0.088*** 0.082*** 0.091*** 0.082*** 0.093*** 0.094*** 0.096*** 0.094*** 0.085*** 0.092*** 0.092*** 0.094*** 0.088*** 0.085*** 0.091*** 0.103*** 0.094*** 0.088*** 0.092*** S. E. 0.020 0.021 0.020 0.027 0.018 0.021 0.020 0.027 0.019 0.023 0.021 0.020 0.016 0.019 0.023 0.021 0.020 0.021 0.035 0.022 0.021 0.021 0.021 0.025 0.023 0.022 0.022 0.019 0.019 0.021 Obs. 2,209 2,217 2,173 1,979 2,242 2,231 2,123 2,078 2,011 2,100 2,247 2,245 2,242 2,242 2,183 2,243 2,157 2,163 2,109 2,203 2,205 2,253 2,225 2,209 2,173 2,005 2,242 2,185 2,190 2,253 Regions 248 253 251 223 258 257 246 241 237 242 258 258 258 258 252 258 247 250 243 254 251 259 255 254 251 228 258 252 252 259 R² within 0.481 0.493 0.487 0.486 0.474 0.489 0.497 0.494 0.498 0.492 0.489 0.488 0.477 0.491 0.451 0.491 0.494 0.493 0.499 0.498 0.489 0.489 0.487 0.491 0.496 0.495 0.49 0.496 0.494 0.489 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days) and life expectancy (at birth). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 22 6. Conclusion It is a well-established finding in the empirical literature on the determinants of health and mortality that unemployment affects suicides in developed countries. Evidence from the United States (Ruhm, 2000), Japan (Kuroki, 2010), and selected European countries (Brainerd, 2001) shows that unemployment increases suicide mortality. Stuckler et al. (2009), find a positive correlation between unemployment and suicides in a panel of 24 European countries. Other authors, however, challenge these findings. According to Andrés (2005), the correlation of unemployment and suicide is biased and disappears after controlling for timevarying local factors with region-specific trends. This paper addresses the influence of unemployment on suicide mortality with a focus on Europe. To that end, it employs a new regional panel dataset of 275 European regions in 29 countries over the period 1999 to 2010. The sample covers the years of European Monetary Union, as well as the economic crisis starting in 2008. In contrast to Andrés (2005), the results suggest that unemployment does have a significant positive influence on suicide mortality. This influence varies among gender and age groups. Males of working age (younger than 65 years) are particularly sensitive, while old-age suicide mortality (older than 65 years) does not respond to fluctuations in unemployment. These results confirm the theoretical prediction that unemployment increases suicide mortality (of the working-age population), but has no effect on suicides in the old-age population. This finding highlights the theoretical assumption that unemployment implies a negative shock in expected income for the (unemployed share of the) working-age population, while the old-age population does not suffer (directly) from unemployment. Moreover, my findings indicate that real economic growth negatively affects suicide rates of working-age males. According to this, two separate factors negatively affect 23 male suicides in an economic downturn: firstly, a decrease in growth, and secondly, an increase in unemployment. The results hold after robustness tests, such as sample variations and after including regionspecific trends. Moreover, suicide mortality responds to life expectancy, a result that supports the economic theory (Hamermesh and Soss, 1974). These results are in line with those presented by a large body of empirical literature on the determinants of suicide mortality, particularly for non-European countries (Ruhm, 2000; Koo and Cox, 2008; Kuroki, 2010; Luo et al., 2011; Stuckler et al., 2011), but contrary to previous findings for Europe (Neumeyer, 2004, Andrés, 2005). The different finding may reflect the application of new regional data and