L’inquiétude financière qui s’est installée dans plusieurs pays du monde depuis quelques mois nous a poussé à porter une attention particulière à la littérature récemment publiée sur les facteurs économiques. La question est abordée aussi bien d’une perspective de l’individu autant que d’un point de vue macro. Dans cet envoi, vous trouverez donc quelques articles ayant traité le problème sur une base historique ou bien, comme celui de Stephanie Burrows et Danielle St-Laurent, membres-chercheurs du CRISE, qui ont étudié le niveau de défavorisation chez des Canadiens décédés par suicide. Pauvreté, insécurité financière, faible revenu, chômage, crise économique et ses impacts, sont des problématiques souvent étudiées par les suicidologues. Cependant, la relation entre ces variables et le suicide n’est pas toujours celle attendue, dépendamment de la population étudiée et du type de recherche effectué.
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Burrows, S., Auger, N., Gamache, P., St-Laurent, D., & Hamel, D. (2011). Influence of social and material individual and area deprivation on suicide mortality among 2.7 million Canadians: A prospective study. BMC Public Health, 11(1), 577.
Résumé: BACKGROUND: Few studies have investigated how area-level deprivation influences the relationship between individual disadvantage and suicide mortality. The aim of this study was to examine individual measures of material and social disadvantage in relation to suicide mortality in Canada and to determine whether these relationships were modified by area deprivation. METHODS: Using the 1991-2001 Canadian Census Mortality Follow-up Study cohort (N=2,685,400), measures of individual social (civil status, family structure, living alone) and material (education, income, employment) disadvantage were entered into Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for male and female suicide mortality. Two indices of area deprivation were computed - one capturing social, and the other material, dimensions - and models were run separately for high versus low deprivation. RESULTS: After accounting for individual and area characteristics, individual social and material disadvantage were associated with higher suicide mortality, especially for individuals not employed, not married, with low education and low income. Associations between social and material area deprivation and suicide mortality largely disappeared upon adjustment for individual-level disadvantage. In stratified analyses, suicide risk was greater for low income females in socially deprived areas and males living alone in materially deprived areas, and there was no evidence of other modifying effects of area deprivation. CONCLUSIONS: Individual disadvantage was associated with suicide mortality, particularly for males. With some exceptions, there was little evidence that area deprivation modified the influence of individual disadvantage on suicide risk. Prevention strategies should primarily focus on individuals who are unemployed or out of the labour force, and have low education or income. Individuals with low income or who are living alone in deprived areas should also be targeted.
Milner, A., McClure, R., Sun, J., & De Leo, D. (2011). Globalisation and suicide: An empirical investigation in 35 countries over the period 1980-2006. Health & Place, 17(4), 996-1003.
Résumé: BACKGROUND: Globalisation is mediated through a variety of flows including persons, information and ideas, capital, and goods. The process is increasingly recognised as a potential mediator of changes in attitudes and habits around the globe. AIM: This research investigated the relationship between globalisation and suicide rates in 35 countries over the period 1980-2006. METHODS: The association between a globalisation "index" and suicide rates was tested using a fixed-effects regression model. The model also tested the influence of eleven other socio-economic variables on male and female suicide rates. RESULTS: Overall, high levels of the globalisation index were associated with higher male and female suicide rates; however, the significance of this association dropped when assessed alongside other social and economic variables. CONCLUSIONS: While the nature of these findings should be regarded as exploratory, this paper highlights the need for researchers to consider the influence of world-changing phenomena like globalisation on suicide, which might deeply upset the traditional structure of societies with mixed types of impact.
Milner, A., McClure, R., & De Leo, D. (2010). Socio-economic determinants of suicide: an ecological analysis of 35 countries. Social Psychiatry and Psychiatric Epidemiology, [Epub].
