Economic fluctuations and suicide: A comparison of Taiwan and Hong Kong

Abstract

This study examines the impact of unemployment on suicide rates in Taiwan and Hong Kong during the period of rising unemployment (1997–2003) and its subsequent decline (2003–2007), with 2003 as the turning point. During these initial years of high unemployment, suicide rates increased markedly in Hong Kong and Taiwan; however, as employment conditions improved, suicide rates fell in Hong Kong but continued to increase in Taiwan. ARMAX time-series models with appropriate time lags were used to assess the impact of unemployment on suicide rates for both periods. It was found that for Taiwan, the unemployment rate was positively related with the suicide rate for both males and females during the period of high unemployment, whereas a negative relationship was observed as the rate of unemployment decreased. On the other hand, the reduction in suicide rates since 2003 was not statistically significantly related to the improvement of employment conditions for Hong Kong; whereas the suicide rate in Taiwan still remained at a high level due to the increasing number of charcoal burning suicide deaths despite improvements in employment conditions.

In conclusion, lower unemployment was not necessarily associated with lower suicide rates. Exogenous factors other than economic ones have been suggested to be important for understanding differences in suicide patterns in Hong Kong and Taiwan. The impact of employment conditions on suicide across different countries deserves further investigation.

Introduction

Recent studies have shown that general mortality rates fluctuate with economic conditions, rising in expansions and falling in recessions (Khang et al., 2005, Tapia Granados, 2008, Tapia Granados and Diez Roux, 2009). The only exception is suicide, which tends to increase in unfavorable economic environments (Chan et al., 2007, Chang et al., 2009, Chen et al., 2010, Gunnell et al., 1995, Khang et al., 2005, Morrell et al., 1993, Norstrom, 1995, Tapia Granados, 2008, Tapia Granados and Diez Roux, 2009, Yu et al., 2007). In other words, structural socioeconomic conditions may have a substantial impact on suicidal behavior. The association between unemployment conditions and the increase in suicide rates is particularly prominent among working age males, still most often the breadwinners in society (Blakely et al., 2003, Chan et al., 2007, Chen et al., 2010, Platt and Hawton, 2000, Tapia Granados, 2005). A recent meta-analysis of the association between suicide and socioeconomic characteristics of geographical areas revealed that studies from Asian countries, compared to research from the West, were more likely to observe a positive impact of adverse socioeconomic conditions on the increase in suicide rates (Rehkopf & Buka, 2006).

In addition to the ecological correlation between societal economic fluctuations and suicide mortality, individual level data also indicate that suicide is more common among the unemployed and among those who are marginalized in the labor market (Agerbo, 2005, Blakely et al., 2003, Platt and Hawton, 2000, Qin et al., 2003). However, there have been debates about whether the unemployment–suicide relationship at the individual level is causal or is actually confounded by “health selection” (i.e. poorer health or mental health leading to suicide as well as unemployment) (Agerbo, 2003, Preti, 2003). Only well-designed longitudinal follow-up studies are able to provide convincing evidence for the unemployment-suicide link, but conducting such studies is extremely labor intensive and time consuming. A case-control design that takes account of mental disorders may be a more plausible alternative. However, the results of some case-control studies have been inconsistent (Beautrais et al., 1998, Jones et al., 1991, Newman and Bland, 2007).

The aim of this study is to provide empirical evidence to demonstrate how changing economic environments impact suicide rates in Hong Kong and Taiwan, which have experienced dramatic economic decline and expansion for the period 1997–2007. Taiwan (with a population of 23 million) and Hong Kong (7 million), two major economic centers in Asia, have both witnessed dramatic changes in suicide rates over the past decade (1997–2007). The suicide rate for Hong Kong increased from 12.6 per 100,000 in 1997 to a historical high of 18.6 in 2003, returning to about 14.5 in 2007, a 50% increase up to 2003 and 30% decrease thereafter, whereas Taiwan’s suicide rate increased from 10.0 per 100,000 in 1997 to 14.2 in 2003 and to 17.2 in 2007 – a 70% monotonic increase in a decade. The suicide rate in Taiwan had leveled off a bit in 2007–2009. One important contributing factor in this sharp rise is related, at least in part, to the emergence of a new suicide method – burning barbecue charcoal in a closed space to induce carbon monoxide poisoning (Kuo et al., 2008, Liu et al., 2007, Yip and Lee, 2007). The rapid rise in the use of this new method is believed to be related to economic downturns for the period (1997–2003) (Chan et al., 2005, Chang et al., 2009). Furthermore, after the media portrayed carbon monoxide poisoning as a painless and peaceful way of eliminating financial burdens; charcoal burning suicides dramatically increased by 30% in Hong Kong and 20% in Taiwan during high rates of unemployment during 1997–2003 (Liu et al., 2007). The unemployment rate in 2003 was 7.9% and 5.0% for Hong Kong and Taiwan, respectively – historically high figures in both places. Research has indicated that this novel method of suicide has drawn a new cohort of people to engage in suicidal behaviors who otherwise would not have tried to kill themselves (Chan et al., 2005, Chen et al., 2009, Kuo et al., 2008, Liu et al., 2007, Yip and Lee, 2007). The marked increases in the suicide rate in both Taiwan and Hong Kong for the period 1997–2003 were driven by a complex amalgamation of financial disruptions, fear of losing jobs, and adjustment to a rapidly changing external environment, as well as by the rapid rise in charcoal burning suicide (Chan et al., 2005, Liu et al., 2007, Yip and Lee, 2007).

The Asian financial crisis, which took off in late 1997, reached its greatest economic slump in 2003 due to the SARS epidemic. The economies and economic conditions of Hong Kong and Taiwan gradually improved from the second half of 2003 during 2003–2007 (Directorate-General of Budget Accounting and Statistics Executive Yuan Taiwan, 2009, International Monetary Fund, 2009), but the aftermath of severe financial crises is usually deep and protracted, and it was estimated that the banking crisis and consequent declines in output and employment lasted in Hong Kong for about six years (from 1997/1998–2003) following the Asian financial crisis (Reinhart & Rogoff, 2009). A prominent economic decline was also observed in Taiwan (Chen, 2008). Although there was a slight economic expansion in Taiwan after 2001, it was short-lived and was quickly overturned by the increase in oil prices in 2002, followed by the SARS epidemic in 2003 (Chen, 2008). Economic conditions started to improve, however, during 2003–2007, with both Taiwan and Hong Kong entering a stage of economic expansion (Chen, 2008, Reinhart and Rogoff, 2009). Using unemployment rates as an example, in Taiwan, the unemployment rate before 2000 was generally around 3%; the yearly average unemployment rate reached a historical peak of about 5.0% in 2002 and 2003; the rate then gradually decreased to 3.7% in 2007, reflecting a steady recovery of the economy during 2003–2007. Similarly, in Hong Kong, the unemployment rate reached a high of 7.3% and 7.9% in 2002 and 2003 respectively; the rate steadily decreased thereafter to 4.0% in 2007. Overall, the year 2003 can be viewed as a turning point for employment conditions in Taiwan and Hong Kong, with both economic entities somewhat recovering during the period 2003–2007. The fluctuation in unemployment rates in Taiwan and Hong Kong from 1997 to 2007 provides an opportunity to examine suicide rates – particularly charcoal burning suicides, which have not previously been studied – in relation to employment conditions. It is of interest to compare the similarities and differences in suicide rates in general – and in charcoal burning suicide in particular – in Taiwan and Hong Kong during the course of this economic transformation, since not only are the methods of suicide used in these two places similar, but they also have a common cultural inheritance and a similar ethnic composition.