different samples. While Andrés (2005) explores crossnational data for 27 European countries over the period 1970 to 1998, this paper investigates a panel dataset of 275 European regions over the period 1999 to 2010. It is conceivable that previous studies fail to significantly identify the relationship between unemployment and suicide because of a relatively large level of aggregation (Kunce and Anderson, 2004, and Maag, 2008). The new evidence presented in this paper, may, thus, reflect the application of more disaggregated data and a considerable improvement in the sample size. The conflicting results of previous studies of European data at the national level, as presented in Andrés (2005) and Stuckler et al. (2009), remain a challenge for future research, particularly because both studies apply national panel data, provided by the WHO, starting in 1970. It is conceivable that the different findings reflect differing empirical strategies or sample sizes. In-line with Stuckler et al. (2009) and based on a new panel dataset at the regional level, my findings suggest that a one percentage point increase in unemployment is associated with an (approximately) one percent increase in suicides among individuals aged younger than 65 years. 24 The results strengthen the assumption that the recent economic crisis will be accompanied by an increase in suicide mortality, particularly in South Europe. Sullivan et al. (2013) highlight the need for suicide prevention strategies in the light of increasing suicide rates in the United States. The results presented in this paper suggest taking into account the effects of economic fluctuations on mental health and developing a viable suicide prevention strategy against the background of on-going fiscal and economic adjustments in Europe. 25 References Andrés, A. R. (2005), ‘Income Inequality, Unemployment, and Suicide: A Panel Data Analysis of 15 European Countries’, Applied Economics, 37, 439–451. Andrés, A. R., Halicioglu, F., Yamamura, E. (2011), ‘Socio-economic determinants of suicide in Japan’, The Journal of Socio-Economics, 40, 723-731. Antonakakis, Nikolaos (2013), “Fiscal Austerity, Unemployment and Suicide in Greece”, MPRA Paper No. 45198. Becker, S. O., Wössmann, L. (2011), ‘Knocking on Heaven’s Door? Protestantism and Suicide’, CESifo Working Paper No. 3499. Brainerd, E. (2001), ‘Life and Death in Eastern Europe—Economic Reform and Mortality in the Former Soviet Union: A Study of the Suicide Epidemic in the 1990s’, European Economic Review, 45, 1007–1019. Breuer, H.-W- M., Breuer, J., Fischbach-Breuer, B. R. (1986), ‘Social, Toxicological and Meteorological Data on Suicide Attempts’ European Archives of Psychiatry and Neurological Sciences, 235, 367–370. Browning, M., Heinesen, E. (2012), ‘Effect of job loss due to plant closure on mortality and hospitalization’ Journal of Health Economics, 31, 599–616. Chen, J., Choi, Y., C., Mori, K., Sawada, Y., Sugano, S. (2012), ‘Recession, Unemployment, and Suicide Mortality in Japan’ Japan Labour Review, 9, 75-92. Deisenhammer, E. A. (2003), ‘Weather and suicide: the present state of knowledge on the association of meteorological factors with suicidal behaviour’, Acta Psychiatrica Scandinavica, 108, 402-409. Di Tella, R., MacCulloch, R. J., Oswald, A. J. (2003), ‘The Macroeconomics of Happiness’, The Review of Economics and Statistics, 85, 809-827. 