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Societal Economic Costs and Benefits from Death: Another Look

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Title: Societal Economic Costs and Benefits from Death: Another Look
Language: English
Authors: Stack, Steven
Source: Death Studies. Apr 2007 31(4):363-372.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals/default.html
Peer Reviewed: Y
Physical Description: PDF
Page Count: 10
Publication Date: 2007
Document Type: Information Analyses
Journal Articles
Descriptors: Medical Services, Employment Level, Employment Opportunities, Costs, Suicide, Social Networks, Nurses, Job Development, Grief, Mental Health Programs, Economic Factors, Cancer, Diseases, Socioeconomic Influences, Economic Impact, Disease Incidence, Mortality Rate, Social Isolation
DOI: 10.1080/07481180601187217
ISSN: 0748-1187
Abstract: B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide. (Contains 3 tables.)
Abstractor: Author
Number of References: 14
Entry Date: 2007
Accession Number: EJ764055
Database: ERIC
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  Value: <anid>AN0024195994;dea01apr.07;2019Mar30.06:28;v2.2.500</anid> <title id="AN0024195994-1">Societal Economic Costs and Benefits from Death: Another Look. </title> <p>B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide.</p> <p>Yang and Lester's ([<reflink idref="bib14" id="ref1">14</reflink>]) main argument is well taken. Previous research has neglected the potential cost savings to society from deaths due to suicide (e.g., Clayton & Barcelo, [<reflink idref="bib2" id="ref2">2</reflink>]; Palmer et al., [<reflink idref="bib6" id="ref3">6</reflink>]; Stoudemire et al., [<reflink idref="bib10" id="ref4">10</reflink>]; Wyatt et al., [<reflink idref="bib13" id="ref5">13</reflink>]). Certainly persons who die before the age of retirement save society costs for such programs as social security, Medicare, and pensions. For example, in 1990, the average age of suicides was 44.78 years, 21.22 below the retirement age of 65 (productive years life lost, PYLL, =21.22), whereas the mean age of death from cancer was 69.37 (PYLL = −4.37). Persons dying of cardiovascular disease average 76.51 years at death (U.S. Public Health Service, [<reflink idref="bib12" id="ref6">12</reflink>]). For the latter two causes of death, which claim most lives, there are substantially lower "indirect costs" or costs due to lost wages because most persons are already retired. However, even with substantial losses due to lost wages over 20 PYLL, suicides are calculated to actually save society funds, principally due to savings from avoiding costs for social security, pensions, and medical care in retirement (Yang & Lester, [<reflink idref="bib14" id="ref7">14</reflink>]). Suicides, then, may be one of the few causes of death that account for a net savings for society.</p> <p>The present analysis builds on their argument by addressing several neglected issues. First, the cost savings may be underestimated due to a likely overestimate of the cost of mental health services of suicides in their last year of life (a direct cost to society). As a corollary, the costs of suicide need to be compared with those of natural deaths. Herein I argue that the cost for health services for suicides is apt to be much lower than that for health services for the leading natural causes of death. Second, there is a hidden paradox needing discussion. Whereas health services to those approaching death are a cost to society, at the same time they create a demand for employment in the health sector and thereby prop up the national economy. In that sense, cost savings in health care for the dying can backfire, if carried too far, and contribute to the probability of an economic recession. Third, I deal with the neglected issue of estimating the relative grieving costs of suicide compared to natural deaths.</p> <hd id="AN0024195994-2">Costs for Treating Suicidal Persons</hd> <p>Suicidal persons can exert a significant demand for mental health services including diagnosis, counseling, continuing care, rehabilitation, and drug treatment of their various mental disorders. These represent a direct cost to society. Yang and Lester are to be commended for including estimates of these treatment costs in their own synthetic work; some writers fail to include the full range of treatment costs in their estimates of direct costs for suicide. For example, Palmer et al. ([<reflink idref="bib6" id="ref8">6</reflink>]) included inpatient costs but apparently exclude outpatient costs.