Occupational and social determinants of mortality from suicide: an Italian register-based case-control study.

Abstract

Occupational suicides are an emerging issue in occupational epidemiology. Risk factors like economic sectors, professions and types of contracts are not well-investigated, particularly in Italy. A case-control study was carried out using mortality data collected in Italy from 2005 to 2018. We selected as cases those who died by suicide and as controls all other causes of death. The occupational characteristics were retrieved from two administrative archives, considering a working activity within the 3 years preceding the event. We fitted logistic regression models to calculate sex-specific mortality odds ratios (MORs) by employment sector, type of contract, professional qualification and working time. Results were adjusted for age class, education, marital status, professional status and territorial factors. The study population included 8862 suicides and 177 027 controls. Unemployed workers were found to have twice the risk compared with employed workers in both sexes. Education level and marital status were found to be determinants for suicide. The sectors at higher risk for suicide included the security and investigation in males (MOR=2.34 (1.94-2.83)) and healthcare (MOR=1.79 (1.39-2.30)) and residential social care (MOR=1.55 (1.17-2.06)) in females only. Precarious work was identified as a risk factor compared with permanent jobs (MORs=1.29-2.08). Professions at higher risk are health specialists, qualified professionals in personal health services, farmers and fishing/hunting with different skills, and unqualified operators in fixed machinery, manufacturing, mining and construction. Risks were sex-dependent. The study highlights a potential role of occupation in the suicide risk and the need to investigate specific sectors and professions.