993707

article-commentary2021
SJP0010.1177/1403494821993707King and LaMontagneCOVID-19 and suicide risk in the construction sector

Scandinavian Journal of Public Health, 2021; 49: 774–778

Commentary

COVID-19 and suicide risk in the construction sector: preparing for a

perfect storm

Tania L. King1 & Anthony D. Lamontagne1,2

1Centre for Health Equity, University of Melbourne, Melbourne, Australia, and 2Institute for Health Transformation and
School of Health and Social Development, Deakin University, Burwood, Australia

Abstract
Aims: Worldwide, construction industries are considered to be key economic pillars of the societies they serve, and
construction workers constitute a sizeable proportion of the global paid workforce. In many parts of the world, construction
workers are at elevated risk of suicide. Here, we examine the extent to which construction workers may be differentially
exposed to the economic effects of COVID-19. Methods: A narrative review and synthesis of the literature was conducted.
Results: The economic and labour market shock resulting from the COVID-19 pandemic has led to a convergence of factors
that may significantly exacerbate suicide risk among construction workers, particularly among those with lower skills.
Conclusions: With important insights from previous financial crises, it is vital that governments, industry and
workplaces act rapidly to mitigate suicide risk among vulnerable groups such as construction workers. Mental
healthcare investment is needed, and must be complemented by prevention and control in the workplace and
in the general community. Anticipating, preparing and acting to ameliorate this risk, particularly among low
skilled construction workers, will save many livelihoods, as well as lives.

Keywords: Occupational health, suicide, mental health, workplace, COVID-19

Introduction Compositional drivers of suicide in the

Globally, the construction sector employs an esti-
mated 7% of the world’s paid workforce [1], and
accounts for about 13% of global gross domestic
product (GDP) [2]. Excess mortality from suicide
among construction workers has been consistently
observed in countries such as the United Kingdom
[3], the USA [4], Denmark [5], Italy [6], Australia
[7] and Canada [8]. In England for example, the risk
of suicide among low-skilled male construction
workers is over three times higher than the male
national average [9]. Here we argue that a unique
combination of factors may place construction work-
ers at heightened risk of suicide during and after the
COVID-19 pandemic.
construction workforce
There are some well documented compositional fac-
tors that are theorised to contribute to the elevated
suicide rates among construction workers in many
industrialised countries. Gender is one of these: con-
struction workers are predominantly men, and men’s
greater risk of suicide relative to women is well docu-
mented [10]. Globally, the male-to-female suicide
rate ratio is about 1.9; however, in high-income
countries, the age-standardised suicide rate for men
is more than 3 times higher than that of women [10].
Men are also less likely than women to seek help
when distressed [11]. In addition, the construction
workforce is commonly younger than the general

Correspondence: Tania L. King, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207
Bouverie Street, Melbourne, VIC 3010, Australia. E-mail: tking@unimelb.edu.au

Date received 6 October 2020; reviewed 20 December 2020; accepted 13 January 2021

