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Caregiving as suicide-prevention: an ecological 20-country study of the association between men’s family carework, unemployment, and suicide

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Abstract

Purpose

Suicide rates are generally higher in men than in women. Men’s higher suicide mortality is often attributed to public-life adversities, such as unemployment. Building on the theory that men’s suicide vulnerability is also related to their private-life behaviors, particularly men’s low engagement in family carework, this ecological study explored the association between men’s family carework, unemployment, and suicide.

Methods

Family-carework data for twenty Organization for Economic Co-operation and Development (OECD) countries were obtained from the OECD Family Database. Sex-specific age-standardized suicide rates came from the Global Burden of Disease dataset. The association between men’s engagement in family carework and suicide rates by sex was estimated, with OECD’s unemployment-benefits index and United-Nations’ Human Development-Index (HDI) evaluated as controls. The moderation of men’s carework on the unemployment-suicide relationship was also assessed.

Results

Overall and sex-specific suicide rates were lower in countries where men reported more family carework. In these countries, higher unemployment rates were not associated with higher male suicide rates. In countries where men reported less family carework, higher unemployment was associated with higher male suicide rates, independent of country’s HDI. Unemployment benefits were not associated with suicide rates. Men’s family carework moderated the association between unemployment and suicide rates.

Conclusion

This study’s findings that higher levels of men’s family carework were associated with lower suicide mortality, especially among men and under high-unemployment conditions, point to the suicide-protective potential of men’s family carework. They are consistent with evidence that where gender equality is greater, men’s and women’s well-being, health, and longevity are greater.

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Acknowledgements

YY Chen was supported by the Ministry of Science and Technology (MOST 108-2314-B-532-007-MY2), National Health Research Institutes (NHRI-EX108-10818PI), and Taipei City Department of Health (10901-62-008). PSF Yip was supported by a Humanities and Social Sciences Prestigious Fellowship Scheme (HSSPF, 37000320), and a General Research Fund (106200063).

Author information

Authors and Affiliations

  1. Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan

    Ying-Yeh Chen

  2. Department of Public Health, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan

    Ying-Yeh Chen

  3. Department of Social Work and Social Administration, Faculty of Social Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong

    ZiYi Cai & Paul S. F. Yip

  4. School of Sociology and Anthropology, Xiamen University, Xiamen, China

    Qingsong Chang

  5. Department of Psychology, Colorado State University, Fort Collins, CO, USA

    Silvia Sara Canetto

  6. Hong Kong Jockey Club Center for Suicide Research and Prevention, University of Hong Kong, Pok Fu Lam, Hong Kong

    Paul S. F. Yip

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  1. Ying-Yeh Chen
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  2. ZiYi Cai
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Corresponding authors

Correspondence to Silvia Sara Canetto or Paul S. F. Yip.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki’s standards and its later amendments. Ethics-committee approval was waived because all data were anonymous and publicly available.

Appendices

Appendix 1

Country list (year of time-use survey)

Austria (2008)

Belgium (2006)

Canada (2010)

Estonia (2000)

Finland (2009)

France (2009)

Germany (2012)

Italy (2008)

Japan (2011)

Korea (2009)

Latvia (2002)

Lithuania (2002)

Mexico (2002)

Norway (2010)

Poland (2004)

Slovenia (2001)

Spain (2009)

Sweden (2001)

United Kingdom (2001)

United States (2010)

Appendix 2: Spearman’s correlation coefficients for the relationship between predictors and suicide rates, by sex

 

Suicide rates

Total

Male

Female

Men’s carework# involvement (one child)

− 0.46*

− 0.45*

− 0.45*

Men’s carework# involvement (two or more children)

− 0.43

− 0.42

− 0.42

Unemployment rate

0.31

0.34

0.01

Human Development Index

− 0.28

− 0.33

− 0.10

Unemployment benefits

− 0.27

− 0.35

− 0.01

  1. *p < 0.05
  2. #Male to female ratio of family carework time

Appendix 3: Men’s family carework and suicide rates: main effects and moderation effects, controlling for level of country’s human development index and unemployment benefits

 

Main effect model

Moderation model

β coefficient

95% CI

β coefficient

95% CI

Total suicide rates

 Parents with one child

  Men’s carework

− 2.28*

(− 4.05, − 0.51)

− 1.32

(− 3.71, 1.11)

  Unemployment rate

0.01

(− 0.05, 0.08)

0.14

(− 0.09, 0.38)

  Unemployment benefits

0.24

(− 1.40, 1.88)

0.96

(− 1.07, 3.09)

  Human Development Index (HDI)

0.34

(− 8.47, 9.07)

0.41

(− 8.21, 8.93)

  Men’s carework × unemployment rate

  

− 0.24

(− 0.68, 0.18)

 Parents with two or more children

  Men’s carework

− 2.71 *

(− 4.87, − 0.57)

− 1.61

(− 4.18, 0.97)

  Unemployment rate

0.01

(− 0.05, 0.07)

0.16

(− 0.06, 0.37)

  Unemployment benefits

0.34

(− 1.35, 2.02)

1.12

(− 0.82, 3.08)

  Human Development Index (HDI)

1.38

(− 7.87, 10.47)

2.40

(− 6.59, 11.21)

  Men’s carework × unemployment rate

  

− 0.31

(− 0.74, 0.12)

Male suicide rates

 Parents with one child

  Men’s care work

− 2.22**

(− 4.04, − 0.51)

− 0.95

(− 3.30, 1.41)

