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. Author manuscript; available in PMC: 2026 May 9.
Published in final edited form as: Am J Prev Med. 2026 Feb 17;71(1):108323. doi: 10.1016/j.amepre.2026.108323

Job Problems in Suicide: National Violent Death Reporting System, 2020–2022

Hope M Tiesman 1, Suzanne M Marsh 2, Bridget H Lyons 3, Janet M Blair 4
PMCID: PMC13154816  NIHMSID: NIHMS2153562  PMID: 41713629

Abstract

Introduction:

Job problems have been found to be a suicide risk factor among different workers and occupations. This analysis used National Violent Death Reporting System (NVDRS) data to understand how job problems are characterized and identify common suicide-related job problems by industry and occupation.

Methods:

NVDRS data from 2020 – 2022 for suicide decedents aged ≥ 18 years from 50 states, D.C., and Puerto Rico were used. Industry and occupation were coded using the NIOSH Industry & Occupation Computerized Coding System. The job problem variable is a dichotomous variable that was expanded to 9 categories using suicide case narratives. Multivariable logistic regression models calculating adjusted odds ratios (aORs) compared circumstances between job-related suicides and non-job-related suicides. Analyses were conducted in 2024–2025.

Results:

The analysis identified 101,589 suicide decedents with at least one known circumstance endorsed; 8% (n=8,354) had a reported job problem. Decedents with job problems were mostly white (80%) and male (85%). Nearly 70% of job-related suicides were due to unemployment or job stress (n=5652; 68%). There were differences in job problems across industry and occupation. Multivariable analyses found the strongest risk factors for a job-related suicide compared to a non-job related suicide were presence of a financial problem (aOR=9.70, 95% CI=9.15–10.28) and current depressed mood (aOR=3.31, 95% CI=3.17–3.47).

Conclusions:

Findings show the significance of job-related suicide risk factors at the systemic and individual levels. Workplace suicide prevention efforts could be tailored to occupations including supporting recently unemployed blue-collar workers and improving the psychosocial work environment for white-collar workers.

Keywords: suicide, occupation, surveillance

Introduction

Suicide is recognized as an important public health problem in the United States. In the U.S. in 2023, 49,316 people died by suicide (1). Suicide is complex and results from the interaction of individual, relationship, community, and societal factors (2). Occupation has been associated with suicide risk (2). Increased suicide risk for certain occupations may be associated with work factors such as long working hours, access to lethal means, and/or community characteristics, such as low income (3).

The Centers for Disease Control and Prevention’s (CDC) National Violent Death Reporting System (NVDRS) is a surveillance tool for suicide research. Between 2002 and 2022, 48 studies using NVDRS suicide data narratives were published (4). One variable found to be a commonly noted circumstance in many NVDRS studies is ‘Job Problem’ (5–7). This dichotomous variable in NVDRS is defined as a situation “where the victim was experiencing a problem at work that appeared to have contributed to the suicide” (8). However, this is a broad concept that may mean different things to different occupations. For example, a job problem could mean fewer work hours and the loss of financial means, or more work hours and challenges to one’s family-life balance. A better understanding of the factors in the variation of suicide risk across occupations may help inform workplace prevention programs and messaging.

The current study uses NVDRS data to better understand and describe the role of job problems in suicide fatalities across industry and occupation. Results identify which job-related suicide risk factors are more prevalent by industry and occupation. Findings can be used to develop and refine industry or occupation-specific workplace-based suicide prevention programs and messaging.

Methods

Study Sample

Data from the 2020 – 2022 NVDRS were used as they were the most recent data available at the time of analysis. NVDRS is an active, state, territory, and jurisdiction based, surveillance system and has previously been described (9). Briefly, the system collects data on all homicides, suicides, deaths due to legal intervention (excluding executions), unintentional firearm deaths, and deaths due to undetermined intent. NVDRS combines data from three sources - death certificates, coroner or medical examiner (C/ME) reports, and law enforcement (LE) reports. Information is entered into an encrypted, web-based system by trained abstractors in participating jurisdictions who review records and combine information into a single incident using standardized CDC guidance. By combining multiple sources, NVDRS is considered a comprehensive report of circumstances contributing to a suicide including mental health, relationship issues, physical health conditions, and job or financial problems (8–9). As of 2020, all 50 states, Puerto Rico, and the District of Columbia are included in NVDRS (7). This project was reviewed by CDC IRB, deemed not research because it involved decedents, and was conducted consistent with applicable federal law and CDC policy.§ 1

