Cylus et al. Respond to "Unrealized Benefits?"

We thank Dr. Bruckner (1) for his thoughtful critique of our article (2), which highlights the many challenges involved in determining how social policies affect health. Dr. Bruckner raises several interesting methodological issues. A valid point is that we cannot establish whether effects of unemployment benefit programs occur only among unemployed persons who actually receive benefits or whether benefit programs might prevent suicide among other populations who are not in receipt of benefits. In response, Bruckner suggests that we investigate effects of unemployment benefit programs in the population that is actually eligible to receive those benefits (1). We caution against this approach, for several reasons. First, changes in unemployment benefits affect not only the income of workers themselves but also that of their family members, regardless of their labor-market status. This may lead to spillover effects for persons not directly eligible for benefits and may explain why we found no significant differences in the relationship between unemployment benefit programs and suicides by age group.