© Author(s) 2021
Article reuse guidelines: sagepub.com/journals-permissions
DOI: 10.1177/1403494821993707
https://doi.org/10.1177/1403494821993707
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 COVID-19 and suicide risk in the construction sector   775
working population, and suicide rates are typically
higher in younger men relative to older groups [12].
Furthermore, low socioeconomic position is also a
risk factor for suicide, particularly among young men
[13]. While these compositional characteristics of the
construction workforce are likely to contribute to the
elevated suicide rates among construction workers, it
is recognised that other factors play an important
role, and increasing attention is being paid to work-
place characteristics of the construction sector
(referred to below as contextual drivers).
Contextual drivers of suicide in the
construction workforce
Informal and undeclared work arrangements are com-
mon within the global construction workforce, which
means there are significant gaps in social security pro-
tections for workers [14]. Construction jobs are often
insecure, with a high prevalence of temporary and
casual arrangements, and there is high mobility within
the workforce [14, 15]. Construction workers also
have limited job control, as well as regular periods of
unemployment or underemployment [16]. There is a
large body of work demonstrating that many of these
characteristics including job stressor exposures [17,
18], underemployment [19] and loss of employment
(unemployment) [20] are strong predictors of poor
mental health as well as suicidal thoughts, behaviours
and mortality. Construction workplaces are also highly
masculine environments in which dominant mascu-
line norms prevail [21]; many masculine norms are
known risk factors for suicidal behaviours [22]. The
net effect of these factors is a psychosocial and norma-
tive environment that appears to exacerbate suicide
risk among construction workers in some countries
and contexts.
Economic crises and suicide: why
COVID-19 may represent the (im)
perfect storm of risk factors for
construction workers
The constellation of differential exposures and dif-
ferential vulnerabilities characteristic of the construc-
tion sector represents a recognised high-risk public
health situation in many countries preceding the
COVID-19 pandemic. The economic and labour
market shock resulting from the COVID-19 pan-
demic has the potential to exacerbate suicide risk
profoundly in this substantial proportion of the work-
ing population. We focus here on suicide because of
its severity as an outcome, acknowledging that there
are also various other impacts of economic shocks on
physical and mental health. We also acknowledge that
there is likely to be substantial global variation, with
construction sectors in some countries more affected
than others.
Forecasts emerging from the World Bank suggest
that the COVID-19-induced global recession will be
the most severe since the Second World War, and will
precipitate economic declines in per capita outputs in
the largest share of economies since 1870 [23].
Globally, the economic contraction associated with
COVID-19 is already leading to substantial job losses
across many sectors. In September of 2020, the
International Labour Organization estimated that
work-hour losses recorded in the second quarter of
2020 (compared to the final quarter of 2019) were
17.3%, equivalent to 495 million full time jobs, a pat-
tern that appeared to be sustained over the third quar-
ter, with projections that fourth quarter statistics will
be more dire than previously predicted [24]. The sum-
mative picture emerging from these statistics is of a
bleak economic forecast that is unlikely to ease quickly.
The association between recession or economic con-
traction and suicide is well recognised [25]. The global
financial crisis (GFC) of 2007–2009 was associated
with an excess in suicides across the world [25–27]. A
study of global public data from 63 countries found
that the relative risk of suicide related to unemployment
attributable to the GFC was 20–30% [26]. Similar esti-
mates were reported elsewhere such as in Australia,
with an estimated 19–22% increase in the suicide rate
among the unemployed in association with a rise from
approximately 4% to 6% unemployment [27], and a
7% increase in suicide among employed men [27].
Alarmingly, the course of COVID-19 and its economic,
social and health consequences are as yet indeterminate
and it is likely that the mental health costs of COVID-
19 will not be fully realised and reckoned for many
years. Recognising the different vulnerabilities of differ-
ent groups within society is essential to informing coor-
dinated and proactive intervention efforts.
Construction worker vulnerability to unemploy-
ment and financial hardship due to the COVID-19-
induced economic contraction highlights their current
precariousness. This, combined with vulnerabilities
unique to the industry and its workforce composition,
represents an unfortunate confluence of factors that
places them at particularly heightened risk of suicide
during and after the COVID-19 pandemic.
Preparing for, and responding to, this
potential crisis
Considerable insights have been gleaned from exten-
sive studies of economic shocks and their associated
impacts on public health, and should inform responses.
In high-income countries, many people who die by
776    King and LaMontagne
suicide are experiencing mood disorders or substance
use problems at the time of death [28]. Investment in
mental health services is therefore crucial. Mental health
services commonly fail to engage men – both in terms of
initiating contact, and in retaining engagement when
contact is made – and it is therefore vital that investment
is made in mental healthcare approaches that are tai-
lored to men’s needs in general, but particularly to blue-
collar men’s needs in the construction and related
sectors. The growing availability of online or telehealth
services may offer an opportunity to engage in ways that
minimise stigma and other barriers.
Mental healthcare-directed interventions must also
be complemented by prevention and control in the
workplace and in the general community. Industry-
based suicide prevention programmes can play a criti-
