Economic Influences and Socioeconomic Status

Epidemiological analyses reveal that occupation, employment status, and socioeconomic status (SES) affect the risk of suicide. A recent IOM report (2001) describes at length the influence of social factors (including employment and SES) on health in general. Many of the same issues exist when focusing on suicide. Some studies that address these issues for suicide and suicidal behavior are described here.

Occupation

Some professions have higher risk for suicide than others. Physicians and dentists, for example, have elevated suicide rates even after controlling for confounding demographic variables, whereas higher suicide rates for occupational groups such as police officers and manual laborers, may be best explained by the demographics of these subgroups (see Chapter 2). It is interesting that in some northern European countries, rates among physicians show gender differences; women having greater risk than men (in Sweden, see Arnetz et al., 1987; in England and Wales see Charlton, 1995; Hawton et al., 2001; in Finland, see Lindeman et al., 1997; Stefansson and Wicks, 1991). Some suggest that greater access to means among these professions contribute to the higher rates (Pitts et al., 1979). While some find that blue-collar workers are more likely to complete suicide, others find high suicide among professional classes (Kung et al., 1998), confirming earlier theories (e.g., Powell, 1958) suggesting that the risk of suicide is elevated at both ends of the occupational prestige spectrum. Chapter 2 describes recent research on this phenomenon.

Specific influences of occupation-related factors on suicide remain unclear. Mental illness and employment variables influence each other, with mental illness sometimes disrupting employment, and unemployment sometimes exacerbating mental illness. Research has implicated economic strain in marital disruption (e.g., Conger et al., 1990; Kinnunen and Pulkkinen, 1998; Vinokur et al., 1996; White and Rogers, 2000), and Zimmerman (1987) found, for example, that state welfare spending appears to influence suicide rates via increasing income and lowering divorce (see above section on marital status and suicide). The occupation-suicide relationship also demonstrates variability according to ethnic differences. One recent study (Wasserman and Stack, 1999) suggests no difference between Black and White suicide in high-status occupations when controlling demographic factors, whereas Whites evidence greater suicide rates for low-status jobs. South (1984), however, found a positive correlation between diminishing Black-White income gaps and Black sui-



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