Poor social integration and suicide: Fact or artifact? A case-control study

Center for the Study and Prevention of Suicide, University of Rochester, Rochester, New York, United States
Psychological Medicine (Impact Factor: 5.43). 11/2004; 34(7):1331-7. DOI: 10.1017/S0033291704002600
Source: PubMed

ABSTRACT Sociological studies have shown that poor social integration confers suicide risk. It is not known whether poor integration amplifies risk after adjusting statistically for the effects of mental disorders and employment status.
A case-control design was used to compare 86 suicides and 86 living controls 50 years of age and older, matched on age, gender, race, and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. Social integration was defined in reference to two broad levels of analysis: family (e.g. sibship status, childrearing status) and social/ community (e.g. social interaction, religious participation, community involvement).
Bivariate analyses showed that suicides were less likely to be married, have children, or live with family. They were less likely to engage in religious practice or community activities and they had lower levels of social interaction. A trimmed logistic regression model showed that marital status, social interaction and religious involvement were all associated with suicide even after statistical adjusting for the effects of affective disorder and employment status. Adding substance abuse to the model eliminated the effects of religious involvement.
The association between family and social/community indicators of poor social integration and suicide is robust and largely independent of the presence of mental disorders. Findings could be used to enhance screening instruments and identify problem behaviors, such as low levels of social interaction, which could be targeted for intervention.

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    • "The presence of an axis IV diagnosis (psychosocial or environmental problems, above all problems with primary social support group) also seemed to be a risk factor for suicide completion. In fact, recent stressful events or the lack of social support have been identified as risk factors for suicide completion (Duberstein et al., 2004; Overholser, et al.). Although a history of previous suicide attempts is a main risk factor for future suicide completion (Cooper et al., 2005; Hawton et al., 2003; Yoshimasu et al., 2008), our data suggest that repeated suicide attempts are concentrated in subjects who attempt but fail to commit suicide: most patients who completed suicide did so either during the first attempt (60.4%) or during the first or second attempt (92.3%). "
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    ABSTRACT: BACKGROUND: Suicide attempters and suicide completers are two overlapping but distinct suicide populations. This study aims to present a more accurate characterization by comparing populations of suicide attempters and completers from the same geographical area. METHODS: Samples and procedure: All cases of attempted suicide treated at the emergency room of the Corporacio Sanitària i Universitària Tauli Parc de Sabadell in 2008 (n=312) were compared with all completed suicides recorded in the same geographical area from 2008 to 2011 (n=86). Hospital and primary care records were reviewed for sociodemographic and clinical variables. Statistical analysis: Chi-square, ANOVA, and Mann-Whitney U tests were used to identify characteristics related to suicide completion. RESULTS: Compared to suicide attempters, suicide completers were more likely to be male (73.3% vs. 37.8%; p<0.001), pensioners (73.7% vs. 23.4%; p<0.001), and people living alone (31.8% vs. 11.4%; p=0.006). Suicide completers more frequently presented somatic problems (71.7 vs. 15.7; p<0.001), Major Depressive Disorder (54.7% vs. 27.9%; p<0.001), and made use of more lethal methods (74.1 vs. 1.9; p<0.001). Suicide completers were more likely to have been followed by a primary care provider (50.0% vs. 16.0%; p<0.001). 92.3% of the suicides committed were completed during the first or second attempt. LIMITATIONS: Suicide completers were not evaluated using the psychological autopsy method. CONCLUSIONS: Despite presenting a profile of greater social and clinical severity, suicide completers are less likely to be followed by Mental Health Services than suicide attempters. Current prevention programs should be tailored to the specific profile of suicide completers.
    Journal of Affective Disorders 04/2013; 150(3). DOI:10.1016/j.jad.2013.03.013
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    • "Thwarted belongingness is the feeling that one is not socially connected nor integrated into valued relationships (Joiner, 2005), and refers to an unmet need to belong (Van Orden et al., 2012), or an absence of reciprocal caring relationships (Van Orden et al., 2010). This construct is similar to other known predictors of suicide such as feelings of loneliness and social isolation, and lack of social integration (Duberstein et al., 2004; Van Orden et al., 2012); conversely, when an individual's need to belong is satisfied, suicide risk is mitigated (Gordon et al., 2011). Perceived burdensomeness is the sense that one ineffectively contributes to the welfare of others in their social network (Joiner, 2005), and develops when the need for social competence, or the desire to be effective in one's social group, is unmet. "
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    ABSTRACT: BACKGROUND: Suicide is the 10th leading cause of death in the US, and rates of suicide are higher in rural than urban areas. As proposed by the Interpersonal-Psychological Theory of Suicide, thwarted belongingness and perceived burdensomeness are risk factors for suicidal behavior, although protective individual-level characteristics such as forgiveness, may indirectly affect suicidal behavior by decreasing the deleterious effect of thwarted interpersonal needs. METHOD: A sample of uninsured adults recruited from a rural primary clinic (N=101) completed the Brief Multidimensional Measure of Religiousness and Spirituality; Suicidal Behaviors Questionnaire-Revised; Interpersonal Needs Questionnaire; and Center for Epidemiologic Studies Depression Scale. Parallel and serial multivariable mediation analyses were conducted to test for direct and indirect effects of forgiveness on suicidal behavior. RESULTS: In parallel mediation, covarying depressive symptoms, forgiveness of self had an indirect effect on suicidal behavior, through perceived burdensomeness. Inclusion of depressive symptoms as a mediator revealed an indirect effect of forgiveness of self and others on suicidal behavior via depression, thwarted belongingness, and perceived burdensomeness in a serial mediation model. LIMITATION: A longitudinal study, with an equal representation of males and diverse populations is needed to replicate our findings. DISCUSSION: Our findings have implications for the role health providers can play in addressing suicide with rural patients. Promoting forgiveness, may, in turn affect interpersonal functioning and decrease risk for suicidal behavior.
    Journal of Affective Disorders 02/2013; 149(1-3). DOI:10.1016/j.jad.2013.01.042
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    • "Research attempting to understand such temporal and geographic variation in suicide rates has a long tradition, beginning with Durkheim's (1951) classic study on the subject. Although suicide risk is undoubtedly affected by individual circumstances and characteristics, such as a history of mental illness and/or substance abuse, environmental social conditions also importantly affect suicide rates (Duberstein et al. 2004a, b; Thorlindsson and Bjarnason 1998). According to Durkheim, low levels of Significant decrease in suicide rate Significant increase in suicide rate Unshaded = No change in suicide rate Fig. 1 Trends in U.S. suicide rates, by U.S. state, 1985–2000. "
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    ABSTRACT: Using pooled cross-sectional time-series data for the 50 U.S. states over a 25-year period, this article examines how well four conceptual groups of social correlates-demographic, economic, social, and cultural factors-are associated with the 1976-2000 patterns in overall suicide rates and suicide by firearms and other means. Unlike past research that typically considers only one dimension, this analysis differentiates between spatial and temporal variation in suicide rates to determine whether and how social correlates operate differently in these two contexts. Results indicate that suicide rates correspond closely to social correlates. Within U.S. states, lower overall suicide rates between 1976 and 2000 were associated with demographic change (e.g., larger numbers of foreign-born) as well as with fewer numbers of Episcopalians. Across U.S. states, variation in overall suicide rates over the period was related to demographic (percentage male), economic (per capita income), social (percentage divorced), and cultural (alcohol consumption and gun ownership) factors. However, findings differ importantly by type of suicide, and across time and space. Reasons for these distinct patterns are discussed.
    Demography 11/2012; 50(2). DOI:10.1007/s13524-012-0176-y
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