</p> <p>The existing literature on the costs of suicide, however, is often unclear on how many suicidal persons receive psychological treatment. In the most ambitious investigation to date, Chisolm et al. ([<reflink idref="bib1" id="ref9">1</reflink>]) provided no data on what proportion of treatment costs for persons with bipolar disorders are attributed to those who commit suicide. Stoudemire et al. ([<reflink idref="bib10" id="ref10">10</reflink>]) cited some evidence that major depression is the primary cause of approximately 60% of suicides, and that 67% of persons suffering from major depression receive psychological services. As a corollary, 67% × 60% of persons who commit suicide would be expected to receive treatment for major depression (40% of suicides). However, major depression is not the only psychological cause of suicide. Other causes of suicide that often are associated with treatment would be schizophrenia and bipolar disorder. For example, Wyatt et al. ([<reflink idref="bib13" id="ref11">13</reflink>]) estimated that 8,734 persons with schizophrenia died through suicide in 1991, accounting for nearly one third of all suicides in that year. Hence, following Stoudemire et al.'s (1986) method, we would assume that considerably more than 40% of persons who commit suicide receive mental health services, and that the figure is probably in excess of 70%.</p> <p>A key limitation of Stroudemire et al.'s ([<reflink idref="bib10" id="ref12">10</reflink>]) method for estimating the proportion of people who commit suicide that sought mental health services in the last year of life is that persons who commit suicide might receive less help, possibly due to the cost of such services given their relatively lower economic status (Stack, [<reflink idref="bib8" id="ref13">8</reflink>]). Alternatively, one might speculate that persons who commit suicide might seek help more than others because of the life-threatening nature of their ailments. The data that were necessary to make such estimates for the nation as a whole were not available until over a decade after the Stroudmire et al. ([<reflink idref="bib10" id="ref14">10</reflink>]) article and have not yet been mined to address this issue.</p> <p>The Mortality Follow Back Survey (National Center for Health Statistics, [<reflink idref="bib5" id="ref15">5</reflink>]) can be used to estimate the proportion of suicidal individuals who actually receive treatment. Data are available on 2,043 individuals who died from suicide. Data were collected through psychological autopsies, interviews with the significant others of the deceased, to ascertain their characteristics and living circumstances at the time of the their death. Table 1 presents data on the percentage of persons who saw a mental health professional at least once in the 12 months before their death. For comparison, the percentage of persons who sought the same psychological services at least once in the 12 months prior to their death is provided for the four leading internal causes of death (cardiovascular disease, cancer, chronic obstructive pulmonary diseases and infections (including HIV/AIDS). Further, the same data on all external causes of death are provided.</p> <p>TABLE 1 Percentage of Persons in Each Category of Death Who Saught Mental Health Help during the Last Year of Life</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Category of death</td><td>Percentage seeking mental health help (%)</td><td>Number of deaths</td><td>Estimated demand for mental health help</td></tr></thead><tbody><tr><td>Internal causes</td></tr><tr><td> Cardiovascular disease</td><td>4.47</td><td>914,783</td><td>40,890</td></tr><tr><td> Cancer (malignant neoplasms)</td><td>5.88</td><td>567,359</td><td>33,360</td></tr><tr><td> Infectious and parasitic diseases</td><td>12.8</td><td>54,579</td><td>6,986</td></tr><tr><td> Chronic obstructive pulmonary diseases</td><td>6.76</td><td>127,680</td><td>8,631</td></tr><tr><td>External causes</td></tr><tr><td> Accidents, except motor vehicle</td><td>7.64</td><td>44,442</td><td>3,395</td></tr><tr><td> Homicide</td><td>4.49</td><td>24,333</td><td>1,093</td></tr><tr><td> Motor vehicle accidents</td><td>4.12</td><td>46,816</td><td>1,929</td></tr><tr><td> Suicide</td><td>20.36</td><td>30,876</td><td>6,286</td></tr><tr><td> Other external causes</td><td>17.0</td><td>2,295</td><td>390</td></tr><tr><td>All other causes of death</td><td>7.95</td><td>295,657</td><td>23,505</td></tr><tr><td><italic>Note</italic>. Data from the National Center for Health Statistics (<xref ref-type="bibr" rid="bibr5">2000</xref>).</td></tr></tbody></table> </ephtml> </p> <p>The data in Table 1 indicate that persons who commit suicide are the most apt to seek mental health services in the last year of life; approximately one in five (20%) sought such help at least once during the last year of life. Persons dying of other external causes (other than homicides, motor vehicle accidents, and all other accidents) were the second most likely group to seek help (17%), followed by those with infectious diseases (13%). However, a significant percentage of persons who died from the three leading causes of death sought mental health services (between 5–7%). The figure of one in five suicide victims seeking mental health services in their last year of life is substantially below the minimum of 40% estimated by Stroudmire et al. ([<reflink idref="bib10" id="ref16">10</reflink>]).