26 Dixon, P. G., Kalkstein, A. J. (2009), ‘Climate-Suicide Relatinships: A Research Problem in Need of Geographic Methods and Cross-Disciplinary Perspectives’ Geography Compass, 3, 1–14. Driscoll, J. C., Kraay, A. C. (1998), ‘Consistent Covariance Matrix Estimation With Spatially Dependent Panel Data’, Review of Economics and Statistics 80, 549-560. Durkheim, E. (1897), ‘Suicide: A study in sociology’, Free Press, New York, 1951. Economou, M., Madianos, M., Theleritis, Peppou, L. E., Stafanis, C. N. (2011), ‘Increased suicidality amid economic crisis in Greece’, The Lancet, 378, 1459. Economou, M., Madianos, M., Theleritis, Peppou, L. E., Stafanis, C. N. (2012), ‘Suicidality and the economic crisis in Greece’, The Lancet, 380, 337. Eurostat (2013), ‘Euro area unemployment at 11.7 %’, Eurostat Newsrelease, December 2012. Fountoulakis, K. N., Grammatikopolous, I. A., Koupidis, S. A., Siamouli, M., Theodorakis, P. N. (2012), ‘Health and the Financial Crisis in Greece’ The Lancet, 379, 1001-1002. Fountoulakis, K. N., Koupidis, S. A., Siamouli, M., Grammatikopolous, I. A., Theodorakis, P. N. (2013), ‘Suicide, recession, and unemployment’ The Lancet, 381, 721-722. Gearing, R. E. Lizardi, D. (2009), ‘Religion and Suicide’ Journal of Religion and Health, 48, 332-341. Gerdtham, U., Johannesson, M. (2003), ‘A note on the effect of unemployment on mortality’ Journal of Health Economics, 22, 505–518. Hamermesh, D. S., Soss, N. M. (1974), ‘Theory of Suicide’ Journal of Political Economy, 82, 83-98. Jungeilges, J., Kirchgässner, G. (2002), ‘Economic welfare, civil liberty, and suicide: an empirical investigation’ The Journal of Socio-Economics, 31, 215-231. Karanikolos, M., Mladovsky, P., Cylus, J., Thomson, S., Basu, S., Stuckler, D., Mackenbach, J. P., McKee, M. (2013), ‘Financial Crisis, Austerity, and Health in Europe’, The Lancet, 381, 1323-1331. 27 Kentikelenis, J., Karanikolos, M., Papanicolas, M., Basu, S., Mc Kee, M., Stuckler, D. (2011), ‘Health Effects of the Financial Crisis: Omens of a Greek Tragedy’, The Lancet, 378, 14571458. Koo, J., Cox, W. M. (2008), ‘An Economic Interpretation of Suicide Cycles in Japan’, Contemporary Economic Policy, 26, 162-174. Krugman, P. (2012), ‘Europe’s Economic Suicide’, New York Times, April, 15th. Kunce M. and Anderson, A. L. (2002),‘The Impact of Socioeconomic Factors on Suicide Rates. A Methodological Note’, Urban Studies, 39, 155-162. Kuroki, M. (2010), ‘Suicide and Local Unemployment in Japan: Evidence from Municipal Level Suicide Rates and Age-Specific Suicide Rates’, Journal of Socio-Economics, 39, 683– 691. Leigh, A., Jencks, C. (2007), ‘Inequality and mortality: Long-run evidence from a panel of countries’ Journal of Health Economics, 26, 1–24. Luo, F., Florence, C., Quispe-Agnoli, M., Ouyang, L. Crosby, A. E. (2011), ‘Impact of Business Cycles on US Suicide Rates, 1928–2007’, American Journal of Public Health, 101, 1139–1146. Maag T. (2008), ‘Economic Correlates of Suicide Rates in OECD Countries’, SCALA Discussion Paper, No 6, 2008. McKee, M., Karanikolos, M., Belcher, P., Stuckler, D. (2012), ‘Austerity: a Failed Experiment on the People of Europe’, Clinical Medicine, 12, 346–350. Neumayer, E. (2003a), ‘Are Socioeconomic Factors Valid Determinants of Suicide? Controlling for National Cultures of Suicide with Fixed-Effects Estimation’, Cross-Cultural Research, 37, 307–329. Neumayer, E. (2003b), ‘Socioeconomic Factors and Suicide Rates at Large-unit Aggregate Levels: A Comment’, Urban Studies, 40, 2769-2776. Neumayer, E. (2004), ‘Recessions Lower (Some) Mortality Rates: Evidence from Germany’, Social Science and Medicine, 58, 1037–1047. 28 Noh, J.-H. (2009), ‘Does unemployment increase suicide rates? The OECD panel evidence’ Journal of Economic Psychology, 30, 575–582. Platt, S. (1984), ‘Unemployment and Suicide Behaviour: A Review of the Literature’ Social Science and Medicine, 19, 93-115. Polyzos, N. (2012), ‘Health and the Financial Crisis in Greece’ The Lancet, 379, 1000. Reeves, A., Stuckler, D., McKee M., Gunnell, D., Chang, S.