cal role. Some are consistent with best practice suicide
prevention and Mrazek and Haggerty’s spectrum of
interventions for reducing the risk of mental disorders
[29]. MATES in Construction in Australia, for exam-
ple, has been shown to have social validity among con-
struction workers [30], effectiveness in shifting beliefs
around suicide [31], and effectiveness in improving
suicide prevention literacy, intentions to offer help to
workmates and intentions to seek help for themselves
[32]. Employers, in addition to being key partners in
industry-based programmes, are obliged to ensure
psychologically as well as physically safe working con-
ditions in most industrialised democracies. Many
employers and unions also provide support services
for workers in distress – such as employee assistance
programmes (EAPs). For precariously employed con-
struction workers, union membership can offer access
to EAPs, redundancy funds and other services. All
construction sector stakeholders have important con-
tributions to make in mitigating the economic impacts
of the pandemic; the scaling up of existing programmes
would be most expeditious. Finally, governments at all
levels have critical roles to play through unemploy-
ment and retraining programmes, and stimulation of
the economy through investment and/or incentivising
sustainable jobs and sustainable businesses [33].
Other government efforts – such as measures to
strengthen housing stability – will complement labour
market strategies.
Inequities within construction workers
and the need for an intersectional eye
It is also important that approaches attend to intersec-
tionality and seek to understand the ways that the
experiences of construction workers may vary by dif-
ferent identities and axes of disadvantage. Fundamental
to this is the need to recognise that some groups are at
greater risk of suicide than others. We know that lower
skilled construction workers such as labourers are at
greatest risk of suicide, and that during the GFC, sui-
cide rates among this group increased to a greater
extent than for higher skilled workers in the sector
[34].This may be explained by the fact that as unskilled
workers, they are exposed to poorer working condi-
tions and lower pay, and they are typically younger
than other workers [34]. Unskilled workers are also
known to be more vulnerable to job loss, and are more
socially disadvantaged. In effect then, they will be at
particularly heightened risk as a result of COVID-19
because they have limited social resources to buffer
the effects of exposure to poor working conditions,
unemployment, or both. Further to this, worldwide,
the construction industry relies heavily on migrant
labour [35]. Migrant construction workers are often
employed informally, heightening their vulnerability
to unsafe, unfair and sometimes illegal work arrange-
ments and practices [35]. In many countries, migrant
workers also experience significant levels of discrimi-
nation and stigmatisation, intensifying their experi-
ences of marginalisation [36]. Migrant workers are
more likely than other workers to lose their jobs dur-
ing times of economic contraction, and limited access
to social protection (many are excluded from health
and income security measures) threatens the health
and wellbeing of many of these migrant workers and
their families [36]. Access to social protection and
assistance may be further obstructed by experiences of
discrimination and stigmatisation.
The convergence of these differential vulnerabilities
and exposures within construction workers are of
major public health significance, particularly because
they align with fundamental inequities within society
that place more socially disadvantaged groups at
greater risk of suicide as well as poorer health out-
comes more generally [37]. Ensuring all workers have
access to social protection such as sickness benefits,
income support during periods of unemployment and
affordable healthcare is vital, and has been identified
as fundamental to fighting COVID-19 according to
international labour standards [38]. This also aligns
with broader calls for mental health strategies to be
less focussed on treatment interventions, and more
focussed on the social determinants of health [39] –
approaches that are relevant and applicable across sec-
tors, and will also set the foundations for a more
equitable world beyond COVID-19.
Conclusion
Worldwide, construction industries are considered to
be key economic pillars of the societies they operate
in, and construction workers constitute a sizeable
proportion of the paid workforce. There are many
 COVID-19 and suicide risk in the construction sector   777
different needs and imperatives that governments
around the world are grappling with as they rapidly
try to respond to the challenges that the COVID-19
pandemic has presented. Rightly, the initial focus has
been on addressing the most pressing and salient
health effects of COVID-19 infection and transmis-
sion. But the public health risks clearly extend beyond
that of the immediate effects of the virus, and the
economic impacts of COVID-19 represent a particu-
lar risk to construction workers around the world.
Anticipating and preparing to mitigate this risk, par-
ticularly among low skilled construction workers, will
save many livelihoods, as well as lives.
Acknowledgements
The author(s) dedicate this article to the memory of
their treasured colleague, Allison Milner. Her work
– represented extensively in the evidence docu-
mented here – laid much of the foundation for the
arguments presented and continues to influence and
inspire.
Declaration of conflicting interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship, and/
or publication of this article.
Funding
The author(s) disclosed receipt of the following finan-
cial support for the research, authorship, and/or publi-
cation of this article: This project was supported by an
(Australian) National Health and Medical Research
Council (NHMRC) partnership project Grant
(APP1134499) and a NHMRC ‘Million Minds’ Grant
(APP1199972). TK is supported by an Australian
Research Council Discovery Early Career Researcher
Award (DE200100607).
ORCID iD
Tania L. King https://orcid.org/0000-0002-1201-
2485
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