</p> <p>In order to put the demand for mental health services in a larger framework, data were collected from the Mortality Detail File (U.S. Public Health Service, [<reflink idref="bib12" id="ref17">12</reflink>]) for 1990 to provide raw numbers of persons dying from each cause of death. These were then multiplied by the estimated proportion seeking mental health services from the National Mortality Follow Back Survey (National Center for Health Statistics, [<reflink idref="bib5" id="ref18">5</reflink>]). These data are provided in Table 1.</p> <p>It is estimated that of the 30,876 persons who died through suicide, about 6,286 sought mental health services at least once in their last year of life. However, this is approximately only 6% of the demand for such services, because slightly over 100,000 persons who died in 1990 are estimated to have sought such help. So, the potential savings for society from this expense, though significant, is small compared to the amount spent on similar services to persons dying natural deaths.</p> <p>Further, the extent and cost of medical services provided to those who die from suicide needs to be compared to a more general index of health care services. Although those who die from cancer or heart disease are less apt than those dying from suicide to use psychological services, the former group would be expected to generate considerable demand for other medical services in their last year of life. Expenses for such services as chemotherapy, bypass and stent implant surgeries, and hip and knee replacements are expensive and require a significant number of medical visits. It is important to compare medical costs for suicides with medical costs for natural deaths using a common metric such as medical visits.</p> <p>Table 2 provides data on two preliminary measures of cost, based on the frequency of visits to doctor's offices for suicide deaths and eight other major categories of deaths from internal and external causes from Table 1 (National Center for Health Statistics, 2000). Column 1 show that nearly a quarter of those who died from suicide (25%) had not seen a physician at all during the last 12 months of life. In comparison, this was true of only 6% of those who died from cancer and 13% of those who died of cardiovascular disease. Table 2 indicates that 10% of those who died from suicide saw a physician 25 or more times. This is much lower than the figures for cancer deaths, 35% and somewhat lower for those dying of cardiovascular disease, 15%. These data suggest that the cost for medical care for suicides in the final year of life may be significantly lower than that associated with major causes of natural deaths.</p> <p>TABLE 2 Percentage of Persons in Each Category of Death by Frequency of Visits to a Physician of Any Type in the Last 12 Months of Life</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Category of death</td><td>No visits (%)</td><td>25 or more visits (%)</td></tr></thead><tbody><tr><td>Internal causes</td></tr><tr><td> Cardiovascular disease</td><td>13.11</td><td>14.56</td></tr><tr><td> Cancer (malignant neoplasms)</td><td>6.05</td><td>34.91</td></tr><tr><td> Infectious and parasitic diseases</td><td>7.00</td><td>35.98</td></tr><tr><td> Chronic obstructive pulmonary diseases</td><td>11.42</td><td>15.82</td></tr><tr><td>External causes</td></tr><tr><td> Accidents, except motor vehicle</td><td>22.11</td><td>8.18</td></tr><tr><td> Homicide</td><td>53.3</td><td>1.64</td></tr><tr><td> Motor vehicle accidents</td><td>35.19</td><td>1.65</td></tr><tr><td> Suicide</td><td>24.49</td><td>9.85</td></tr><tr><td> Other external causes</td><td>33.04</td><td>6.08</td></tr><tr><td> All other causes of death</td><td>15.86</td><td>15.70</td></tr><tr><td>Mean, all deaths</td><td>20.25</td><td>15.26</td></tr><tr><td><italic>Note</italic>. Data from National Center for Health Statistics (<xref ref-type="bibr" rid="bibr5">2000</xref>).</td></tr></tbody></table> </ephtml> </p> <hd id="AN0024195994-3">Employment Benefits from Medical Costs</hd> <p>It is important to note that the medical costs for preventing death translate into employment opportunities for those working in the medical sector of the economy. The health care sector has helped to prop up our economy, having added 1.7 million jobs since 2001. The rest of the economy has added a net of none (Mandell, [<reflink idref="bib4" id="ref19">4</reflink>]). Unlike many jobs in manufacturing and other sectors where production can be outsourced, health care is dependent on local labor markets. For example, the production of cars can go overseas, but routine medical visits typically cannot. People spend the bulk of medical costs at home, thus helping our economy. Cutbacks on health care may save on the one hand through lowering insurance costs, but cost society on the other hand in terms of employment losses and corresponding losses in aggregate demand for goods and services. Because the health care sector has emerged as the main creator of employment opportunities, maintaining an unhealthy population may be critical for the economy. Up to a point, enhancing the war against death may correspondingly enhance the economy.