Regarding the coding of cases, cases where the decedent was 18 years of age or older and the “Job Problem” variable was endorsed were reviewed and more detail obtained by using the narrative text fields derived from the LE and C/ME reports. These fields are generally one paragraph in length and describe the incident in detail. Approximately 225 suicide deaths with a reported job problem were selected randomly for review and coded by the primary author to develop initial job problem categories, definitions, and coding rules. The following nine categories were developed: (1) Employer recently terminated employment; (2) A medical condition impacted employment; (3) Decedent voluntarily left, quit, or retired from job; (4) Decedent was in some sort of trouble at work; (5) Job stress; (6) Issues with a family business; (7) Generic work problem of an undetermined nature; (8) Issues with long-term unemployment; and (9) No job problem mentioned in narrative fields (Appendix Table 1). In very few cases, multiple categories could be selected. To make the categories mutually exclusive, an order of precedence was developed. The last category considered was (1) Employer recently terminated employment (i.e., if a decedent had medical issues and was fired from their job, they would be coded as (2) A medical condition impacted employment). For some analyses, categories 1 (employer recently terminated employment) and 8 (issues with long-term unemployment) were combined into a single ‘Any Type of Unemployment’ category.

Next, all suicides with a reported job problem (N=8,353) were reviewed and independently coded by all four co-authors. If any of the co-authors were unsure of the best code to assign, the authors discussed in a group, and the primary author made a final decision on the most appropriate category. Codes were verified by the primary author by manually reviewing 15% of deaths in each category. If more than 10% of suicides were found to be coded inconsistently, the primary author re-reviewed the entire category for accuracy. A flow chart depicting inclusions and exclusions is included in the Appendix (Figure 1).

Measures

NVDRS includes decedents’ usual industry and occupation based on death certificate information (8). Occupation reflects the type of work a person does, while industry reflects the business activity of the company (10). Industry and occupation in NVDRS are coded using the National Institute for Occupational Safety and Health (NIOSH) Industry and Occupation Computerized Coding System (NIOCCS) (11). Occupation was coded using the 2019 U.S. Census Bureau’s Occupation codes (12). Industry was coded using the 2017 U.S. Census Bureau North American Industry Classification System codes (13).

Several sociodemographic variables were examined in relation to the job problem variable including sex, age, marital status, education, race/ethnicity, and military status. Other NVDRS variables were also examined. This included method of suicide, location of suicide, presence of a mental health problem (depression, anxiety disorder, post-traumatic stress disorder), currently/ever in treatment for a mental health problem, presence of a drug or alcohol problem, decedent used alcohol before suicide, presence of a physical health problem, presence of a financial problem, exposed to recent suicide, intimate partner problem, in a recent argument, history of suicidal thoughts, and history of suicide attempt.

Statistical Analysis

Descriptive statistics were calculated and compared for suicide decedents with and without a reported job problem by demographics (sex, age group, race/ethnicity, marital status, and education). Crude odds ratios (cORs) were used to determine statistically significant differences in demographics for suicide decedents with and without a job problem. Among suicide decedents with a job problem, this process was repeated for those with and without an unemployment-related job problem and with and without job stress. Finally, separate multivariable logistic regression models were constructed to calculate adjusted odds ratios (aORs) for the presence of a mental health problem while controlling for age, race/ethnicity, education, marital status, and sex. The Cochran-Armitage Trend Test was used to test for a trend in education level. Analyses were conducted in 2024–2025 using SAS software (SAS version 9.3, SAS Institute Inc., Cary NC, USA).

Results

There were 101,589 individuals aged 18 years or older, with at least one known circumstance endorsed, who died by suicide between 2020 and 2022, with 8,354 deaths (8%) associated with a reported job problem (Table 1). Of these 8,354 deaths, 29% were due to the employer terminating employment, 21% due to job stress, 18% were long-term unemployment issues, 7% were in trouble at work, 7% had a medical issue impacting employment, 6% had family business issues, 5% left their job or retired, 4% had a generic job problem, and 4% did not elaborate on the job problem. Among suicide decedents with a job problem, nearly 70% were due to unemployment or job stress.

Table 1.