Résumé: PURPOSE: A long tradition of research has shown a relationship between suicide rates and socio-economic factors. However, most investigations have neglected to account for country-specific influences. The purpose of this study was to clarify the association between socio-economic variables and gender-specific suicide rates in 35 countries, using analytic techniques able to control for effects embedded within different country contexts. METHOD: Data relating to male and female age-standardised suicide rates (obtained from the WHO Statistical Information System) were analysed using fixed-effect regression. The possible associations between suicide rates and social variables were tested using data for 35 countries over the period 1980-2006. RESULTS: Findings indicated that higher male and female suicide rates were associated with increased female labour force participation, unemployment, and the proportion of persons over 65 years. Reductions in male and female suicide rates were associated with increased health spending per capita. The study also revealed that higher fertility was associated with a reduction in male suicide. Female labour force participation had a stronger effect on male suicide rates. CONCLUSIONS: The results of this study suggest that variables related to the labour market and the economy were better explanatory factors of suicide rates than population-level indicators of interpersonal relationships. Although results were generally similar for males and females, males appeared to be more sensitive to changes in the social environment than women.
Gaygisiz, E. (2010). National income, life satisfaction, and male-female suicide ratio in industrialised countries. Perceptual and Motor Skills, 111(2), 433-436.
Résumé: The relationships between gross domestic product (GDP) per capita, life satisfaction, and male-female suicide ratio were analyzed for 25 industrialized countries. GDP per capita was the strongest correlate of male-female suicide ratio even when life satisfaction was controlled using partial correlations. Life satisfaction correlated significantly with GDP per capita but not with suicide rates.
Muazzam, S., & Nasrullah, M. (2011). Macro determinants of cause-specific injury mortality in the OECD countries: An exploration of the importance of GDP and unemployment. Journal of Community Health, 36(4), 574-582.
Résumé: Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4 year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP. Similar trend was found in females, except suicidal injury mortalities that also increased with increasing GDP. When we modeled cause-specific injury mortality rates with unemployment, injuries due to firearm missiles, homicide, and other violence increased with increase in unemployment rate among males. However, among females only accidental falls were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed.
Yur'yev, A., Varnik, A., Varnik, P., Sisask, M., & Leppik, L. (2010). Employment status influences suicide mortality in Europe. International Journal of Social Psychiatry, [Epub].
Résumé: BACKGROUND: The present study attempted to assess the relationship between suicide mortality and employment status in Europe. METHODS: Suicide trends were obtained from the World Health Organization, employment rates from the Conference Board Total Economy Database, and questions about citizens'attitudes towards employment from the European Social Survey. Correlations were analysed. Differences between mean scores for attitudes in Western and Eastern Europe were calculated. RESULTS: Employment and suicide trends are negatively correlated in most countries. Suicide mortality is associated with unemployment risk and expectations of inadequate financial resources during unemployment, and negatively correlated with an assured high standard of living for the unemployed. Suicide mortality and the degree of conviction that the government should ensure jobs for all are weakly correlated. Attitudes towards employment and unemployment in Eastern and Western Europe diverge. CONCLUSIONS: Changes in employment rates influence suicide mortality in many European countries. Factors that increase suicide mortality include lack of confidence in employment status and unemployed people's expectations of insufficient income and low living standards. Suicidal behaviour is more strongly related to attitudes linked with employment status among males than females. In Eastern Europe the status of being unemployed is feared more, and people rely more on the government.
Stuckler, D., Meissner, C., Fishback, P., Basu, S., & McKee, M. (2011). Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929-1937. Journal of Epidemiology and Community Health, [Epub].
Résumé: Background Previous research suggests that the Great Depression led to improvements in public health. However, these studies rely on highly aggregated national data (using fewer than 25 data points) and potentially biased measures of the Great Depression. The authors assess the effects of the Great Depression using city-level estimates of US mortality and an underlying measure of economic crisis, bank suspensions, at the state level. Methods Cause-specific mortalities covering 114 US cities in 36 states between 1929 and 1937 were regressed against bank suspensions and income data from the Federal Deposit Insurance Corporation Database, using dynamic fixed-effects models and adjustments for potential confounding variables. Results Reductions in all-cause mortalities were mainly attributable to declines in death rates owing to pneumonia (26.4% of total), flu (13.1% of total) and respiratory tuberculosis (11.2% of total), while death rates increased from heart disease (19.4% of total), cancer (8.1% of total) and diabetes (2.9%). Only heart disease can plausibly relate to the contemporaneous economic shocks. The authors found that a higher rate of bank suspensions was significantly associated with higher suicide rates but lower death rates from motor-vehicle accidents ; no significant effects were observed for 30 other causes of death or with a time lag. Conclusion In contrast with existing research, the authors find that many of the changes in deaths from different causes during the Great Depression were unrelated to economic shocks. Further research is needed to understand the causes of the marked variations in mortality change across cities and states, including the effects of the New Deal and Prohibition.
Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., & McKee, M. (2011). Effects of the 2008 recession on health: a first look at European data. Lancet, 378(9786), 124-125.
Résumé: 2 years ago, we published a paper in The Lancet reviewing the mortality experience of 26 European countries during economic crises over three decades. We showed how increases in unemployment had been associated with increased suicides among people younger than 65 years and with fewer road-traffic fatalities (reflecting lower car use). On the basis of our analyses, we predicted that the economic crisis that began in summer, 2008, would have similar consequences. To what extent have our predictions been fulfilled? We can now offer a preliminary assessment based on data on mortality in several European countries for 2009.
Luo, F., Florence, C., Quispe-Agnoli, M., Ouyang, L., & Crosby, A. (2011). Impact of business cycles on US suicide rates, 1928-2007. American Journal of Public Health, 101(6), 1139-1146.
Résumé: Objectives. We examined the associations of overall and age-specific suicide rates with business cycles from 1928 to 2007 in the United States. Methods. We conducted a graphical analysis of changes in suicide rates during business cycles, used nonparametric analyses to test associations between business cycles and suicide rates, and calculated correlations between the national unemployment rate and suicide rates. Results. Graphical analyses showed that the overall suicide rate generally rose during recessions and fell during expansions. Age-specific suicide rates responded differently to recessions and expansions. Nonparametric tests indicated that the overall suicide rate and the suicide rates of the groups aged 25 to 34 years, 35 to 44 years, 45 to 54 years, and 55 to 64 years rose during contractions and fell during expansions. Suicide rates of the groups aged 15 to 24 years, 65 to 74 years, and 75 years and older did not exhibit this behavior. Correlation results were concordant with all nonparametric results except for the group aged 65 to 74 years. Conclusions. Business cycles may affect suicide rates, although different age groups responded differently. Our findings suggest that public health responses are a necessary component of suicide prevention during recessions.
Li, Z., Page, A., Martin, G., & Taylor, R. (2010). Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: A systematic review. Social Science and Medicine, [Epub].
Résumé: The overall importance of a risk factor for suicide in a population is determined not only by the relative risk (RR) of suicide but also the prevalence of the risk factor in the population, which can be combined with the RR to calculate the population attributable risk (PAR). This study compares risk factors from two well studied domains of suicide research - socio-economic deprivation (relatively low RR, but high population prevalence) and mental disorders (relatively high RR risk, but low population prevalence). RR and PAR associated with suicide was estimated for high prevalence ICD-10/DSM-IV psychiatric disorders and measures of socio-economic status (SES) from individual-level, population-based studies. A systematic review and meta-analysis was conducted of population-based case-control and cohort studies of suicide where relative risk estimates for males and females could be extracted. RR for any mental disorder was 7.5 for males and 11.7 for females, compared to RR for the lowest SES groups of 2.1 for males and 1.5 for females. PAR in males for low educational achievement (41%, range 19-47%) and low occupational status (33%, range 21-42%) was of a similar magnitude to affective disorders (26%, range 7-45%) and substance use disorders (9%, range 5-24%). Similarly in females the PAR for low educational achievement (20%, range 19-22%) was of a similar magnitude to affective disorders (32%, range 19-67%), substance use disorder (25%, range 5-32%) and anxiety disorder (12%, range 6-22%). The findings of the present study suggest that prevention strategies which focus on lower socio-economic strata (more distal risk factors) have the potential to have similar population-level effects as strategies which target more proximal psychiatric risk factors in the prevention and control of suicide.
