Article Text
Abstract
Background In recent decades, suicide and fatal overdose rates have increased in the US, particularly for working-age adults with no college education. The coincident decline in manufacturing has limited stable employment options for this population. Erosion of the Michigan automobile industry provides a striking case study.
Methods We used individual-level data from a retrospective cohort study of 26 804 autoworkers in the United Autoworkers-General Motors cohort, using employment records from 1970 to 1994 and mortality follow-up from 1970 to 2015. We estimated HRs for suicide or fatal overdose in relation to leaving work, measured as active or inactive employment status and age at worker exit.
Results There were 257 deaths due to either suicide (n=202) or overdose (n=55); all but 21 events occurred after leaving work. The hazard rate for suicide was 16.1 times higher for inactive versus active workers (95% CI 9.8 to 26.5). HRs for suicide were elevated for all younger age groups relative to those leaving work after age 55. Those 30–39 years old at exit had the highest HR for suicide, 1.9 (95% CI 1.2 to 3.0). When overdose was included, the rate increased by twofold for both 19- to 29-year-olds and 30- to 39-year-olds at exit. Risks remained elevated when follow-up was restricted to 5 years after exit.
Conclusions Autoworkers who left work had a higher risk of suicide or overdose than active employees. Those who left before retirement age had higher rates than those who left after, suggesting that leaving work early may increase the risk.
- Suicide
- mental health
- longitudinal studies
- employment
- ageing
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Twitter ElserHolly.
Contributors EAE made substantial contributions to the acquisition, conception and design of the work, and interpretation of data. KTC made substantial contributions to the data analysis. HE made substantial contributions to the conception and design of the work, and interpretation. SP made substantial contributions to the analysis and interpretation of the work. CAR made substantial contributions to the analysis and interpretation of the data. MAC made substantial contributions to the interpretation of data. SMD made substantial contributions to the design of the work. SG-M made substantial contributions to the conception of the work. JC made substantial contributions to the conception of the work and interpretation of data. All authors were involved in the drafting or revising the work critically. All authors have approved the final version to be published. All authors agree to be accountable for all aspects of the work.
Funding This work was supported in part by the National Institute on Aging at the National Institutes of Health (grant 2P30AG01283).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.