Job Problems among Suicide Decedents >18 Years —National Violent Death Reporting System, 2020 – 2022a

2020 2021 2022 2020–2022
Job Problem Number (%) Number (%) Number (%) Total
Employer Terminated Employment 956 (33%) 706 (26%) 760 (28%) 2422 (29%)
Job Stress 559 (19%) 598 (22%) 588 (21%) 1745 (21%)
Long-term Unemployment Issues 535 (19%) 524 (19%) 426 (16%) 1485 (18%)
Trouble at Work 182 (6%) 202 (7%) 203 (7%) 587 (7%)
Medical Reason 142 (5%) 193 (7%) 212 (8%) 547 (7%)
Issues with a Family Business 162 (6%) 141 (5%) 165 (6%) 468 (6%)
Left Job or Retired 127 (4%) 134 (5%) 144 (5%) 405 (5%)
Generic Job Problemb 91 (3%) 109 (4%) 124 (5%) 324 (4%)
No Job Cause Found in Narrative Text 135 (5%) 118 (4%) 118 (4%) 372 (4%)
Total 2889 2725 2740 8,354
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a

Data for California are for deaths occurring in 32 counties, data for Florida are for deaths occurring in 32 counties, data for Texas are for deaths occurring in 13 counties (Supplementary Box).

b

Generic work problem of an undetermined nature

There were differences across the socio-demographics of suicide decedents with a reported job problem (Table 2). Suicide decedents with a job problem were younger than those without job problems (43.8 years vs. 48.2 years; p <0.0001; data not shown). Suicide decedents with a job problem were more likely to be male (cOR=1.51, 95% CI=1.42–1.61). Increasing level of education was associated with a significantly higher likelihood of reporting a job problem Cochran-Armitage Trend Test (p<0.0001). Suicide decedents with an unemployment-related job problem differed from those with a stress-related job problem (Table 2). Men were more likely to have an unemployment-related job problem (cOR=1.40, 95% CI=1.23–1.57), but less likely to have a stress-related job problem (cOR=0.64, 95% CI=0.56–0.73). Increasing level of education was significantly associated with a lower likelihood of reporting an unemployment-related job problem, but a higher likelihood of having a stress-related job problem (Cochran-Armitage Trend Test p<0.0001 & p<0.0001, respectively).

Table 2.

Socio-Demographics of Suicide Decedents > 18 Years by Job Problem - National Violent Death Reporting System, 2020 – 2022a,b

Decedents With Job Problems Crude Odds Ratio Decedents With Any Type of Unemploymentc Crude Odds Ratio Decedents With Job Stress Crude Odds Ratio Total Suicides
N (%) (95% CI) N (%) (95% CI) N (%) (95% CI) N (%)
Sex
Male 7106 (85%) 1.51 (1.42–1.61) 3409 (87%) 1.40 (1.23–1.57) 1399 (80%) 0.64 (0.56–0.73) 80823 (80%)
Female 1247 (15%) ref 497 (13%) ref 346 (20%) ref 20758 (20%)
Age Group (years)