Classen, T. J., & Dunn, R. A. (2011). The effect of job loss and unemployment duration on suicide risk in the United States: a new look using mass-layoffs and unemployment duration. Health Economics, [Epub].
Résumé: We examine the link between employment status and suicide risk using a panel of US states from 1996 to 2005 with monthly data on suicides, the duration of unemployment spells and the number of job losses associated with mass-layoff events. The use of aggregate data at the monthly level along with the distribution of unemployment duration allows us to separate the effect of job loss from the effect of unemployment duration, an important distinction for policy purposes, especially for the timing of potential interventions. Our results are consistent with unemployment duration being the dominant force in the relationship between job loss and suicide. Nevertheless, mass-layoffs may be powerful localized events where suicide risk increases shortly afterward. Implications for the design of unemployment insurance are discussed.
Cohen, A., Chapman, B. P., Gilman, S. E., Delmerico, A. M., Wieczorek, W., Duberstein, P. R., et al. (2010). Social inequalities in the occurrence of suicidal ideation among older primary care patients. American Journal of Geriatric Psychiatry, 18(12), 1146-1154.
Résumé: OBJECTIVES: To examine whether there is an association between area socioeconomic status and the experience of suicidal ideation among older adults. DESIGN: Secondary analyses of data from a prospective study of naturalistic outcomes of depressive symptoms. SETTING: Monroe County, NY. PARTICIPANTS: A cohort of older adults (>/=65 years, N = 515) attending primary care settings. MEASUREMENTS: Area socioeconomic status was based on the median household incomes of the census tracts (CTs) in which participants lived. At 6- and 12-month follow-up, the longitudinal interval follow-up evaluation was used to assess weekly depressive symptom status over the previous 6 months, which was used to construct a measure of any suicidal ideation during the study. RESULTS: Residents of CTs with median household incomes of less than $30,000/yr were more likely to experience suicidal ideation than residents of higher income CTs . Adjustment for demographic and baseline clinical factors did not eliminate the association. Subsequent models that adjusted for medical, functional, and psychosocial variables did not explain this association either. CONCLUSIONS: There is a robust association between lower CT income and the occurrence of suicidal ideation in a primary care cohort of older adults over 1 year. These findings indicate the need for more research into how social worlds come to influence the emotional well being of older adults and whether social factors such as CT income can be used to identify individuals at increased risk for suicidal behavior.
Chabaud, F., Debarre, J., Serazin, C., Bouet, R., Vaiva, G., & Roelandt, J. L. (2010). Étude des profils de population selon le niveau de risque suicidaire en France : Enquête « santé mentale en population générale ». L'Encéphale, 36(3 Suppl), 33-38.
Résumé: L’étude utilise les données de l’enquête Santé Mentale en Population Générale(SMPG) OMS-DREESEPSM en France Métropolitaine. Les dimensions psychopathologiques ont été déterminées à l’aide du questionnaire Mini International Neuropsychiatric Interview (MINI). Ce questionnaire comporte un outil d’évaluation du risque suicidaire gradué en quatre niveaux : nul, léger, moyen ou élevé. La méthode statistique utilisée est une analyse factorielle des correspondances multiples qui permet de synthétiser l’information contenue dans un grand nombre de variables et d’individus, à travers la projection mathématique de ces caractéristiques sur un graphique. Cette étude permet d’identifier des groupes d’individus ayant un niveau de risque suicidaire proche en leur associant les caractéristiques sociales, économiques et psychopathologiques. Elle illustre le rôle essentiel des caractéristiques économiques et sociales des individus dans l’existence d’un risque suicidaire et celui des psychopathologies dans la détermination du niveau de ce risque. Ces résultats apportant une typologie des déterminants du risque suicidaire en population générale, posent l’idée d’une stratégie des programmes d’intervention intégrant mieux les aspects socio-économiques, ce qui trancherait avec les stratégies traditionnelles plus médicales.
