Mental Health
Macroeconomic antecedents of involuntary psychiatric commitments in Denmark Parvati Singh* Parvati Singh Marquianna Griffin Camilla Hvidtfeldt Lars H. Andersen
Economic downturns may precede reduced social tolerance towards the mentally ill that, in turn, may manifest as increased reporting of disordered individuals for involuntary psychiatric commitments (reduced tolerance hypothesis). In some instances, societies may also act out against vulnerable minority groups during economic downturns by way of increased scapegoating of such groups for involuntary psychiatric commitments (frustration-aggression-displacement hypothesis). We examine the relation between quarterly aggregated counts of unemployed persons (exposure) and involuntary psychiatric commitments (outcomes) in the 1) overall population (test of reduced tolerance), and 2) among non-western immigrants (test of frustration-aggression-displacement hypothesis) in Denmark, over 84 quarters, from 2001 to 2018 (72 quarters). We use AutoRegressive Integrated Moving Average (ARIMA) time-series analysis to examine the relation between the exposure (0, 1 quarterly lags) and outcomes, controlling for seasonality, trends, autocorrelation, and population denominators. Results from time-series analyses indicate 48 additional involuntary psychiatric commitments in the overall population, one quarter after increase in 100,000 additional unemployed persons (p-value < 0.01). Sub-group analyses show increased involuntary commitments among Danes (coefficient = 0.25, p < 0.01) as well as among non-western immigrants (coefficient= 0.12, p <0.01), one quarter following increase in the unemployed population. We do not observe an increase in overall as well as sub-group-level voluntary psychiatric admissions in relation to the exposure. Our findings support both reduced tolerance as well as frustration-aggression hypotheses, and highlight the relation between ambient macroeconomic conditions and adverse psychiatric outcomes in large populations.