18–24 797 (10%) ref 391 (10%) ref 189 (11%) ref 11071 (11%)
25–34 1708 (20%) 1.26 (1.15–1.37) 845 (22%) 1.02 (0.86–1.21) 383 (22%) 0.93 (0.76–1.14) 19231 (19%)
35–44 1666 (20%) 1.37 (1.25–1.49) 821 (21%) 1.01 (0.86–1.20) 339 (19%) 0.82 (0.67–1.01) 17385 (17%)
45–54 2008
(24%)		 1.76 (1.62–1.92) 912 (23%) 0.87 (0.74–1.02) 429 (25%) 0.88 (0.72–1.07) 16684 (16%)
55–64 1760
(21%)		 1.56 (1.43–1.70) 789 (20%) 0.85 (0.72–1.00) 331 (19%) 0.75 (0.61–0.91) 16341 (16%)
≥65 415 (5%) 0.26 (0.23–0.30) 149 (4%) 0.58 (0.46–0.74) 74 (4%) 0.70 (0.52–0.94) 20877 (21%)
Race/ethnicity d
White non-Hispanic 6705 (80%) ref 3072 (79%) ref 1411 (81%) ref 79238 (78%)
Black non-Hispanic 494 (6%) 0.77 (0.70–0.85) 275 (7%) 1.49 (1.24–1.79) 80 (5%) 0.73 (0.57-
0.93)		 7397 (7%)
American Indian or Alaska Native non-Hispanic 73 (1%) 0.59 (0.47–0.75) 40 (1%) 1.35 (0.86–2.13) 11 (1%) 0.65 (0.34–1.23) 1412 (1%)
Asian non-Hispanic 237 (3%) 1.05 (0.92–1.20) 101 (3%) 0.82 (0.63–1.06) 70 (4%) 1.49 (1.12–1.97) 2677 (3%)
Other 139 (2%) 0.97 (0.82–1.16) 302 (8%) 1.33 (1.12–1.57) 115 (7%) 0.95 (0.77–1.17) 1686 (2%)
Hispanic or Latino 706 (9%) 0.90 (0.82–0.98) 117 (3%) 0.96 (0.75–1.23) 58 (3%) 1.07 (0.77–1.44) 9179 (9%)
Marital Status
Single 3351 (40%) ref 1765 (46%) ref 664 (38%) ref 39734 (40%)
Married, Civil Union 2874 (35%) 1.11 (1.06–1.17) 1008 (26%) 0.49 (0.44–0.54) 778 (45%) 1.50 (1.34–1.69) 30892 (31%)
Divorced/separated 1964 (24%) 0.98 (0.92–1.04) 1046 (27%) 1.02 (0.92–1.15) 284 (16%) 0.68 (0.59–0.80) 23776 (23%)
Widowed 108 (1%) 0.20 (0.24–0.16) 49 (1%) 0.75 (0.51–1.10) 12 (1%) 0.51 (0.28–0.93) 6082 (6%)
Education
Less than high school 639 (8%) ref 375 (10%) ref 85 (5%) ref 12027 (12%)
High school graduate/GED 3087 (38%) 1.39 (1.28–1.52) 1599 (42%) 0.76 (0.64–0.90) 524 (30%) 1.33 (1.04–1.71) 42545 (43%)
Some college or associate’s degree 2174 (26%) 1.69 (1.54–1.85) 1017 (27%) 0.62 (0.52–0.74) 429 (25%) 1.60 (1.25–2.06) 25166 (25%)
Bachelor’s Degree 1527 (19%) 2.30 (2.09–2.54) 604 (16%) 0.46 (0.38–0.56) 423 (25%) 2.50 (1.94–3.22) 13340 (13%)
Master’s degree or Higher 797 (10%) 2.47 (2.21–2.75) 236 (6%) 0.30 (0.24–0.37) 266 (15%) 3.27 (2.49–4.28) 6550 (6%)
Mechanism of Injury
Firearm 4595 (55%) 1.20 (1.10–1.32) 2035 (52%) 0.95 (0.80–1.13) 988 (57%) 1.05 (0.85–1.30) 54350 (54%)
Hanging, strangulation, suffocation 2426 (29%) 1.30 (1.18–1.43) 1243 (32%) 1.26 (1.05–1.51) 485 (28%) 0.96 (0.77–1.20) 26809 (26%)
Poisoning 748 (9%) 0.86 (0.77–0.96) 364 (9%) 1.14 (0.92–1.41) 152 (8%) 0.98 (0.75–1.28) 12087 (12%)
All Other 580 (7%) ref 264 (7%) ref 120 (7%) ref 8140 (8%)
TOTAL 8354 3907 1745 101,589
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a