-S., Basu, S. (2012), ‘Increase in state suicide rates in the USA during economic recession’, The Lancet, 380, 1813-1814. Ruhm, C. J. (2000), ‘Are Recessions Good for Your Health?’ Quarterly Journal of Economics, 115, 2, 617–650. Stiglitz, J. (2012), ‘Austerity – Europe’s man-made disaster’ Social Europe Journal, 2012. Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., McKee, M. (2009), ‘The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis’, The Lancet, 374, 315-323. Stuckler, D., Meissner, C., Fishback, P., Basu, S., McKee, M. (Stuckler et al., 2011a), ‘Banking Crises and Mortality During the Great Depression: Evidence from US Urban Populations, 1927–1939’, Journal of Epidemiol Community Health, 66, 410-419. Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., McKee, M. (Stuckler et al., 2011b), ‘Effect of the 2008 recession on health: a first look at European data’, The Lancet, 378, 124-125. Sullivan E. M., Annest, J. L., Luo, F., Simon, T., Dahlberg, L. L. (2013), ‘Suicide among adults aged 35-64 years – United States, 1999-2010’, Morbidity and Mortality Weekly Report, 62, 321-326. Tapia Granados, J. A. (2005), ‘Recession and Mortality in Spain, 1980-1997’ European Journal of Population, 21, 393–422. Virén, M. (1996), ‘Suicide and business cycles: Finish evidence’ Applied Economics Letters, 3, 737-738. Wagner, A. (1864), ‘Die Gesetzmässigkeit in den scheinbar willkührlichen menschlichen Handlungen vom Standpunkte der Statistik’, Boyes und Geisler, Hamburg. 29 Walsh, B., Walsh, D. (2011), ‘Suicide in Ireland: The Influence of Alcohol and Unemployment’, Economic and Social Review, 42, 1, 27–47. Winkelmann, L, Winkelmann, R. (1998), ‘Why Are the Unemployed So Unhappy? Evidence from Panel Data’ Economica, 65, 1-15. Yang, B., Lester, D. (1995), ‘Suicide, homicide and unemployment’ Applied Economics Letters, 2, 278-279. 30 Appendix Table A 1 Fixed Effects Regressions, Full Set of Controls, Age Group < 65 Years Dependent variable: Suicide mortality rate Explanatory variables Unemployment Fertility Weather Life expectancy Total population Men Women level log level log level log 0.201*** (0.056) 0.027 (1.677) -0.084 (0.178) -0.539 (0.386) 1.857** (0.584) -0.107 (0.209) -0.015 (0.019) -0.055** (0.023) 0.397*** (0.091) 0.002 (2.242) 0.015 (0.294) 2.221*** (0.509) -0.152 (0.134) -0.015 (0.020) 0.076** (0.033) -0.413 (2.111) -0.173 (0.114) 2.065** (0.797) 0.162 (0.490) -0.023 (0.026) -1.365** (0.597) -0.064*** (0.019) Life expectancy: male Life expectancy: female GDP per capita Economic growth Cross-section fixed effects Period fixed effects Region-specific trends Number of observations Number of regions R² -0.485*** -0.087** (0.146) (0.030) -0.197 0.135 (1.289) (0.299) -0.017 -0.162 (0.019) (0.474) -1.578 (1.256) -0.046*** (0.014) -0.160 (0.133) -0.271** (0.106) -1.633 (1.805) -0.087** (0.034) -0.085 (0.086) -0.350** (0.112) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,428 212 0.477 1,428 212 0.346 1,428 212 0.454 1,428 212 0.331 1,399 212 0.295 1,399 212 0.262 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), GDP per capita (log), and economic growth (annual growth rate of gross value added). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 31 Table A 2 Fixed Effects Regressions, Full Set of Controls, Age Group > 65 Years Dependent variable: Suicide mortality rate Explanatory variables Total population level Unemployment Fertility Weather Life expectancy -0.101 (0.071) -9.345 (8.962) -0.790 (0.506) -0.549 (0.333) Life expectancy: male log Men level Women log -0.060 -0.059 0.049 (0.362) (0.228) (0.312) -0.199 -8.087 -0.133 (0.287) (4.697) (0.224) -0.055*** -1.514*** -0.059*** (0.015) (0.441) (0.011) -0.033 (0.030) -2.097* -0.071 (1.122) (0.048) Economic growth Cross-section fixed effects Period fixed effects Region-specific trends