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Seth Perlman, AP
In this Nov. 20, 2014, file photo, supporters of legislation that will raise the minimum wage in Illinois rally outside the Illinois State Capitol in Springfield Ill.

SALT LAKE CITY — Curbing the national suicide rate may require more than simply increasing mental health services, such as therapy and medication, according to new research that demonstrates a link between suicide and the minimum wage.

A working paper circulated by the National Bureau of Economic Research this week showed that among American adults without a college education, raising the minimum wage by 10 percent reduced suicides by 3.6 percent on average across states. Increasing the earned income tax credit by 10 percent decreased suicides by about 5.5 percent.

A 10 percent increase in both the minimum wage and earned income tax credit — a a refundable tax credit for low-income working individuals and families — could prevent around 1,230 suicides a year, according to the paper's authors, economists Anna Godoey and Michael Reich from the University of California, Berkeley and public-health specialists William Dow and Christopher Lowenstein.

To evaluate how policy changes like these might affect the rate of suicides, the research team looked at states that raised their minimum wage or earned income tax credit between 1999 and 2015 and measured the changes in suicide rates before and after. They also adjusted for national trends by evaluating states that didn't see changes in the minimum wage or earned income tax credit.

“When they implement these policies, suicides fall very quickly,” Godoey told the Washington Post.

Godey told Berkeley News that greater financial security is connected to improved life satisfaction and mental health.

The strong link between changes to tax and wage policies should encourage policymakers to understand the “full consequences of changes to economic policies,” when debating increasing the federal minimum wage, Godoey said.

Jim Mone, AP
In this April 29, 2013, file photo, Lyle Cafe owner Barbara Johnson calls for an increase in the Minnesota minimum wage at the Capitol in St. Paul.

Suicide is the 10th leading cause of death in the United States and the national suicide rate has increased by 33 percent in the past two decades, according to the U.S. Centers for Disease Control and Prevention. Many policymakers and individuals have called for more public funding for mental health care services in response to these alarming statistics.

But a growing body of research that links mental health with economic policy and outcomes indicates a broader response may be necessary.

For example, a 2014 study published in the American Economic Journal found mothers who received a higher earned income tax credit reported better mental and physical health. When there's an economic downturn resulting in increased unemployment, there tends to be an associated increase in suicide 18-24 months later, according to a 2015 study published by Psychology Research and Behavior Management.

And a March study published in the American Journal of Preventive Medicine showed that a $1 increase in a state's minimum wage was associated with a 1.9 percent decrease in suicides, even after adjusting for overall state economic conditions, like employment rates and productivity.

"Ten years ago, we were talking about the need to do more therapies to prevent suicide, but in the last two or three years, we are starting to recognize that we are not going to therapy our way out of the suicide crisis," Raymond Tucker, a spokesman for the American Association of Suicidology and an assistant professor of psychology at Louisiana State University in Baton Rouge, told U.S. News.

There’s no one-size-fits-all prevention strategy for at-risk people or a single program that will stop suicides from happening. But addressing some of the social ills associated with suicide through public health initiatives, like raising the minimum wage and improving economic and social inequality, could have a meaningful impact, according to Tucker.

The federal minimum wage has been $7.25 an hour since 2009. During a forum with union workers last week, six Democratic 2020 presidential candidates said they support raising the federal minimum wage, bringing the issue to the forefront of the presidential primary race, Voxreported.

Mary Altaffer, AP
Activists at cheer during a rally after the New York Wage Board endorsed a proposal to set a $15 minimum wage for workers at fast-food restaurants with 30 or more locations, Wednesday, July 22, 2015, in New York.

Changes to the minimum wage affect Americans with the lowest income. The association between minimum wage increases and suicide rates was strongest among young women and black and hispanic men because those Americans are the most likely to have minimum-wage jobs, according to the working paper.

For those who think minimum wage hikes increase unemployment, raising wages may not seem like a reasonable solution for preventing suicides. Some studies find the minimum wage has either no or only a small effect on employment, while others find significant effects. Reducing taxes for small businesses and improving vocational training programs, in addition to expanding the earned income tax credit, are among alternative solutions for improving the prospects of working class Americans.