</p> <hd id="AN0024195994-4">Costs of Grieving</hd> <p>A likely criticism of Yang and Lester is that they were unable to estimate the costs of grieving by the survivors of suicide. For example, mourning may lower productivity. Suicides may have a deleterious effect (on average) for survivors in a way that increases their use of mental health services. School performance of young survivors of suicides may be affected and other survivors may be driven into substance abuse and deviant behaviors, which have negative personal and societal effects. Although a full range of possible negative effects of suicides cannot presently be calculated, researchers can make crude estimates of the frequency of grieving by cause of death.</p> <p>It is often assumed that there are more grieving costs among the survivors of suicide than the survivors of natural deaths. Suicides are often unexpected, tragic, unnecessary, and involving relatively young persons with many decades of life ahead of them. Nevertheless, it needs to be noted that the social networks of persons who commit suicide are not as expansive as natural deaths. Persons who commit suicide are more apt than persons who die of natural deaths to be divorced. Ex-spouses would be expected to grieve less and have less demand for psychological counseling services than current spouses. Further, suicidal individuals are also more apt to be living alone. Suicidal persons are less apt than those dying natural deaths to have significant others, ones who presently live with them, to grieve their deaths. Persons who are actually living with a person before the death are assumed to be among those with the highest economic and psychological costs from death of significant others. Suicidal persons have fewer children, so have fewer biological relatives to grieve for them. Suicidal persons are less apt than others to be frequent churchgoers, thus lowering the number of potential grievers among co-religionists. In any event, suicides are more socially isolated (for reviews, see Lester, [<reflink idref="bib3" id="ref20">3</reflink>]; Stack [<reflink idref="bib8" id="ref21">8</reflink>][<reflink idref="bib9" id="ref22">9</reflink>]). Given the less extensive social networks of suicidal persons, it is likely that they have fewer persons to grieve for them than their age-matched peers. However, it is also true that by being younger, suicidal persons are more likely to have parents who are alive to grieve for them than persons dying natural deaths.</p> <p>An analysis was done using the data from the National Mortality Follow Back Survey (National Center for Health Statistics, [<reflink idref="bib5" id="ref23">5</reflink>]). Suicides were compared to all others deaths. In order to isolate the effect of death by suicide on networks, a control was introduced for age, a covariate of networks. Available measures of strength of social networks included: divorced (0,1), living alone (0,1), and not participating in religious activities. In addition, I included a measure of social isolation: that the survey team was unable to locate a person to do a psychological autopsy. A total of 3,930 deaths lacked psychological autopsy data in the survey.</p> <p>Table 3 presents relevant data on the density of social networks of suicides vs. natural deaths. In all instances the suicides were significantly more isolated than the persons dying of other causes. From the odds ratios, the suicides were 1.35 times more apt to live alone, 1.15 times more apt to be divorced, and 1.82 times more apt to report no religious activities in the 12 months prior to death. Further, the suicides were 24% more likely to have no psychological autopsy. Although these data do not show that the suicides were less grieved than the other deaths, they do suggest less dense networks and fewer potential grievers for the suicides.</p> <p>TABLE 3 The Effect of Death by Suicide vs. All Other Causes, and Age on Four Indicators of Social Networks</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Dependent and independent variables</td><td>Logistic coefficient</td><td>Standard error</td><td>Wald chi square</td><td>Odds ratio</td></tr></thead><tbody><tr><td>Y = Divorced</td></tr><tr><td> Suicide death</td><td>.13<xref ref-type="fn" rid="fn2" /></td><td>.06</td><td>4.18</td><td>1.14</td></tr><tr><td> Age</td><td>−.004<xref ref-type="fn" rid="fn2" /></td><td>.008</td><td>28.9</td><td>.99</td></tr><tr><td> Constant</td><td>−1.71<xref ref-type="fn" rid="fn2" /></td><td>.04</td><td>1365</td><td>—</td></tr><tr><td>Y = Lives alone</td></tr><tr><td> Suicide death</td><td>.30<xref ref-type="fn" rid="fn2" /></td><td>.06</td><td>23.5</td><td>1.35</td></tr><tr><td> Age</td><td>.02<xref ref-type="fn" rid="fn2" /></td><td>.0008</td><td>638.9</td><td>1.02</td></tr><tr><td> Constant</td><td>−2.33<xref ref-type="fn" rid="fn2" /></td><td>.04</td><td>2235.3</td><td>—</td></tr><tr><td>Y = No religious activities</td></tr><tr><td> Suicide death</td><td>.60<xref ref-type="fn" rid="fn2" /></td><td>.05</td><td>116.5</td><td>1.82</td></tr><tr><td> Age</td><td>.003<xref