Assessing the Economic and Quality of Life Impacts of Grief and Suicide in the United States

Abstract

This dissertation includes several studies regarding the impact of grief and suicide on economic and quality of life outcomes in the US. Measuring this impact allows for comparisons to other health conditions and provides a foundation for understanding the value of investing in grief support and suicide prevention interventions.

The first study examined the impacts of grief on medical expenditures. Individuals whose spouse died had expenditure increases of $498 in the year following the death (p=0.018), and children ages 1-24 whose parent died had an average decrease of $334 in expenditures (p=0.032). In identifying the sample, two-thirds of bereaved individuals were excluded from the analysis because of changes in health insurance the year before or the year after the death.

The remaining studies explored the prevalence and burden of suicide-related bereavement. A US nationally-representative survey was conducted with adolescents and adults who knew someone who died by suicide. Among adolescents ages 15-17, 44% knew someone who died by suicide and an additional 17% knew someone who attempted suicide. An estimated 7% of adolescents were currently experiencing emotional, mental, or physical health effects from a suicide death or attempt. In the adult US population, 58% of people knew someone who died by suicide and 7% were experiencing complicated grief.

Multiple measures of health-related quality of life were used in the survey. The preference weighted measure of health utility was measured using both a time trade-off (TTO) question and the EuroQol 5 dimensions (EQ-5D). Only those who were currently experiencing health effects from the suicide exposure were asked the TTO question and 94% either skipped the question or were unwilling to trade off time. Respondents’ current health, as reported in a visual analogue scale, was transformed to approximate their health utility as measured with the EQ-5D.

Retrospective approximations of health utility over time were combined to measure the quality adjusted life years (QALYs) lost from suicide-related bereavement. QALYs lost from suicide decedents were also estimated based on health utility estimates by age and sex among those with fair or good health, and average life-expectancy. Each suicide resulted in approximately 16.4 QALYs lost from the bereaved and 14.3 QALYs lost from the deceased, or a total of 30.6 per suicide. At a national level, the 44,965 suicides in 2016 resulted in approximately 1.4 million QALYs lost.

Absenteeism losses (not being at work) and presenteeism losses (being at work but not being as productive as normal) were quantified from the national survey on suicide bereavement. Estimates of net productivity losses among the suicide decedents were also generated. Together the productivity losses totaled $3.0 million per suicide death, or $134 billion from all the suicides in 2016.

These studies found substantial economic and quality-of-life losses from suicide deaths alone; thus grief in general poses very substantial losses each year. The majority of these losses appear to take place outside the health care sector. A public health approach is needed to support and help those bereaved from suicide and all causes of death.