Data for California are for deaths occurring in 32 counties, data for Florida are for deaths occurring in 32 counties, and data for Texas are for deaths occurring in 13 counties (Supplementary Box).

b

Rows do not sum to Total due to missing data

c

Combines category 1(employer recently terminated employment) and category 8 (issues with long-term unemployment)

d

Persons of Hispanic or Latino (Hispanic) origin might be of any race but categorized as Hispanic; all racial groups are non-Hispanic GED=General Educational Development

There were differences in job problems across decedent’s occupation and industry (Table 3). The two occupations with the highest proportion of suicide decedents with a job problem were: Legal (n=91, 14%) and Computer & Mathematical (n=244, 12%). The top two industries were Management of Companies & Enterprises (n=11, 13%); Professional, Scientific, & Technical Services (n=571, 12%). For unemployment related issues, the highest proportions of suicides were among Food Preparation & Serving Related occupations (n=196, 64%) and the Information industry (n=77, 62%). For stress-related job problems, the highest proportions of suicides were among Educational Instruction & Library occupations (n=68, 38%) and the Education Services industry (n=88, 33%).

Table 3.

Industry and Occupation of Suicide Decedents > 18 Years by Job Problem - National Violent Death Reporting System, 2020 – 2022a

Decedents With Job Problems Decedents With Unemploymentc Decedents With Job Stress Total
Occupation b N (%) N (%) N (%)
 Legal 91 (14%) 29 (32%) 33 (36%) 665
 Computer and Mathematical 244 (12%) 102 (42%) 73 (30%) 1979
 Protective Service 306 (12%) 94 (31%) 84 (28%) 2634
 Healthcare Practitioners and Technical 378 (11%) 124 (33%) 111 (29%) 3322
 Management 828 (11%) 280 (34%) 200 (24%) 7402
 Business and Financial Operations 264 (11%) 101 (38%) 88 (33%) 2476
 Architecture and Engineering 215 (9%) 88 (41%) 67 (31%) 2267
 Community and Social Service 82 (9%) 27 (33%) 26 (32%) 873
 Life, Physical, and Social Science 78 (9%) 36 (46%) 21 (27%) 877
 Educational Instruction and Library 182 (9%) 54 (30%) 68 (38%) 1964
 Food Preparation and Serving Related 310 (9%) 196 (63%) 42 (14%) 3386
 Military 173 (9%) 28 (16%) 51 (30%) 1825
 Transportation and Material Moving 801 (9%) 445 (56%) 115 (14%) 9407
 Arts, Design, Entertainment, Sports, & Media 173 (8%) 93 (54%) 23 (13%) 2207
 Installation, Maintenance, and Repair 461 (8%) 240 (52%) 88 (19%) 5619
 Office and Administrative Support 326 (8%) 153 (47%) 75 (23%) 4083
 Sales and Related 560 (8%) 262 (47%) 111 (20%) 6377
 Production 556 (8%) 288 (52%) 101 (18%) 6666
 Healthcare Support 120 (7%) 54 (45%) 31 (26%) 1677
 Personal Care and Service 110 (7%) 56 (51%) 12 (11%) 1473
 Construction and Extraction 891 (7%) 504 (57%) 117 (13%) 12010
 Building & Grounds Cleaning & Maintenance 180 (6%) 92 (51%) 36 (20%) 2971
 Farming, Fishing, and Forestry 35 (5%) 20 (57%) 7 (20%) 775
 Not in Workforce/Unknown 990 (5%) 541 (55%) 165 (17%) 18654
TOTAL 8354 (7%) 3907 (47%) 1745 (21%) 101,589
Industry b
Management of Companies & Enterprises 11 (13%) 8 (73%) 2 (18%) 83
Professional, Scientific, & Technical Services 571 (12%) 224 (39%) 181 (32%) 4897
Wholesale Trade 114 (11%) 44 (39%) 31 (27%) 994
Finance and Insurance 235 (10%) 91 (39%) 71 (30%) 2245
Health Care and Social Assistance 655 (10%) 253 (39%) 183 (28%) 6451
Public Administration 428 (10%) 112 (26%) 136 (32%) 4203
Accommodation and Food Services 462 (10%) 267 (58%) 68 (15%) 4794
Military 175 (9%) 30 (17%) 51 (29%) 1878
Educational Services 270 (9%) 88 (33%) 88 (33%) 2942
Transportation and Warehousing 546 (9%) 273 (50%) 91 (17%) 5964
Retail Trade 612 (9%) 287 (47%) 116 (19%) 6889
Information 127 (9%) 78 (61%) 27 (21%) 1487
Utilities 96 (9%) 42 (44%) 29 (30%) 1108
Arts, Entertainment, and Recreation 188 (9%) 110 (59%) 26 (14%) 2181
Mining, Quarrying, and Oil and Gas Extraction 72 (8%) 41 (57%) 15 (21%) 920
Construction 1043 (8%) 561 (50%) 141 (14%) 13414
Manufacturing 902 (8%) 451 (50%) 184 (20%) 10703
Other Services (except Public Admin) 389 (8%) 193 (50%) 57 (15%) 4805
Real Estate and Rental and Leasing 79 (7%) 24 (30%) 22 (28%) 1134
Administrative & Support and Waste Management & Remediation Services 249 (7%) 122 (49%) 47 (19%) 3356
Agriculture, Forestry, Fishing & Hunting 107 (6%) 43 (40%) 21 (20%) 1884
Not in Workforce/Unknown 1023 (5%) 565 (55%) 158 (16%) 19257
TOTAL 8354 (7%) 3907 (47%) 1745 (21%) 101,589
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a

Data for California are for deaths occurring in 32 counties, data for Florida are for deaths occurring in 32 counties, and data for Texas are for deaths occurring in 13 counties (Supplementary Box).

b

Industry and occupation are coded using the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS)

c

Combines category 1(employer recently terminated employment) and category 8 (issues with long-term unemployment)

Table 4 shows the multivariable logistic models for suicide decedents with any job problem. After controlling for age, education, sex, marital status, and race/ethnicity, suicide decedents with a reported job problem had greater odds of experiencing all examined suicide risk factors including current mental health problems, current depressed mood, physical health problem, exposure to recent suicide, legal problem, drug or alcohol problem, and history of suicidal thoughts and attempts. The most pronounced differences for men and women were presence of a financial problem (aOR=8.27, 95% CI=7.76–8.82; aOR=8.11, 95% CI=7.00–9.44).

Table 4.

