Insecure employment and the social determinants of suicide: a narrative synthesis review

BACKGROUND: Employment-related suicide is a global public health problem, which is becoming more urgent as the world’s workforce is increasingly employed under insecure conditions. Workers who lack secure employment—including those who are unemployed and in various forms of precarious employment—experience poorer health. Suicide is hidden in the literature on worker health, often subsumed by the focus on mental illness. This article presents a review of research on the relationship between insecure employment and suicide and what is known about the pathways underlying this relationship. This systematic review takes a narrative synthesis approach. The review is grounded in a social determinants of health paradigm and findings are synthesised into a socioecological model. Eighty-three articles are included. RESULTS: Suicide for people without secure employment is determined by factors that may be grouped into socio-structural factors, law and policy, employment and working conditions, place and community, and individuals. Reviewed studies identified the inter-relationships between determinants of suicide affecting people without secure employment at multiple levels of the socioecological model. CONCLUSIONS: When a socioecological lens is applied to the relationship between insecure employment and suicide, it is evident that those without secure employment are exposed to a multitude of pathways by which the risk of suicide may be increased. Reviewed articles provided important insights into the role of context-specific structural mechanisms in shaping the employment landscape and the social meaning attributed to employment status. Good quality employment is a priority for leveling the social gradient in suicide.