ref-type="fn" rid="fn2" /></td><td>.0006</td><td>38.48</td><td>1.003</td></tr><tr><td> Constant</td><td>−.67<xref ref-type="fn" rid="fn2" /></td><td>.03</td><td>320.2</td><td>—</td></tr><tr><td>Y = No psychological autopsy</td></tr><tr><td> Suicide death</td><td>.21<xref ref-type="fn" rid="fn2" /></td><td>.05</td><td>14.3</td><td>1.24</td></tr><tr><td> Age</td><td>−.01<xref ref-type="fn" rid="fn2" /></td><td>.0008</td><td>203.7</td><td>.98</td></tr><tr><td> Constant</td><td>−1.06<xref ref-type="fn" rid="fn2" /></td><td>.04</td><td>688.1</td><td>—</td></tr><tr><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>Future work is needed to more accurately estimate the wages lost (indirect costs) of suicides. As Yang and Lester ([<reflink idref="bib14" id="ref24">14</reflink>]) correctly noted, suicidal persons, given their high rate of mental troubles, are less productive in their work, on average, than other workers. It is very likely that wages lost (e.g., Clayton & Barcelo, [<reflink idref="bib2" id="ref25">2</reflink>]; Palmer et al., [<reflink idref="bib6" id="ref26">6</reflink>]; Stoudemire et al., 1995) have been overestimated, and, as a consequence, the savings that Yang and Lester report are underestimated. Persons dying of suicide tend to have a lower socio-economic status than their counterparts (e.g., Stack, [<reflink idref="bib7" id="ref27">7</reflink>][<reflink idref="bib8" id="ref28">8</reflink>]). They earn less money and have a higher rate of unemployment than other workers. Hence, using average wages, even adjusted for gender and age, overestimate the lost earnings of those who die young of suicide. With such corrections, the net savings to society from suicide would be greater than reported by Yang and Lester. This is a highly significant issue because the largest cost is indirect (lost wages due to preretirement death). The quality and quantity of grief may be linked to class as well.</p> <p>Suicide may be one of only a few causes of death where there is a net savings for society. Homicide might be a close competitor. There are approximately 15,000–20,000 homicide deaths a year with a PYLL larger than that for suicide, and a higher per death savings from social security, pension, and other post retirement costs. There are relatively few homicide victims over age 65. However, homicides accrue additional costs for society, mainly related to the criminal justice processing of thousands of convicted offenders a year who will spend a substantial part of their lives in prison at a cost averaging $20,142 per year per prisoner in 1996 dollars (U.S. Bureau of the Census, 2002). With no costs for incarceration, accidental deaths may be the main competitors with suicide for societal cost savings. However, accidental deaths account for less than 5% of all deaths, so the cost savings will tend to be lost in the larger picture of mortality. The vast majority of natural deaths occur well into the retirement years where savings to society are unlikely.</p> <ref id="AN0024195994-5"> <title> References </title> <blist> <bibl id="bib1" idref="ref9" type="bt">1</bibl> <bibtext> Chisholm, D., Van Ommeren, M., Ayuso-Mateos, J., & Saxena, S. (2005). Cost-effectiveness of clinical interventions for reducing the global burden of bipolar depression. British Journal of Psychiatry, 187, 559–567.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Clayton, D. & Barcelo, A. (2000). The cost of suicide mortality in new brunswick. Chronic Diseases in Canada, 20, 89–95.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref20" type="bt">3</bibl> <bibtext> Lester, D. (2000). Why people kill themselves. Springfield, OH: Charles C Thomas Publishers.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref19" type="bt">4</bibl> <bibtext> Mandell, M. (2006, September 25). What's really propping up the economy?Business Week, 55–62.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref15" type="bt">5</bibl> <bibtext> National Center for Health Statistics. (2000). National mortality follow back survey, 1993. Codebook. Ann Arbor, MI: Inter-University Consortium for Political and Social Research.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref3" type="bt">6</bibl> <bibtext> Palmer, C. S., Revicki, D. A., Halpern, M. T., & Hatziandreu, G. (1995). The Cost of suicide and suicide attempts in the United States. Clinical Neuropharmacology, 18(3), S25–S33.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref27" type="bt">7</bibl> <bibtext> Stack, S. (1982). Suicide: A decade review of the sociological literature. Deviant Behavior, 4, 41–66.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref13" type="bt">8</bibl> <bibtext> Stack, S. (2000a). Suicide: A 15 year review of the sociological literature: Part I. Cultural and economic factors. Suicide & Life Threatening behavior, 30: 145–162.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref22" type="bt">9</bibl> <bibtext> Stack, S. (2000b). Suicide: A 15 year review of the sociological literature: Part II. Modernization and social integration perspectives. Suicide & Life Threatening Behavior, 30, 163–176.