6. Concluding
comments IMF-lending programs have been heavily criticized over the years, both for failing to improve macroeconomic outcomes and for producing negative side-effects that worsen people's lives in participating countries. With respect to suicides, the sociology literature has long recognized that adverse economic conditions, particularly if accompanied by disturbances of social order, can affect a population's suicidality (Stack, 2000; Marmot and Wilkinson, 2006; Van Orden et al., 2010). Suicide rates can then be connected to participation of countries in IMF programs through the Fund's conditionality, to the extent that IMF agreements often require fast reforms, which, at least in the short run, are likely to result in abrupt changes in existing socio-economic structures and in wider socio-economic inequalities. In addition to their impact through fast structural reforms, IMF programs can also result in a higher rate of suicide-mortality indirectly, through weakened social-safety nets, to the extent that the constraints usually imposed on participating countries' fiscal policy often reduce the ability of governments to fund services that can mitigate some of the adverse social consequences of economic change. Indeed, recent evidence by Antonakakis and Collins (2015) based on Eurozone periphery dataset indicates a robust causal relationship between public-expenditure reductions and suicide deaths. Using data on 30 transition & developing countries that received non-concessionary IMF loans during 1991e2008, our results confirm the hypothesis of an underlying positive association between suicide-mortality rates and countries' IMF-program participation. The effect is more pronounced among males. Comparing age groups, our results suggest that the suicide-increasing effect of program-participation is larger among middle-age groups. At the same time, the size of IMF loans is found to have only a weak 52 E. Goulas, A. Zervoyianni / Social Science & Medicine 153 (2016) 44e53 suicide-reducing effect, suggesting that this effect cannot offset the conditionality aspect of programs that tends to raise the probability of suicidal behaviour among participating countries' populations. Overall, our results enhance the arguments, already appearing extensively in the literature on other aspects of social consequences of Fund programs, that social-safety nets need to be designed in participating countries to protect the unprivileged part of the population when countries are exposed to programs in an attempt to resolve their economic problems.