Suicide Circumstances among Suicide Decedents > 18 Years With a Job Problem - National Violent Death Reporting System, 2020 – 2022a

OVERALL MEN WOMEN
Circumstanceb Odds Ratio Adjusted Odds Ratio d Odds Ratio Adjusted Odds Ratio d Odds Ratio Adjusted Odds Ratio e Total
Current Mental Health Problem (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI)
 Depression/dysthymia 1.88 (1.80–1.97) 1.89 (1.80–1.98) 1.54 (1.46–1.62) 1.46 (1.38–1.53) 1.37 (1.22–1.54) 1.32 (1.17–1.48) 35806 (30%)
 Anxiety Disorder 1.96 (1.84–2.08) 1.97 (1.84–2.09) 1.72 (1.60–1.84) 1.60 (1.49–1.72) 1.63 (1.43–1.85) 1.56 (1.37–1.78) 11633 (10%)
 Post-traumatic stress disorder 1.22 (1.07–1.39) 1.14 (1.00–1.30) 0.98 (0.85–
1.13)		 0.92 (0.79–
1.06)		 1.15 (0.84–1.45) 1.03 (0.75–1.41) 3101 (3%)
Mental Health
 Current depressed mood 3.31 (3.17–3.47) 3.41 (3.26–3.57) 2.60 (2.47–2.73) 2.66 (2.53–2.80) 2.60 (2.31–2.91) 2.64 (2.35–2.96) 29929 (25%)
 Current mental health treatment 1.68 (1.59–1.76) 1.66 (1.58–1.75) 1.41 (1.33–1.49) 1.31 (1.23–1.38) 1.39 (1.24–1.57) 1.32 (1.18–1.49) 22944 (19%)
 History of mental health treatment 1.77 (1.69–−1.85) 1.73 (1.65–1.81) 1.43 (1.36–1.50) 1.31 (1.24–1.38) 1.52 (1.36–1.71) 1.43 (1.27–1.61) 31691 (26%)
Life Events
 Presence of a physical health problem 0.93 (0.88–0.99) 1.24 (1.16–1.32) 0.73 (0.68–0.78) 0.95 (0.88–1.02) 0.80 (0.68–0.93) 0.99 (0.84–1.17) 20508 (17%)
 Presence of a financial problem 9.70 (9.15–10.28) 10.01 (9.43–10.62) 8.05 (7.56–8.58) 8.27 (7.76–8.82) 7.43 (6.41–8.62) 8.11 (7.00–9.44) 6240 (5%)
 Presence of a criminal/legal problem 2.22 (1.99–2.47) 2.16 (1.94–2.42) 1.79 (1.58–2.01) 1.75 (1.55–1.97) 2.10- (1.61–2.73) 1.97 (1.50–2.57) 2804 (2%)
 Presence of a intimate partner problem 1.31 (1.23–1.41) 1.20 (1.12–1.28) 1.04 (0.97–1.12) 0.95 (0.89–1.03) 1.13 (0.94–1.35) 1.01 (0.84–1.21) 12023 (10%)
 Recent argument or conflict 1.26 (1.19–1.34) 1.19 (1.12–1.27) 1.02 (0.96–1.10) 0.94 (0.89–1.02) 0.97 (0.83–1.14) 0.92 (0.79 –1.09) 15919 (13%)
 Exposed to recent suicide 2.15 (1.89–2.43) 2.16 (1.90–2.45) 1.78 (1.54–2.05) 1.73 (1.50–2.00) 1.96 (1.50–2.58) 2.02 (1.53–2.66) 2134 (2%)
Drug or Alcohol Problems
 Decedent had alcohol problem 2.21 (2.10–2.32) 2.20 (2.10–2.31) 1.76 (1.66–1.86) 1.76 (1.66–1.86) 1.69 (1.48–1.94) 1.72 (1.50–1.97) 18713 (16%)
 Used alcohol in hours preceding suicide 1.57 (1.48–1.65) 1.48 (1.41–1.57) 1.48 (1.39–1.57) 1.39 (1.31–1.48) 1.56 (1.37–1.79) 1.49 (1.30–1.71) 19422 (17%)
 Decedent had substance use problem 1.18 (1.12–1.26) 1.16 (1.10–1.23) 0.95 (0.89–1.02) 0.91 (0.85–0.97) 0.95 (0.82–1.10) 0.96 (0.82–1.11) 18194 (15%)
Suicide Intent and Planning
 History of suicidal thoughts 1.51 (1.45–1.59) 1.51 (1.45–1.59) 1.15 (1.09–1.21) 1.12 (1.07–1.18) 1.31 (1.17–1.47) 1.29 (1.15–1.45) 34878 (29%)
 Disclosed suicide intent 1.36 (1.29–1.44) 1.37 (1.30–1.44) 1.06 (1.00–1.13) 1.06 (1.00–1.12) 1.20 (1.05–1.38) 1.20 (1.05–1.37) 21773 (18%)
 Prior suicide attempt(s) 1.21 (1.14–1.28) 1.23 (1.16–1.31) 1.05 (0.98–1.12) 0.98 (0.92–1.05) 0.99 (0.87–1.12) 0.97 (0.85–1.10) 18219 (15%)
Incident occurred at Work 2.48 (2.10–2.94) 2.28 (1.92–2.70) 2.37 (1.98–2.83) 2.41 (2.17–2.67) 2.94 (1.54–5.60) 2.62 (1.36–5.04) 1077 (1%)
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a

