And now there is research on how the US job exodus parallels an increase in suicides. A one percentage point increase in unemployment correlated with an 11 percent increase in suicides, according to Peter Schott, a Yale University economist who coauthored the report with Justin Pierce, a researcher at the Federal Reserve Board.

The jobs went first, the result of trade deals that sent them overseas. Once-humming factories that dressed office workers and soldiers, and made goods to furnish their homes, stand abandoned, overtaken by weeds and graffiti.

FALL RIVER — In this struggling industrial city, changes in trade policy are being measured not only in jobs lost, but also in lives lost — to suicide.


The research doesn’t prove a definitive link between lost jobs and suicide; it simply notes that as jobs left, suicides rose. Workers who lost their jobs may have been pushed over the edge and turned to suicide or drug addiction, lacking financial resources or community connections to get help, the authors suggest.

The research contributes to a growing body of work that shows the dark side of global trade: the dislocation, anger, and despair in some parts of the country that came with the United States’ easing of trade with China in 2000. The impact of job losses was greatest in places such as Fall River and other cities in Bristol County, along with rural manufacturing counties in New Hampshire and Maine, vast stretches of the South, and portions of the Rust Belt.

“There are winners and losers in trade,” Schott said. “If you go to these communities, you can see the disruptions.”

The unemployment rate in Fall River remains persistently high and at 5.5 percent in September was a good two points above the Massachusetts average. Nearly one in three households gets some sort of public assistance.


Opposition to global trade policies became a rallying cry in Donald Trump’s campaign, propelling him into the White House with strategic wins in the industrial Midwest and the South. Trump has threatened to impose tariffs on Chinese goods and has bashed recent US trade pacts.

John Botelho doesn’t know if US trade policy killed his brother. He knows it didn’t help.

Botelho and his three younger brothers, all originally from the Azores, opened an apparel factory in Fall River in the early 1980s, along the banks of Cook Pond, about half a mile from the Rhode Island border. They worked alongside each other and their 300 employees, sewing tailored pants and jackets for leading labels, primarily Jones New York, along with Talbots and Ann Taylor.

In the late 1990s, the clothing companies started to cut their orders as they chased cheaper labor elsewhere, first in the American Southwest and Central America, and then in China, which Botelho says was “the last nail in the coffin.”

By 2001, the work had dried up and the Botelho brothers were forced to shut their two factories. His brother Victor never quite got over the collapse of the business, Botelho said. He was depressed, and his relationship with his family deteriorated. About a decade after the operation ceased, Victor killed himself. He was 52.

“It was a chain effect,” said Botelho, 68, who retired as a heating and air conditioning technician, a job he took after the factory closed. “It can be very tough. Some people never recuperate.”


It’s difficult to pinpoint how many suicides are directly tied to job losses and other financial struggles because victims don’t often leave notes or explanations, said Annemarie Matulis, director of the Bristol County Regional Coalition for Suicide Prevention. The decision to take one’s life is probably linked to a number of factors, including mental illness, isolation, lack of proper treatment, and despair, Matulis said.

But in 2002, Bristol County’s suicide rate spiked to 8 per 100,000 people, from 5 per 100,000 the year earlier, and remained above the state average for most of the decade that followed. The county’s suicide rate reached 12 per 100,000 people in 2015, compared with 9 per 100,000 statewide, according to the latest data available from the Centers for Disease Control.

Bristol County has among the highest suicide rates in the state. Massachusetts traditionally has been below the US rate, which was 13 per 100,000 people in 2014, the last year for which there are nationwide statistics.

In Bristol County, most of the victims were white men between the ages of 44 and 65, a group that can be hard to reach with traditional interventions by health care providers such as psychologists or with community meetings, Matulis said. That has forced the coalition to consider different approaches to addressing the stubbornly high suicide rate. In coming weeks, the coalition plans to leave business cards — outlining signs of depression and phone numbers to call for help — at retailers, gas stations, bus terminals, laundromats, and men’s rooms.


“They’re not men in trouble,” Matulis said of those who have killed themselves. “They’ve not had a prior criminal record, not even a parking ticket. These are quiet, invisible men who lost hope. Something happened along the way. The American dream never came true.”

