Robert Galbraith/Reuters

A new report makes plain some of the grim results of housing-related stressors, and suggests practices that could save lives.

Suicides in America continue to creep upward. Between 2003 and 2013, the rate of deaths caused by suicide climbed from just shy of 11 per 100,000 residents to 13.* Suicide rates rose for every age cohort in the U.S. over that time span. In 2013, more people between the ages of 25 and 74 died by their own hands than died in automobile crashes.

In 2010, just as the U.S. was beginning to climb out of the global financial crisis, suicide was the second-leading cause of death for adults aged 25 to 34 in the U.S., and the fourth-leading cause of death for adults aged 35 to 54. With the Great Recession behind us, public health officials are now trying to measure the toll of the housing crisis in terms of lost life and psychological distress.

A new study released this month in the American Journal of Public Health offers one answer to this complex question. The report finds that suicides spurred by severe housing stress—evictions and foreclosures—doubled between 2005 and 2010.

The study is the work of researchers from the Division of Violence Prevention at the U.S. Centers for Disease Control and Prevention. Led by Katherine A. Fowler, five researchers analyzed suicide findings from 16 states that participate in the National Violent Death Reporting System. The NVDRS is an epidemiological surveillance system that abstracts data from a variety of sources, including death certificates, law-enforcement agencies, coroners, medical examiners, forensic laboratories, and other vital-statistics providers.

"This study was the first to our knowledge to systematically examine suicides linked with eviction and foreclosure," the report reads.

(AJPH)

The researchers identified 929 suicides between 2005 and 2010 related to evictions or foreclosures. The total numbers were fairly split—51 percent were eviction-related and 49 percent foreclosure-related—although the relative increases varied, as the chart above shows. The vast majority of housing-related suicides over the course of the crisis were committed by whites (87 percent) and men (79 percent). The total housing-related suicide figures doubled between 2005 and 2010, with significant jumps between 2006 and 2007 and from 2007 to 2008.

A large share of the deaths (37 percent) happened within two weeks of a specific housing crisis, such as an eviction notice or court hearing. The overwhelming majority of these suicides (79 percent) took place before the renters or owners actually lost their housing.

(AJPH)

Over the course of the housing crisis, the share of suicides motivated by housing stress grew. While eviction- or foreclosure-related suicides accounted for just a small percentage of overall suicides (1 or 2 percent), these housing-related suicides made up an increasingly large number of all financially motivated suicides recorded in the NVDRS system—from 10 percent in 2005 to 16 percent in 2009. Tellingly, this share then fell between 2009 and 2010, as the crisis began to calm.

"Importantly, these increases were seen even relative to the frequency of all other suicides in the same states during the same time period, and relative to suicides associated with general financial problems in the same sample," the study reads. "This suggests that the rise seen in eviction- or foreclosure-related suicides was not just part of a general rise in suicides."

The increase in suicides for homeowners (foreclosure-related) was much larger than the increase in suicides for renters (eviction-related). Foreclosure-related suicides more than tripled between 2005 and 2010. "This further suggests a relationship between these suicides and the housing crisis, which resulted in a national 389 percent increase in foreclosures between 2005 and 2010," the report reads.

Disturbingly, the study suggests that the mechanism of foreclosure proceedings might actually lead to increased risk for suicide:

Foreclosure may be exceptionally stressful because of its protracted nature and multiple negative events that constitute the process, particularly given the evidence that situational depression may respond in a dose-response fashion to negative life events. In addition, depression is more strongly related to stressful life events for which individuals perceive personal responsibility and lack of control over outcomes. All of these factors are mechanisms that make the foreclosure process a potent psychological stressor.

Reports of suicides related to evictions or foreclosures began to surface in national media early into the housing crisis, of course; but details explaining the frequency or circumstances of housing-related suicides remain elusive, even today. No research explains directly the link between home eviction and foreclosure proceedings and suicide.

Recently, however, researchers have begun to describe this relationship. According to the CDC analysis, mortgage delinquency has been shown to be linked to serious psychological adversity, including major depression (two times greater odds) and "elevated depressive symptoms related to acute stress" (eight times greater odds).

Similar findings can be seen worldwide:

A recent study examining the impact of austerity measures taken in England during the European financial crisis on unemployment and subsequent suicides attributed more than 1,000 excess suicides to these economic conditions between 2008 and 2010. Another found that in Greece, one of the worst-hit economies in Europe, suicide mortality rates among men have increased by more than 22 percent since 2007. Similar trends were observed in several countries (e.g., Japan, Hong Kong, South Korea) following the Asian monetary crisis of 1997.

But this CDC study might be the first to search for a direct link between severe housing distress and suicide.

Naturally, there are some limitations to the research, beginning with the codes assigned to the deaths in the NVDRS. For suicides, epidemiologists abstract the deaths with codes for more than 20 different circumstances, including mental health treatment, history of suicide attempts, presence of suicide letter or other disclosure, acute stressors, and more. The CDC researchers were able to identify cases of suicides related to housing as distinct from those related to other financial pressures—unemployment, rising health care costs, bankruptcy, and so on—but some number of suicides may have gone undetected because they were not coded as such. This is just the reality of epidemiology.

The study is further limited by the sample. Data from 16 states contributed to the study; in 2010, suicides in these states accounted for about 27 percent of all suicides in the U.S. The number of suicides nationally are obviously higher; the rates of suicides might be higher (or lower) as well. Today, a little more than half the states (and U.S. territories, and the District of Columbia) contribute data to the NVDRS.

The 32 states currently participating in the National Violent Death Reporting System (CDC)

Avoiding utterly preventable housing crises is the ideal way to prevent suicides from acute housing stress. The CDC study includes several more specific, useful recommendations going forward, as well. According to the report, the National Strategy for Suicide Prevention suggests training a larger range of professionals—including people in finance—to recognize suicidal stressors and tendencies before they emerge.

The suggestion isn't idle. The CDC study includes findings from the National Foreclosure Mitigation Counseling program that suggest a serious training gap for dealing with housing stress and mental health:

Sixty-eight percent of these counselors reported that "many" to "almost all" clients seen in the past month appeared depressed or hopeless, and 37 percent reported working with at least 1 client in the past month who expressed suicidal thoughts. Although 68 percent of those surveyed perceived it as one of their job responsibilities to refer clients to local health services, only 14 percent reported receiving any training on this task from their employers.

The single most useful figure in the CDC study might be that nearly 80 percent of eviction- and foreclosure-related suicides happen in close proximity to those events. We know now that here is a window to act to identify and hopefully prevent them before they happen.

*Correction: The original post overstated the increase in suicide rates between 2003 and 2013. It has been corrected.

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