Introduction Recent increases in national rates of suicide and fatal overdose have been linked to a deterioration of economic and social stability. The American auto industry experienced these same pressures beginning in the 1980s with the emergence of a competitive global market.

Objectives Using the United Autoworkers – General Motors cohort as a case study, we examine the impact of employment loss on these self-injury mortality events.

Methods For 29,764 autoworkers employed on or after January 1, 1970, we apply incremental propensity score (IPS) interventions, a novel causal inference approach, to examine how proportional shifts in the odds of leaving active GM employment affect the cumulative incidence of self-injury mortality.

Results Cumulative incidence of self-injury mortality was 0.87% (258 cases) at the observed odds of leaving active GM employment (δ = 1) over a 45-year period. A 10% decrease in the odds of leaving active GM employment (δ= 0.9) results in an estimated 7% drop in self-injury mortality (239 cases) while a 10% increase (δ= 1.1) results in a 19% increase in self-injury mortality (306 cases). We reject the null hypothesis of no incremental effect over the range of effects considered (δ in [0.75, 1.25]; P = 0.02).

Conclusion These results suggest that leaving active employment increases the risk of death due to suicide or drug overdose.