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To the Editor:
Milner et al1 evaluated the association between working factors and suicide ideation, and concluded that suicide ideation was positively associated with workplace bullying or harassment and negatively associated with higher job control and security. I have some concerns on their study.
First, Baumert et al2 examined the effect of adverse working conditions at the workplace on suicide mortality in a follow-up study. Adverse chronobiological and physical conditions were related to higher suicide mortality. Full-adjusted hazard ratio of poor chronobiological/physical working conditions for suicide mortality was 2.73 (P = 0.022). In contrast, adverse psychosocial working conditions and job strain had no significant effect on suicide mortality. Suicide ideation and suicide mortality are different indicators. Min et al3 described the prevalence of suicidal ideation in nonprecarious and precarious workers were 4.4% and 10.0%, respectively. In addition, the prevalence of suicidal attempts in nonprecarious and precarious workers were 0.2% and 0.7%, respectively.3 Taken together, suicidal ideation, suicidal attempt, and suicidal death should be specified in the study.
Second, Tiesman et al4 reported the time-trend of suicides occurring in U.S. workplaces. There is the upward trend of suicides in the workplace, and they recommended conducting programs of suicide prevention by exploring occupation-specific risk factors.4 I think that working conditions such as income, insecurity, bullying, or harassment would influence suicidal ideation or attempt with causal association, and psycho-physio-social working conditions are widely included as predictors for suicidal ideation.
Precarious work (job insecurity) is associated with the risk of serious psychological distress among middle-aged men.5 Min et al3 also reported that precarious workers showed a 41% increase of suicidal ideation by adjusting several confounders. Risk assessment by a follow-up study or interventional study is recommended for determining suicide prevention program in the workplace.
1. Milner A, Page K, Witt K, et al. Psychosocial working conditions and suicide ideation: evidence from a cross-sectional survey of working Australians. J Occup Environ Med
2. Baumert J, Schneider B, Lukaschek K, et al. Adverse conditions at the workplace are associated with increased suicide risk. J Psychiatr Res
3. Min KB, Park SG, Hwang SH, Min JY. Precarious employment and the risk of suicidal ideation and suicide attempts. Prev Med
4. Tiesman HM, Konda S, Hartley D, et al. Suicide in U.S workplaces, 2003–2010: a comparison with non-workplace suicides. Am J Prev Med
5. Kachi Y, Otsuka T, Kawada T. Precarious employment and the risk of serious psychological distress: a population-based cohort study in Japan. Scand J Work Environ Health