Incidence of Suicide Decreases with Social Integration

A new study finds that men with more social connections such as marriage and religious affiliations are at less risk of committing suicide.

The findings “suggest that suicide should be dealt with as a public health issue,” says Alexander Tsai, MD, PhD, an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General department of psychiatry, and co-author of the study.

“That is something many primary care practitioners instinctively know when it comes to chronic conditions such as heart disease or diabetes,” says Tsai. “Unfortunately, far fewer experts in the field are advocating a public health approach to suicide prevention.”
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A team including Tsai and colleagues from Harvard Medical School as well as Massachusetts General Hospital and Northeastern University used data from a study of 34,901 male health professionals between the ages of 40 and 75 years when they entered the study in 1988. The authors measured men’s social integration using a series of questions pertaining to marital status, social network size, frequency of contact with social ties, religious participation, and involvement in other types of social groups.

The investigators separated the participants into 4 groups, based on their level of social integration. The team then looked at how many participants committed suicide by February 2012. In total, 147 suicides occurred during the 24-year follow-up period, or an average of about 2 suicides per 10,000 participants per year.

According to the authors, there were about 4 suicides per 10,000 people per year among participants in the lowest social integration category, versus approximately 1.5 suicides per 10,000 people per year among those with the highest levels of social integration. This finding wasn’t surprising, said Tsai, noting that it matched what he had observed in patients.

The researchers caution, however, that the results may not apply to the average person, pointing out that the participants were well-educated males who appeared to be in above-average health, because there were fewer suicides reported than the national average for the age group. The study results may also not be applicable to women, who might respond differently to social integration than men, according to the authors.

“One of the interesting things about our publication is that we studied a cohort of generally healthy men,” adds Tsai. “Even though suicide is a huge public health problem, it is a rare event relative to the total exposure time. As a result, many studies in this literature have generally studied populations enriched for psychiatric morbidity, for example, tracking suicides in people recently discharged after a psychiatric hospitalization.”

Even though mental illness is a strong risk factor, suicide can still occur in the absence of a psychiatric condition, continues Tsai. “So, primary care practitioners should still be thinking about their patients’ social environments, even when it comes to their healthiest patients.”

—Mark McGraw

Reference

Tsai A, Lucas M, et al. Social Integration and Suicide Mortality Among Men: 24-Year Cohort Study of U.S. Health Professionals. Ann Intern Med. 2014.