However, minimum-wage scholar Arindrajit Dube of the University of Massachusetts at Amherst told the Washington Post that the Berkeley study provides “important additional evidence on the possible impact of a higher minimum wage on the standard of living — or living at all."

Who's at risk

Suicide isn't always associated with a history of mental health problems, so prevention efforts should involve more than mental health services, according to Monica H. Swahn, professor of epidemiology and biostatistics at Georgia State University. In fact, more than half of the suicide deaths in the U.S. did not have a known diagnosed mental health condition, according to the Centers for Disease Control and Prevention.

"Suicide prevention is usually focused on the individual and within the context of mental health illness, which is a very limited approach. Typically, suicide is described as an outcome of depression, anxiety, and other mental health concerns including substance use," Swahn wrote for Quartz. "And, these should not be trivialized; these conditions can be debilitating and life-threatening and should receive treatment."

"While there are many reasons for raising concerns about our fragmented mental health system, the treatment gap and associated factors, I don’t think it is sufficient to understand our increasing suicide rates," Swahn continued.

According to the American Foundation for Suicide Prevention, the rate of suicide is highest in middle-age white men. In 2017, white males accounted for 69.67 percent of suicide deaths. Young people, ages 15 to 24, were the least likely to commit suicide.

Other research shows that people who live in rural communities are more at risk, in addition to people at both ends of the economic spectrum — the very poor and very rich. Additional research suggests that inequality, or having lower status relative to one's neighbors, increases the chance of suicide.

Mary Altaffer, AP
New York Gov. Andrew Cuomo speaks during a rally after the New York Wage Board endorsed a proposal to set a $15 minimum wage for workers at fast-food restaurants with 30 or more locations, Wednesday, July 22, 2015, in New York.

"We're brought up our entire lives to judge ourselves in comparison with our peers and to be economically successful,” Simon Gunning, the CEO of Campaign Against Living Miserably (Calm), a UK-based award-winning charity dedicated to preventing male suicide, told BBC. “When there are economic factors we can't control, it becomes very difficult."

"Deaths of despair" is a phrase that was popularized by Princeton economists Anne Case and Angus Deaton in a pair of widely cited 2015 and 2017 papers. The term refers to rising death rates among middle-aged white Americans attributed to “drug overdoses, suicides, and alcohol-related liver mortality — particularly among those with a high school degree or less.”

According to the Berkeley study, mid-life mortality has been on the rise for white people without college degrees since the 1990's. Since 2013, the same has been true for Hispanics and African Americans.

"It is a crisis of economic health," USA Today reported. "The economy is making a transition from muscle to mental — or from muscle to microchip, as with the 1.7 million truck drivers predicted to be largely replaced by self-driving trucks."

"With the United States neglecting vocational education, those with no high school degree have nearly three times the unemployment rate of those with a college degree," the article continues.

Alan Diaz, AP
People march as they protest for increased minimum wages near a McDonald's restaurant on Thursday, Dec. 4, 2014, in the Little Havana area in Miami. Activists, fast-food workers and others are calling for increasing the minimum wage to $15 per hour and allowing workers to form unions without corporate opposition, as part of nationwide demonstrations.

In addition to addressing socioeconomic conditions, the World Health Organization suggests nations develop comprehensive suicide prevention plans that include efforts to reduce access to means of suicide (such as guns), raising awareness that suicides are preventable, more research and training for health workers, educators and police on crisis intervention.

In an article for The New York Times, Matthew Desmond wrote that poverty can exacerbate stress and mental health issues.

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“Poverty can be unrelenting, shame-inducing and exhausting. When people live so close to the bone, a small setback can quickly spiral into a major trauma,” he said.

Godoey said increasing the minimum wage and earned income tax credit could help alleviate such burdens.

“A lot of the time the discussion of higher minimum wages is framed in narrow economic terms,” Godoey told Berkeley News.

“In short,” Godoey added, “our study shows that higher minimum wages are likely to save lives.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1-800-273-8255