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The prevention of suicidal behaviour is still a land of hopes and promises but not of certainties. In fact, Western countries are facing a general decline in suicide rates that seems unrelated to any national plan aimed at obtaining the desired outcomes in those situations that are known to be associated to suicidal behaviour.1 General improvement in living conditions, better access to care, and more effective treatments of mental disorders are the most probable reasons for the recent decrease in suicide rates in many countries. However, the most recent financial-economic turmoil and the current threatening climate of permanent war will have a foreseeable impact on the standard of living, the consequences of which are still to be evaluated.
Socioeconomic events are known to produce important fluctuations in suicide mortality. Unemployment, in particular, seems related to suicide risk along direct and indirect pathways. Blakely and coworkers’ paper in this issue2 adds to evidence indicating a causal association between unemployment and suicide. Their results indicate that this association is not attributable to confounding factors linked to the socioeconomic status and that it is only partly related to health selection or mental disorders. Statistical analyses permit the authors to calculate that mental illnesses account for about half of the deaths, however the effect of unemployment cannot be discounted solely on this basis. In longitudinal studies unemployment predates symptoms of depression.3 Moreover, the lack of economic independence as a result of unemployment reduces the possibility of using social and health services appropriately: …