Macroeconomic antecedents of involuntary psychiatric commitments in Denmark

Abstract Introduction: 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). Methods: We examined the relation between quarterly aggregated counts of unemployed persons (exposure) and involuntary psychiatric commitments (outcomes) in the (1) overall population (test of reduced tolerance), (2) among Danes (excluding non-western immigrants), and (3) among non-western immigrants (test of frustration-aggression-displacement hypothesis) in Denmark, over 72 quarters, from 2001 to 2018, using Danish register data. We specified our exposure as the quarterly counts of unemployed persons in Denmark (0, 1 quarterly lags). We used AutoRegressive Integrated Moving Average (ARIMA) time-series analyses to control for autocorrelation and quarterly volume of voluntary (i.e. non-coercive) psychiatric inpatient admissions. Results: Results from ARIMA time-series analyses indicate 31 additional involuntary psychiatric commitments in the overall Danish population, one quarter after increase in 100,000 additional unemployed persons (p-value < 0.05). We also observe 14 additional involuntary commitments among non-western immigrants at exposure lag 1 (p-value < 0.05). We fail to reject the null for involuntary commitments among Danes (excluding non-western immigrants). Our discovered coefficients correspond with a 6.8% increase in involuntary commitments in the overall population and a 26.9% increase among non-western immigrants one quarter following a 3 standard deviation increase in unemployed persons in Denmark. Conclusions: Our findings support the reduced tolerance and frustration-aggression-displacement hypotheses in the Danish context. The pattern of results highlight the potential consequences of large macroeconomic contractions with respect to involuntary psychiatric commitments and also that minority groups may experience increased vulnerability during periods of heightened ambient stress.