English title: Dimension-specific impact of social exclusion on suicide mortality in Europe
Author(s): Andriy Yur’yev -
Type: Thesis / dissertation
Tackling suicide risks is identified as being amongst one of the priority objectives for the strategy in the field of European public health. Social exclusion is a considerable burning issue for societies, which among others exerts significant pressures on mental health of the population. There seems to be little research into the influence of social exclusion on suicide behaviour. The general purpose of this dissertation was to obtain macro-level evidence on the influence of social exclusion on suicide mortality in the countries of the European region considering different dimensions of the process. The sub-aims of the study were to: (1) determine relevant macro-level indicators which reflect the different dimensions of social exclusion and are available for the majority of European countries; (2) collect and explore male and female suicide mortality rates for majority of European countries; (3) explore the relationship between each considered indicator and suicide mortality rates in Europe among males and females separately; (4) group indicators in accordance to dimensions and evaluate the dimension-specific impact of social exclusion on suicide mortality in Europe for both genders. Twenty-six European countries were included in the analysis. Three dimensions of social exclusion were considered in the study: “economic/employment”, “social/welfare” and “elderly group”. Mean age-adjusted, gender-specific suicide rates were obtained from the WHO European Mortality Database. Employment rates were obtained from the Conference Board Total Economy Database. Data about social expenditures were taken from the database of the Organisation for Economic Co-operation and Development. Data on labour-market exit ages were obtained from the EUROSTAT database. Information about citizens’ attitudes towards different dimensions of social exclusion was taken from the European Social Survey and aggregated towards country-level. Correlations between each of the socio-economic indicators and suicide mortality rates were analysed using Pearson’s test. Differences between the mean scores for Eastern and Western European social exclusion attitudes were considered. Structural equation modelling was applied to investigate the complex theoretical structure of social variables related to “economic/employment” and “social/welfare” dimensions of social exclusion and to explore the relationship with suicide mortality in Europe. The current dissertation comprises four articles which are based on the same material. The theoretical framework incorporates the articles under the social policy umbrella and creates links between them. Articles I and III explore the impact of “economic/employment” dimension of social exclusion. Changes in employment rates are associated with suicide mortality in the majority of the European countries studied. Lack of confidence in employment status, expectation of insufficient income and low living standards for the unemployed may boost suicide mortality. Suicidal behaviour is more strongly related to attitudes associated with employment status in the male than in the female population. Attitudes to employment and unemployment in Eastern and Western Europe differ: in Eastern Europe the status of being unemployed is feared more. Articles II and III explore the impact of the “social/welfare” dimension of social exclusion. Higher social expenditures are inversely associated with suicide mortality in the majority of the studied European countries. The supportive nature of the “social/welfare” dimension may be considered as having suicide-preventive effect. Confidence in social welfare is stronger in the countries of Western Europe. Article III explores the complex impact of the “economic/employment” and “social/welfare” dimensions of social exclusion on suicide mortality. Both “economic/employment” and “social/welfare” dimensions of social exclusion significantly influence suicide mortality among males. The influence of “economic/employment” and “social/welfare” dimensions of social exclusion on female suicide mortality was less prominent and not statistically significant. Article IV attempts to explore the relationship between the elderly suicide mortality and some aspects of social exclusion of the elderly age group. It was assumed that society’s attitudes towards elderly people may influence the elderly suicide mortality. Attitudes towards elderly people were revealed to be more favourable among Western European compared to Eastern European citizens. Extended labour-market exit age of the elderly was associated with lower rates of elderly suicide mortality in the corresponding countries. The findings of the study indicate that the harmful impact of social exclusion on suicide mortality in Europe should be recognised and considered while developing intervention strategies at societal level.
Awarding institution: Tallinn University
Number of pages: 108