Data for California are for deaths occurring in 32 counties, data for Florida are for deaths occurring in 32 counties, and data for Texas are for deaths occurring in 13 counties (Supplementary Box).

b

Includes suicides with one or more precipitating circumstances. More than one circumstance could be present per decedent. Denominator includes suicides with one or more precipitating circumstances. The sums of percentages in columns exceed 100% because more than one circumstance could be present per decedent.

c

Includes decedents with one or more diagnosed current mental health problems; therefore, sums of percentages for diagnosed conditions exceed 100%. Denominators for the diagnosed conditions include the number of decedents with one or more current diagnosed mental health problems.

d

Adjusted for age, race/ethnicity, education, marital status, and gender

e

Adjusted for age, race/ethnicity, education, and marital status

Discussion

The purpose of this study was to better understand the types of job problems that may impact suicide deaths since job problems have been found to be a suicide risk factor across different occupations (5–7; 14–16). While only 8% of suicide decedents had a job problem associated with the suicide, this study found specific characteristics of these deaths. Approximately two out of three job-related suicides were due to unemployment or job stress and appear to have different risk profiles. Suicide decedents with an unemployment-related job problem were more likely to be male, less educated, and employed in blue-collar jobs such as Food Preparation, Farming & Fishing, or Construction. Whereas suicide decedents with job stress were more likely to be female, have higher education, and work in white-collar jobs such as Education, Business, and Computer occupations. These results suggest that a one-size-fits-all workplace suicide prevention program may not be appropriate. In addition, a deeper understanding of industry and occupation-specific suicide risk factors may improve workplace programming and messaging.

Cross-sectional, longitudinal, and population-level studies have found unemployment to be associated with suicide - mortality, attempts, and ideation (17–18). People who are unemployed are almost two times more likely to die by suicide than those that are employed (17). There are different theories on the reasons for this association and the pathways through which unemployment could impact suicide. Losing one’s job can directly impact suicide risk by increasing financial hardship, as well as decreasing access to mental health care (19). Unemployment can also indirectly impact suicide risk through mental health. A recent narrative review found an association between unemployment and measures of mental health, with the most significant finding for depression (20). Research has also shown that increased depressive symptoms can predict future unemployment (21–22). Therefore, depression may mediate the relationship between unemployment and suicide. While the current study adds to the literature on unemployment as a risk factor for suicide, it cannot suggest reasons for the association nor support a direct versus indirect link.

Of suicide decedents with a job problem, 21% were due to job stress. Occupational stress is the “harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources and needs of the worker” (23). While many studies report an association between occupational stress and suicidal behaviors, the studies have methodological challenges (24). However, a large meta-analysis concluded that exposure to job stress is associated with an elevated risk of suicide ideation, attempts, and death (25). Some major causes of occupational stress are work‐related psychosocial hazards including work schedule, workload, job content and control, organizational role, and workplace bullying (26–27). The psychosocial hazards with the strongest association with suicide morbidity and mortality are workplace bullying, low decision latitude, high psychological demands, job strain, and low social support (28–30). In the current study, the authors used narrative text, and the content was often limited to the term ‘job stress’. Therefore, the authors are unable to describe the causes of the job stress. While the current evidence base suggests there is adequate information on job stress and suicidality to justify improving the psychosocial work environment, an improved understanding of differences by sex, occupation, and job roles could improve prevention efforts (31).

Suicide prevention interventions can be effective in preventing suicides and suicidal behavior and can take place in a variety of settings, including the workplace (32). Yet, a recent systematic review of workplace suicide prevention programs concluded there is not enough high-quality evaluations of these programs to conclude that the workplace is an effective location for interventions (33). Also, many workplace-based interventions do not directly address suicide risk factors and instead focus on training others to recognize signs of suicidality (34–35). This study’s findings demonstrate that workplace suicide prevention programs may have a stronger impact if focused on addressing job stressors such as psychosocial hazards or addressing complexities of unemployment that workers may not know about (e.g., policies and benefits).

