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To the Editor:
We thank Dr Kawada for commenting on our paper.
We agree that there are many working conditions—including those described as physical, chemical, chronobiological, and psychosocial—that could adversely affect mental health, and which might directly or indirectly impact suicidal thoughts, suicidal behaviors, and suicide mortality.
As we have highlighted in the introduction of our paper,1 there have been limited studies in relation to suicide ideation.2–4 We thank Professor Kawada for drawing our attention to another recent study.5 This emphasizes the need for more research on the relationships between working conditions and suicidality. A larger number of studies have demonstrated a relationship between psychosocial job stressors and suicide deaths and/or attempts.6–10
As Dr Kawada points out, ideally, we would have data on the three outcomes suicide ideation, attempt, and death. However, suicide is statistically a rare outcome in Australia (the suicide rate in Australia is 12 per 100,000 persons11) and, because of this, we would need a very large sample to observe potential effects of psychosocial job stressors on suicide. Further, although suicide ideation and behaviors are related, there is not necessarily established linear relationship between thoughts about suicide, attempts, and deaths.12 Suicide ideation is also an indicator of psychological distress and mental illness.12 Because of this, it should be treated as a separate and distinct outcome from suicidal behaviors.
The value of the current study is that we were able to demonstrate the role of chronic job stressors—such as low job control and high job demands—as well as more proximal risks for suicide ideation, such as workplace bullying. As we have demonstrated in our paper, poor psychosocial working conditions (low supervisor support, high job demands, and high job insecurity) appear to be related to bullying. Thus, suicide prevention should address the psychosocial environment at an organizational level, as well as other risk symptomatic of a poor working environment such as bullying. Complementing this, workplace suicide prevention should include education and awareness campaigns to reduce stigma, and enable better identification and treatment of suicidality, as well as ongoing rehabilitation and support.
1. Milner A, Page KW, Witt K, LaMontagne AD. Psychosocial working conditions and suicide ideation: evidence from a cross-sectional survey of working Australians. J Occup Environ Med
2. Takada M, Suzuki A, Shima S, Inoue K, Kazukawa S, Hojoh M. Associations between lifestyle factors, working environment, depressive symptoms and suicidal ideation: a large-scale study in Japan. Ind Health
3. Nielsen MB, Nielsen GH, Notelaers G, Einarsen S. Workplace bullying and suicidal ideation: a 3-wave longitudinal Norwegian study. Am J Public Health
4. Ostry A, Maggi S, Tansey J, et al. The impact of psychosocial work conditions on attempted and completed suicide among western Canadian sawmill workers. Scand J Public Health
5. Min KB, Park SG, Hwang SH, Min JY. Precarious employment and the risk of suicidal ideation and suicide attempts. Prev Med
6. Schneider B, Grebner K, Schnabel A, Hampel H, Georgi K, Seidler A. Impact of employment status and work-related factors on risk of completed suicide. A case-control psychological autopsy study. Psychiatry Res
7. Tsutsumi A, Kayaba K, Ojima T, Ishikawa S, Kawakami N. Jichi Medical School Cohort Study Group. Low control at work and the risk of suicide in Japanese men: a prospective cohort study. Psychother Psychosom
8. Baumert J, Schneider B, Lukaschek K, et al. Adverse conditions at the workplace are associated with increased suicide risk. J Psychiatr Res
9. Feskanich D, Hastrup JL, Marshall JR, et al. Stress and suicide in the Nurses’ Health Study. J Epidemiol Community Health
10. Milner A, Spittal MJ, Pirkis J, Chastang J-F, Niedhammer I, LaMontagne AD. Low control and high demands at work as chronic psychosocial risk factors for suicide: an Australian national population-level case-control study. Psychosom Med
. [Epub ahead of print].
11. ABS. Causes of Death, Australia, 2014. Catalogue number 3303.0. Available at: http://www.abs.gov.au/ausstats/[email protected]/mf/3303.0
. Accessed July 1, 2016.
12. Miranda R, Ortin A, Scott M, Shaffer D. Characteristics of suicidal ideation that predict the transition to future suicide attempts in adolescents. J Am Acad Child Adolesc Psychiatry