The risk of suicide can grow after mass layoffs and long-term unemployment, said Richard Dunn, a University of Connecticut economics professor who has studied the issue.

For many of these vulnerable counties, the wallop from job losses to trade with China was followed by the global financial crisis, leaving white-collar workers jobless, as well, and intensifying the toll on these communities, Dunn said.

The downward spiral from unemployment to depression is all too familiar to Charlie Sallaway, 55, of Taunton. He was laid off from his manager’s job at a health care claims company in 2013 when it shrank its call center, part of a consolidation in his industry.

He went on interview after interview, trying to rejoin the job market. He thought his meetings with potential employers went well, but job offers never materialized.

“You go from being busy . . . to being a pariah,” Sallaway said. “People don’t realize how depressing it can be and how much it takes out of you. It hits your self-worth and your identity . . . It’s extremely difficult to pull out of the hole.”

After the Botelho family business closed, one of the four brothers who ran it, Victor M. Botelho, killed himself. John Botelho visited his brother’s gravestone. Jonathan Wiggs/Globe Staff

A year-and-half later, without any job prospects, Sallaway decided to take the money he had inherited from his mother and bought Parcel & Post Plus, a shipping and packaging store on Route 44.


But he still worries about the future for his 24-year-old son, Jake, who is working toward a college degree. In the past, he might have found employment with one of the manufacturers in Bristol County. Now his son lives with him and works part time as a cook in a pizza shop.

“I’m lucky,” Sallaway acknowledged. “In some ways the economy is doing better, but I don’t think the benefits are spread across the board.”

Even in the former factory towns of Bristol County, which had been reliably Democratic, Trump had a strong showing. Fall River firmly backed Hillary Clinton, but Trump’s share of the vote was 50 percent higher than Mitt Romney’s in 2012.

In neighboring New Bedford, Trump outperformed Romney by 44 percent, and in Taunton by 14 percent.

Previous trade deals, including the 1994 North American Free Trade Agreement with Canada and Mexico, chipped away at US manufacturing towns. But economists say the decision to normalize relations with China was far more disruptive. Some economists have estimated the United States may have lost at least 1 million manufacturing jobs from 2000 to 2007 due to freer trade with China.

In Bristol County, which includes Fall River, New Bedford, and Taunton, manufacturing employed nearly a quarter of the workforce in 2000; now it provides jobs for only one in 10 workers.

Most of the manufacturing jobs lost since 2000 are unlikely to return, economists said. Automation has made manufacturing much more specialized, requiring more education and fewer workers, leaving parts of the country struggling to figure out how to reinvent their economies.

“We will probably never have as many manufacturing jobs as we had in 1960,” Dunn said. “The question is how do we train workers and provide them opportunities to feel productive. What’s clear from the election is an increasing number of people don’t have those opportunities or don’t feel that those opportunities will be available.”

Officials in Fall River and Bristol County said they are trying to provide appropriate training, including computer programming, a prerequisite for many manufacturing jobs.

They also point out there have been recent victories.

Amazon.com opened a distribution warehouse in Fall River and has been hiring in recent months to fill 500 jobs.

Companies are eyeing Taunton for its cheaper land, access to highways, and state tax breaks.

Norwood-based Martignetti Cos., among the state’s largest wine and spirits distributors, last year agreed to move its headquarters to a Taunton industrial park.

Mayor Tom Hoye said Taunton has also been more active in recent years, holding community meetings and expanding social services for residents facing distress and drug addiction.

Despite the hits the city and its residents have taken, there is reason to be optimistic about the future, he said.

Jobs are returning, and the county’s suicide rate dropped from 13 per 100,000 people in 2014 to 12 per 100,000 in 2015.

“We’re reinventing ourselves,” Hoye said on a recent morning as he sat in an old elementary school classroom that has served as the temporary mayor’s office for several years.

“It’s tough to lift yourself out of the hole sometimes. But we’re much better off than we were 10 years ago.”

Deirdre Fernandes can be reached at deirdre.fernandes@globe.com. Follow her on Twitter @fernandesglobe.