Number of observations Number of regions R² log 0.056 (0.052) -4.897 (9.134) -0.386 (0.572) 1.778* (0.882) -0.029 (0.520) 0.002 (0.042) -0.053 (0.049) 0.049 (0.392) 0.779 (0.897) -7.125 (4.861) -0.052 (0.072) 0.054 (0.221) -0.273 (0.293) -4.489 (7.438) -0.050 (0.172) 0.020 (0.257) -0.178 (0.391) -1.056 (1.033) -9.372 (5.758) 0.044 (0.059) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,421 212 0.396 1,421 212 0.283 1,417 212 0.281 1,417 212 0.235 1,361 212 0.345 1,361 212 0.234 Life expectancy: female GDP per capita level Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), GDP per capita (log), and economic growth (annual growth rate of gross value added). Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 32 Table A 3 Fixed Effects Regressions, Controlling for Autocorrelation, Age Group < 65 Years Dependent variable: Suicide mortality rate Explanatory variables Total population level Unemployment Fertility Weather Life expectancy 0.090*** (0.021) 1.149 (0.850) -0.156*** (0.043) -0.948*** (0.196) Life expectancy: female Spatial lag Cross-section fixed effects Period fixed effects Region-specific trends Number of observations Number of regions R² log 0.579*** (0.157) 0.042 (0.077) -0.008 (0.008) -0.077*** (0.017) level 0.191*** (0.037) 2.675 (1.488) -0.184 (0.101) Women log 1.100*** (0.274) 0.131 (0.105) -0.008 (0.005) level 0.023 (0.018) -0.821 (1.298) -0.092 (0.083) log 0.777 (0.593) 0.025 (0.266) -0.015 (0.015) -1.377*** (0.214) Life expectancy: male Lagged suicide rate Men -0.186*** (0.048) 0.610*** (0.059) -0.054*** (0.012) -0.551*** -0.107** (0.133) (0.041) -0.240*** -0.238*** -0.253** -0.155*** -0.187*** (0.062) (0.051) (0.078) (0.032) (0.021) 0.758*** 0.567*** 0.674*** 0.291*** 0.471*** (0.068) (0.051) (0.091) (0.049) (0.065) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,994 250 0.465 1,994 250 0.386 1,993 250 0.437 1,993 250 0.351 1,947 249 0.317 1,947 249 0.301 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), GDP per capita (log), lagged suicide rate, and the spatial lag of the suicide rate. Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 33 Table A 4 Fixed Effects Regressions, Controlling for Autocorrelation, Age Group > 65 Years Dependent variable: Suicide mortality rate Explanatory variables Total population level Unemployment Fertility Weather Life expectancy 0.031 (0.037) -1.493 (2.602) -0.706*** (0.211) -0.871*** (0.159) 0.407 (0.250) 0.131 (0.158) -0.063*** (0.017) -0.067** (0.022) Life expectancy: male Life expectancy: female Lagged suicide rate Spatial lag Cross-section fixed effects Period fixed effects Region-specific trends Number of observations Number of regions R² -0.189*** (0.039) 0.623*** (0.100) Men log level Women log 0.124 (0.080) -2.519 (2.832) -1.193*** (0.300) 0.480* (0.223) 0.264 (0.175) -0.042* (0.023) -2.463*** (0.720) -0.067 (0.039) level 0.058** (0.025) -0.148 (3.474) -0.132 (0.304) log 1.395 (0.937) 0.034 (0.319) -0.007 (0.041) -0.047 -0.038 (0.129) (0.022) -0.201*** -0.179*** -0.209*** -0.196*** -0.205*** (0.025) (0.050) (0.022) (0.045) (0.034) 0.353*** 0.333* 0.045 0.478** 0.152 (0.086) (0.176) (0.080) (0.187) (0.121) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 1,982 250 0.425 1,982 250 0.264 1,972 249 0.299 1,972 249 0.225 1,874 248 0.382 1,874 248 0.284 Note: Dependent variable: age-adjusted suicide rate per 100,000 inhabitants (level and log). Explanatory variables are unemployment rate (above 15 years old), fertility, weather conditions (heating degree days, divided by 365 days), life expectancy (at birth), GDP per capita (log), lagged suicide rate, and the spatial lag of the suicide rate. Driscoll-Kraay (1998) standard errors in parentheses. *, **, *** indicate significance at the 10, 5, 1% level. 34