Workplace-based approaches addressing psychosocial hazards can target the individual, the organization, or both (27). Individual-level interventions could include mindfulness, cognitive behavioral therapy, relaxation, stress management, and resilience training (36). Research has found mixed or modest positive effects of these types of interventions on many mental health outcomes in the general working population, such as depression and anxiety (36–37). Organizational‐level approaches directly address the hazard and include redesigning the job or work schedule (27). Organizational-level approaches are likely to be more efficient, have a broader impact, and be more sustainable than individual ones (27). Yet, current workplace mental health programs are disproportionately individual-level interventions, and more attention to reducing job stressors could improve these programs (37–38).

Strategies that reduce financial strain may also reduce suicide rates. Negative economic and employment circumstances can impact mental health and suicide risk. Unemployment and associated financial problems make meeting basic needs such as food and housing difficult, often leading to anxiety and depression which are independent suicide risk factors (39). Unemployment also makes it difficult to obtain mental health care for those without healthcare and experiencing mental health challenges (39). Publicly funded medical coverage, investment in the labor market during economic downturns, and programs to increase low-wage workers’ incomes are associated with lower suicide rates (40). A 2021 systematic review found a small but beneficial effect of unemployment and welfare support policies on suicide rates (40). These policies included unemployment benefits, disability support payments, active labor market programs, and employment protection legislation (40). These policies had a particular benefit for men (40). However, these were ecological studies and questions about causality remain (40).

Even with these limitations, the authors conclude that unemployment policies can be a viable option which governments can use to reduce suicide (40). Interventions that aim to improve the health of unemployed people may have a range of other positive benefits, including improved mental health and physical health, as well as increased chances for re-employment (41). These may include stress management, strengthening of social support, increasing physical exercise, and health-related counseling (41). There are various resources for suicide prevention. The CDC’s Suicide Prevention Resource for Action outlines prevention strategies using the best available evidence including strengthening economic supports and creating healthy organizational policies (42). Related to job stress, the U.S. Surgeon General’s Framework for Workplace Mental Health and Well-being provides a roadmap that workplaces can use to support mental health and well-being (43). The National Institute for Occupational Safety and Health’s Total Worker Health approach focuses on how workplaces can advance worker well-being by using various strategies starting at the organizational level (44).

Limitations

The findings of this study are subject to limitations. First, NVDRS data are not yet nationally representative. California, Florida, and Texas are not currently statewide but are ramping up to statewide coverage. Second, abstractors are limited to the information noted in source documents. It is possible that suicide decedents had a job problem, but it was not documented in the narrative. Information in source documents may be obtained by interviewing family, friends, and other informants. Some details may be unknown to informants and therefore, missing, limited, or incorrect. This includes industry and occupation of decedents who were between jobs, unemployed, or who held multiple jobs. Third, these data included the years of the COVID-19 pandemic and may not generalize to other years. Unemployment, decreased work hours, and reduced access to healthcare did not occur uniformly across industries and occupations. Another limitation is that intercoder reliability was not calculated for this study. Finally, some findings for occupation and industry were based on small numbers and should be interpreted with caution.

Conclusions

This study found the most common reasons for a job-related suicide death were unemployment and job stress. However, factors leading to suicide are numerous, complex, and include elements at the individual, environmental, social, and societal level. Occupational and work-related factors are just one piece of the puzzle. Future research could focus suicide prevention efforts on those recently unemployed as well as men and blue-collar workers. Future efforts could also focus on improving the psychosocial work environment for white-collar workers and informing potential refinements to the job problem variable in the NVDRS.

Supplementary Material

Supplementary Material

Footnotes

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Declaration Of Interest

Hope M. Tiesman has no conflict of interest or financial disclosures

Suzanne Marsh has no conflict of interest or financial disclosures

Bridget Lyons has no conflict of interest or financial disclosures

Janet Blair has no conflict of interest or financial disclosures

Author statement

Hope Tiesman: Supervision, Investigation, Conceptualization, Writing-Original Draft, Writing-Review & Editing. Suzanne Marsh: Formal Analysis, Writing-Original Draft, Writing-Review & Editing. Bridget Lyons: Writing-Original Draft, Writing-Review & Editing. Janet Blair: Investigation, Writing-Review & Editing.

1

§ See e.g., 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.

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Contributor Information

Hope M. Tiesman, U.S. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV.

Suzanne M. Marsh, U.S. Formerly with the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV.

Bridget H. Lyons, U.S. Formerly with the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, Georgia.

Janet M. Blair, U.S. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, Atlanta, Georgia.

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