The “fiscal cliff”

There was public outcry, debate, and political maneuvering over the recent “fiscal cliff” that forced the country to face economic uncertainty in 2013. The U.S. economy has gone through 13 recessions since the Great Depression in 1929, the latest being the “Great Recession,” which started in December 2007 and continued through June 2009. These financial cycles have occurred throughout the history of the U.S. Unfortunately, recessions generally result in a rise in the unemployment rate and a rise in the suicide rate.

According to a Centers for Disease Control and Prevention (CDC) study titled Impact of Business Cycles on U.S. Suicide Rates, 1928–2007, business cycles may affect suicide rates, and it suggests that public health responses are a necessary component of suicide prevention during recessions. The study also revealed age-specific suicide rate responses to the cycles of an economic downturn. Specifically, suicide rates for those individuals between the ages of 25 and 64 rose during economic contractions.*

Figure 1. Self-Inflicted Injuries by Age Range

To examine the occurrence of self-inflicted injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2011, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Specifically searched were external cause of injury codes (E-codes) that fell into the category of self-inflicted manner/intent, based on the CDC’s recommended groupings for presenting injury mortality and morbidity data. (These data are located in appendix C of the NTDB Annual Report 2012.) A total of 11,747 records of self-inflicted injury were found; 9,532 records contained a hospital discharge status, including 4,424 patients discharged to home, 3,181 to acute care/rehab, and 645 sent to skilled nursing facilities; 1,282 died. These patients were 76.4 percent male, on average 38.7 years of age, had an average hospital length of stay of 6.7 days, an intensive care unit length of stay of 5.2 days, an average injury severity score of 11.2, and were on the ventilator for an average of 4.3 days. A breakdown of suicide by age demonstrates the greatest number of records between the ages of 25 and 64 (see figures). Of the 7,070 tested for alcohol, 59 percent were found to be positive.

Figure 2. Hospital Discharge Status

Suicide is a serious public health issue that can be devastating and have long-lasting, harmful effects on individuals, families, and communities. An economic downturn presents the possibility of the loss of a job, the loss of income, the threat of foreclosure—any of which can negatively affect one’s self-image and strain relationships with family and friends.
Taking the nation over the fiscal cliff could have yielded multiple risk factors, although suicide is generally not carried out in response to any one factor, but rather is often the result of a combination of many variables. There is an opportunity for prevention by reducing risk factors while promoting protective measures. For more information on suicide prevention, visit the CDC website.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2012 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.

*Luo F, Florence CS, Quispe-Agnoli M, Ouyang L, Crosby AE. Impact of business cycles on US suicide rates, 1928–2007. Am J Public Health. 2011;101(6):1139-1146.

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