Issue #82: Work-Related Suicide: Evolving Understandings of Etiology & Intervention (pdf)

Contributed by Anthony D. LaMontagne, Sc.D., M.A., M.Ed., Deakin University, Melbourne, Australia

Suicide is a leading cause of death worldwide, and suicide and suicidal behaviours are major contributors to the global burden of disease.  In absolute terms, the majority of suicide deaths occur among people of working age.1 Yet, the role of work and how it might contribute to suicide risk is a relatively under-developed area of research.  This News & Views issue and a recently published extended treatment of the subject,2 provide overviews of the evidence on the role of work in the etiology of suicide, as well as the current state of workplace suicide prevention research, policy & practice.

We propose a definition of work‐related suicide from an occupational health and safety perspective as follows: death by suicide that is wholly or partly caused by work or working conditions.  We argue that the threshold for determining work-relatedness is adequate evidence to justify policy or practice action, an approach informed by the precautionary principle.3 The precautionary principle in public health aims to balance the uncertainty of evidence with legal and ethical duties to act to prevent harm.

We reviewed the case investigation‐based and epidemiologic evidence on work‐related causes of suicide. Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%–13% of suicide deaths.  Recent epidemiologic investigations suggest that this may be a conservative estimate, particularly in light of the rapidly growing evidence suggesting elevated risk in association with various psychosocial working conditions, which are common exposures in working populations.2, 4, 5

We identified six broad categories of potential work‐related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high‐stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work‐related injury or illness. We summarise current evidence in a schema of potential work‐related causes that can also be applied in workplace risk assessment and suicide case investigations (Figure 1: Schema of potential work-related causes of suicide).2

These findings have numerous implications for policy and practice. Various principle‐ and evidence‐based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide‐prevention literacy, reduce stigma, enhance helping behaviours, and in some instances, maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasizes individual‐ and illness‐directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

References

  1. Milner, A., Morrell, S., & LaMontagne, A. (2014). Economically inactive, unemployed, and employed suicides in Australia by age and sex over a 10-year period: What was the impact of the 2007 economic recession?Int J Epidemiol, 43(5), 1500-7
  2. LaMontagne, A., Åberg, M., Blomqvist, S., Glozier, N., Greiner, B., Gullestrup, J., Harvey, S., Kyron, M., Madsen, I., Hanson, L., Maheen, H., Mustard, C., Niedhammer, I., Rugulies, R., Smith, P., Taouk, Y., Waters, S., Witt, K., & King, T. (2024). Work & suicide: Evolving understandings of etiology & intervention. American J Industr Med, 67(8), 679-95 
  3. Kriebel, D. (2009) How much evidence is enough? Conventions of causal inference. Law & Contemp Probs, 72(1), 121-36
  4. Milner, A., Witt, K., LaMontagne, A., & Niedhammer, I. (2018). Psychosocial job stressors and suicidality: A meta-analysis and systematic review. Occup Environ Med, 75(4),245-53
  5. Rugulies, R., Aust, B., Greiner, B., A., Arensman, E., Kawakami, N., LaMontagne, A., & Madsen,  I. (2023). Work-related causes of mental health conditions and interventions for their improvement in workplaces. Lancet, 402(10410),1368-81.

Anthony LaMontagne is Professor of Work, Health & Wellbeing at Deakin University in Melbourne, Australia. His research career has been dedicated to developing the scientific and public understanding of work as a social determinant of health and translating this research into policy and practice to improve workplace and worker health. His research and publications have influenced policy & practice in workplace health both nationally and internationally. Specific areas of interest include workplace mental health, improving job quality and psychosocial working conditions, and evaluating policy interventions.

CPH-NEW is a NIOSH Center of Excellence for Total Worker Health®. CPH-News & Views is a quarterly blog written by center researchers and guest authors on emerging topics related to healthy workplaces. We welcome your responses and discussions. Please send all comments to CPHNEW@uml.edu. 

Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS).  Participation by CPH-NEW does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health (NIOSH). This publication was supported by NIOSH Grant Number 1 U19 OH012299. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH or CPH-NEW.