</bibtext> </blist> <blist> <bibtext> Stoudemire, A., Frank, R., Hedemark, N., & Blazer, D. (1986). The economic burden of depression. General Hospital Psychiatry, 8, 387–394.</bibtext> </blist> <blist> <bibtext> U.S. Bureau of the Census. (2002). Statistical abstract of the united states, 2002. Washington, DC: U.S. Government Printing Office.</bibtext> </blist> <blist> <bibtext> U. S. Public Health Service. (1994). Mortality detail file. Codebook. Ann Arbor, MI: Inter-University Consortium for Political and Social Research.</bibtext> </blist> <blist> <bibtext> Wyatt, R. J., Henter, I., Leary, M. C., & Taylor, E. (1995). An economic evaluation of schizophrenia. Social Psychiatry & Psychiatric Epidemiology, 30, 196–205.</bibtext> </blist> <blist> <bibtext> Yang, B. & Lester, D. (2007). Recalculating the economic cost of suicide. Death Studies, 31, 351–361.</bibtext> </blist> </ref> <ref id="AN0024195994-6"> <title> Footnotes </title> <blist> <bibtext> <emph>Note</emph>. Data from the National Mortality Follow Back Survey (National Center for Health Statistics, 2000).</bibtext> </blist> <blist> <bibtext> *p < .05</bibtext> </blist> </ref> <aug> <p>By Steven Stack</p> <p>Reported by Author</p> </aug> <nolink nlid="nl1" bibid="bib14" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib10" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib13" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref6"></nolink>
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  Data: Societal Economic Costs and Benefits from Death: Another Look
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  Data: <searchLink fieldCode="SO" term="%22Death+Studies%22"><i>Death Studies</i></searchLink>. Apr 2007 31(4):363-372.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals/default.html
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  Data: <searchLink fieldCode="DE" term="%22Medical+Services%22">Medical Services</searchLink><br /><searchLink fieldCode="DE" term="%22Employment+Level%22">Employment Level</searchLink><br /><searchLink fieldCode="DE" term="%22Employment+Opportunities%22">Employment Opportunities</searchLink><br /><searchLink fieldCode="DE" term="%22Costs%22">Costs</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide%22">Suicide</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Networks%22">Social Networks</searchLink><br /><searchLink fieldCode="DE" term="%22Nurses%22">Nurses</searchLink><br /><searchLink fieldCode="DE" term="%22Job+Development%22">Job Development</searchLink><br /><searchLink fieldCode="DE" term="%22Grief%22">Grief</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health+Programs%22">Mental Health Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Economic+Factors%22">Economic Factors</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer%22">Cancer</searchLink><br /><searchLink fieldCode="DE" term="%22Diseases%22">Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Socioeconomic+Influences%22">Socioeconomic Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Economic+Impact%22">Economic Impact</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+Incidence%22">Disease Incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Mortality+Rate%22">Mortality Rate</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Isolation%22">Social Isolation</searchLink>
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  Data: 10.1080/07481180601187217
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  Data: 0748-1187
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  Data: B. Yang and D. Lester (2007) have produced an innovative contribution to the relevant literature. Unlike previous studies, they incorporate estimates of cost savings from suicide. Their argument could be strengthened in 3 ways. First, they may have underestimated some of the cost savings by relying on inflated estimates of mental health usage by suicidal persons. The present analysis shows that only 20% of suicidal individuals see a mental health professional during the last year of life, much lower than previous estimates. Further, persons dying of cancer are 4 times more likely than suicides to report high usage of medical services. Second, our economy relies heavily on the health care sector for job creation, so that we need to exercise caution in interpreting savings in medical care; such savings may also represent costs in employment opportunities for nurses, doctors, and other medical personnel. Third, an anticipated criticism, the costs of the grieving of significant others, needs to be considered. Suicidal persons are shown to have less dense social networks, a sign of fewer potential grievers than in the case of natural deaths. Future work is needed to adjust lost earnings for the lower occupational status of suicides; this is another reason why Yang and Lester may be underestimating cost savings from suicide. (Contains 3 tables.)
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