  Unemployment rate

0.03

(− 0.03, 0.09)

0.19

(− 0.03, 0.40)

  Unemployment benefits

− 0.09

(− 1.66, 1.48)

0.64

(− 1.13, 2.45)

  Human Development Index (HDI)

1.06

(− 6.88, 9.01)

1.55

(− 5.98, 9.09)

  Men’s carework × unemployment rate

  

− 0.29

(− 0.69, 0.10)

 Parents with two or more children

  Men’s carework

− 2.54*

(− 4.63, − 0.48)

− 1.08

(− 3.58, 1.42)

  Unemployment rate

0.02

(− 0.04, 0.08)

0.21

(0.00, 0.42)

  Unemployment benefits

− 0.01

(− 1.67, 1.65)

0.88

(− 0.91, 2.69)

  Human Development Index (HDI)

1.82

(− 6.70, 10.34)

3.63

(− 4.45, 11.70)

  Men’s carework × unemployment rate

  

− 0.38

(− 0.80, 0.04)

Female suicide rates

 Parents with one child

  Men’s care work

− 2.65*

(− 4.91, − 0.40)

− 2.35

(− 5.40, 0.77)

  Unemployment rate

− 0.03

(− 0.11, 0.06)

0.02

(− 0.29, 0.34)

  Unemployment benefits

1.24

(− 1.03, 3.56)

1.49

(− 1.29, 4.51)

  Human Development Index (HDI)

− 1.27

(− 13.43, 10.40)

− 1.53

(− 13.84, 10.28)

  Men’s carework × unemployment rate

  

− 0.09

(− 0.69, 0.49)

 Parents with two or more children

  Men’s carework

− 3.29*

(− 5.91, − 0.71)

− 2.77

(− 6.04, 0.51)

  Unemployment rate

− 0.03

(− 0.11, 0.04)

0.04

(− 0.24, 0.31)

  Unemployment benefits

1.42

(− 0.86, 3.73)

1.76

(− 0.85, 4.40)

  Human Development Index (HDI)

0.39

(− 11.95, 12.03)

0.35

(− 11.94, 11.95)

  Men’s carework × unemployment rate

  

− 0.15

(− 0.74, 0.41)

  1. Note: Data on unemployment benefit for Estonia, Latvia, Lithuania, Mexico, and Slovenia were not available. Men’s carework indicates male to female ratio of family carework time

Appendix 4: Sensitivity analyses based on the 12 countries with more recent carework data (after 2006)

 

Model 1

Model 2

Model 3

β coefficient

95% CI

β coefficient

95% CI

β coefficient

95% CI

Total suicide rates

 Parents with one child

  Men’s carework

− 2.00***

(− 3.17, − 0.83)

− 1.77*

(− 3.31, − 0.27)

− 1.69

(− 4.53, 1.21)

  Unemployment rate

  

− 0.02

(− 0.08, 0.05)

0.00

(− 0.42, 0.41)

  Men’s carework × unemployment rate

    

− 0.02

(− 0.67, 0.63)

 Parents with two children or more#

  Men’s carework

− 2.54***

(− 3.94, − 1.14)

− 2.17**

(− 3.83, − 0.59)

− 2.03

(− 4.90, 0.91)

  Unemployment rate

  

− 0.03

(− 0.09, 0.03)

− 0.01

(− 0.35, 0.32)

  Men’s carework × unemployment rate

    

− 0.03

(− 0.63, 0.57)

Male suicide rates^

 Parents with one child

  Men’s carework

− 40.09*

(− 70.35, − 9.84)

− 41.90*

(− 82.82, − 0.98)

− 23.48

(− 117.00, 70.05)

  Unemployment rate

  

0.11

(− 1.39, 1.60)

2.83

(− 9.52, 15.18)

  Men’s carework × unemployment rate

    

− 4.33

(− 23.81, 15.14)

 Parents with two children or more

  Men’s carework

− 50.11*

(− 87.47, − 12.74)

− 48.25*

(− 93.91, − 2.58)

− 38.20

(− 150.92, 74.53)

  Unemployment rate

  

− 0.12

(− 1.50, 1.26)

1.08

(− 11.11, 13.28)

  Men’s carework × unemployment rate

    

− 2.14

(− 23.64, 19.37)

Female suicide rates

 Parents with one child

  Men’s carework

− 2.68***

(− 4.12, − 1.24)

− 2.17*

(− 4.10, − 0.34)

− 2.83

(− 5.77, 0.24)

  Unemployment rate

  

− 0.03

(− 0.12, 0.05)

− 0.15

(− 0.60, 0.27)

  Men’s carework × unemployment rate

    

0.20

(− 0.51, 0.91)

 Parents with two children or more

  Men’s carework

− 3.42***

(− 5.24, − 1.60)

− 2.67*

(− 4.84, − 0.68)

− 3.10

(− 6.27, 0.19)

  Unemployment rate

  

− 0.05

(− 0.13, 0.03)

− 0.11

(− 0.48, 0.25)

  Men’s carework × unemployment rate

    

0.12

(− 0.57, 0.79)

  1. *p < 0.05; **p < 0.01; ***p < 0.001
  2. ^Linear regression

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Chen, YY., Cai, Z., Chang, Q. et al. Caregiving as suicide-prevention: an ecological 20-country study of the association between men’s family carework, unemployment, and suicide. Soc Psychiatry Psychiatr Epidemiol 56, 2185–2198 (2021). https://doi.org/10.1007/s00127-021-02095-9

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