Maki, N., & Martikainen, P. (2010). A register-based study on excess suicide mortality among unemployed men and women during different levels of unemployment in Finland. Journal of Epidemiology and Community Health, [Epub].
Résumé: Background: Suicide mortality is high among the unemployed, but the role of causation and selection models in producing employment status differences remains to be understood. This study analyses the association between unemployment and suicide during different levels of national unemployment adjusting for several factors that might explain or mediate the relationship. Methods: The data comprised annual population-register and death-register information on 25-64-year-old Finns at the beginning of each year in the period 1988-2003; thus, forming 16 separate follow-up cohorts. Experience of unemployment was measured at baseline and during the previous year for each cohort. Suicide was followed for 12-14 months after each baseline giving a total of 7388 suicides. Results: Overall, age-adjusted suicide mortality was two to three times higher among the unstably employed and almost fourfold among the long-term unemployed. Adjustment for social class and living arrangements had small effect on the HRs, but adjustment for household income per consumption unit decreased the differences by 13% and 31% among the long-term unemployed women and men, respectively. When the national unemployment level was high, excess suicide mortality among the unstably employed was lower than during low unemployment when those becoming unemployed might be more selected. No such differences were found among the long-term unemployed. Conclusion: Long-term unemployment seems to have causal effects on suicide, which may be partly mediated by low income. As the effect of unstable employment is lower during the recessionary stage of the economic cycle some part of the excess suicide among the unstably employed is likely to be attributable to selection into unemployment.
Talala, K. M., Huurre, T. M., Laatikainen, T. K., Martelin, T. P., Ostamo, A. I., & Prattala, R. S. (2011). The contribution of psychological distress to socio-economic differences in cause-specific mortality: a population-based follow-up of 28 years. BMC Public Health, 11, 138.
Résumé: BACKGROUND: Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. The aim of this study is to explore whether different indicators of psychological distress contribute to socio-economic differences in cause-specific mortality. METHODS: The data source is a nationally representative, repeated cross-sectional survey, "Health Behaviour and Health among the Finnish Adult Population" (AVTK). The survey results were linked with socio-economic register data from Statistics Finland (from the years 1979-2002) and mortality follow-up data up to 2006 from the Finnish National Cause of Death Register. The data included 32451 men and 35420 women (response rate 73.5%). Self-reported measures of depression, insomnia and stress were used as indicators of psychological distress. Socio-economic factors included education, employment status and household income. Mortality data consisted of unnatural causes of death (suicide, accidents and violence, and alcohol-related mortality) and coronary heart disease (CHD) mortality. Adjusted hazard ratios were calculated using the Cox regression model. RESULTS: In unnatural mortality, psychological distress accounted for some of the employment status (11-31%) and income level (4-16%) differences among both men and women, and for the differences related to the educational level (5-12%) among men; the educational level was associated statistically significantly with unnatural mortality only among men. Psychological distress had minor or no contribution to socio-economic differences in CHD mortality. CONCLUSIONS: Psychological distress partly accounted for socio-economic disparities in unnatural mortality. Further studies are needed to explore the role and mechanisms of psychological distress associated with socio-economic differences in cause-specific mortality.
Yip, P. S., & Caine, E. D. (2010). Employment status and suicide: the complex relationships between changing unemployment rates and death rates. Journal of Epidemiology and Community Health, [Epub].
Résumé: Background: Existing studies have described a strong correlation between unemployment rates and suicide rates, but the exact mechanisms through which they may interact with one another remain unknown. Method: This study examined the complex relationships between suicide rates and both regional unemployment rates and individual employment status during times of economic recession (2000-3) and recovery (2003-6) in Hong Kong. Results: Despite the strong correlation (0.86) between the unemployment rates and suicide rates for 2000-6, the rates of suicides within the employed and unemployed groups moved in the opposite direction from the overall population trend. That is, the suicide rate among the unemployed decreased during economic recession and increased during recovery. Conclusion: It is important to be able to distinguish precisely between population-level concepts, such as rates, and individual-level characteristics, such as employment status, when considering the development of evidence-based suicide prevention strategies.
