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Margaretha Voss, PhD, MPH, Lotta Nylén, MPH, Birgitta Floderus, PhD, Finn Diderichsen, MD, PhD and Paul D. Terry, PhD

Margaretha Voss is with the Department of Clinical Neuroscience and the Institute of Environmental Medicine, Karolinska Institutet, and the National Institute for Working Life, Stockholm, Sweden. Lotta Nylén is with the National Institute for Working Life, Stockholm, Sweden. Birgitta Floderus is with the Institute of Environmental Medicine and the Department of Public Health Sciences, Karolinska Institutet, and the National Institute for Working Life, Stockholm, Sweden. Finn Diderichsen is with the Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden, and the Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. Paul D. Terry is with the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Correspondence: Requests for reprints should be sent to Margaretha Voss, PhD, MPH, Department of Clinical Neuroscience, Section of Personal Injury Prevention, Karolinska Institutet, Box 12718, SE-112 94 Stockholm, Sweden (e-mail: margaretha.voss{at}cns.ki.se).

Objectives. We investigated the association between unemployment and early cause-specific mortality to determine whether the relationship was modified by other risk indicators.

Methods. Female and male twins (n=20632) were followed with regard to mortality from 1973 through 1996. Questionnaire data from 1973 were used to obtain information on experience of unemployment and on social, behavioral, health, and personality characteristics.

Results. Unemployment was associated with an increased risk of suicide and death from undetermined causes. Low education, personality characteristics, use of sleeping pills or tranquilizers, and serious or long-lasting illness tended to strengthen the association between unemployment and early mortality.

Conclusions. An increased risk of death from external causes implies a need for support for those experiencing unemployment, particularly susceptible individuals.

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