Hong, J., Knapp, M., & McGuire, A. (2011). Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis. World Psychiatry, 10(1), 40-44.
Résumé: The issue of health inequalities has steadily gained attention in South Korea, as income inequality widened and social polarization increased following the country's economic crisis in the late 1990s. While official figures indicate a general trend of worsening mental health, with rapidly rising rates of suicide and depression in particular, the extent of socio-economic inequality with respect to mental health problems has not been well elucidated. This study aimed to measure income-related inequalities in depression, suicidal ideation and suicide attempts in South Korea and to trace their changes over a 10-year period (1998-2007). The concentration index approach was employed to quantify the degree of income-related inequalities, using four waves of the Korea National Health and Nutrition Examination Survey data. The study found persistent pro-rich inequality in depression, suicidal ideation and suicide attempts over the past decade (i.e., individuals with higher incomes were less likely to have these conditions). The inequalities actually doubled over this period. These findings imply a need for expanded social protection policies for the less privileged in the population.
Kuroki, M. (2010). Suicide and unemployment in Japan: Evidence from municipal level suicide rates and age-specific suicide rates. Journal of Socio-Economics, 39(6), 683-691.
Résumé: Most previous studies on the relationship between unemployment and suicide use either individual level data or large unit aggregate level data. The former typically fail to distinguish the observed association from the causal link, and the latter often produce inconsistent findings on the unemployment-suicide relationship, making it difficult to draw policy implications. The present study contributes to this line of research by using two semi-aggregate level data in Japan. The results show that unemployment is significantly associated with male suicide rates, especially those of prime age working men, while the results are not straightforward for female suicide rates.
Chang, S. S., Sterne, J. A., Wheeler, B. W., Lu, T. H., Lin, J. J., & Gunnell, D. (2011). Geography of suicide in Taiwan: Spatial patterning and socioeconomic correlates. Health and Place, 17(2), 641-650.
Résumé: In industrialised Western nations suicide rates tend to be high in inner city areas and socially fragmented neighbourhoods. Few studies have investigated spatial variations in suicide in non-Western settings. We estimated smoothed standardised mortality ratios (1999-2007) for suicide for each of the 358 Taiwanese districts (median population aged 15+: 27,000) and investigated their associations with area characteristics using Bayesian hierarchical models. The geographic distribution of suicide was similar in men and women; young people showed the greatest spatial variation in rates. Rates were highest in East Taiwan, a mostly mountainous rural area. There was no evidence of above average rates in large cities. Spatial patterns of method-specific suicide rates varied markedly, with solids/liquids poisonings showing the greatest geographic variation and hangings the least. Factors most strongly associated with area suicide rates were median household income, population density and lone-parent households. Spatial patterning of suicide in Taiwan differed from that observed in Western nations. Suicide prevention strategies should take into account unique local patterns.
Chen, V. C., Stewart, R., & Lee, C. T. (2011). Weekly lottery sales volume and suicide numbers: a time series analysis on national data from Taiwan. Social Psychiatry and Psychiatric Epidemiology, [Epub].
Résumé: OBJECTIVE: To investigate the association between weekly lottery sales and number of suicide deaths in Taiwan. METHODS: All suicides aged 15+ years during 2004-2006 in Taiwan were included. Poisson autoregression time series models investigated associations of weekly numbers with contemporaneous and recent sales from two national lotteries in operation. Adjustments were made for seasonal fluctuation, temperature, monthly unemployment and autocorrelation. RESULTS: In fully adjusted models, suicide deaths were negatively correlated with sales of tickets for a low-prize, low-cost lottery system. However, they were correlated positively with recent sales for a higher-cost, larger-prize system. Both correlations were stronger for male than female suicide numbers but differed in terms of age groups most strongly implicated. CONCLUSIONS: Associations between lottery sales and suicide numbers differed according to the nature of the lottery. A low-prize, low-publicity system appeared to be more benign than a high-prize, high-publicity one.
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