Do Not Overlook Strong Social Risk Factors for Suicide

Summary and Comment |
July 25, 2014

Do Not Overlook Strong Social Risk Factors for Suicide

  1. Peter Roy-Byrne, MD

Social support and sense of belonging can be powerfully protective against suicide in men.

  1. Peter Roy-Byrne, MD

Suicide, a major public health problem with devastating effects on family and friends, is more common in men than women. Predicting risk has been difficult, with psychiatric diagnosis and psychological factors of limited utility. In a prospective epidemiological study, researchers have now examined the utility of social risk factors in predicting suicide in 34,901 men (mean age, 57; from narrow professional socioeconomic strata) followed from 1988 to 2012, during which 147 men died by suicide.

A social integration index was computed from seven questions on marital status, size of social network, frequency of social contact, religious participation, and participation in other social groups. Analyses controlled for competing mortality risks from medical illness and used antidepressant medication as a proxy for mental illness. Compared with respondents in the lowest quartile, those in the two quartiles with best social support/integration had significantly (≈40%–50%) lower risk for suicide; marital status, social network size, and religious participation were the strongest factors.


This study does not completely control for all mental-illness risk factors but does identify powerfully predictive social risk factors for suicide, consistent with the fact that not everyone who commits suicide has a mental illness. Furthermore, previous suicide prediction studies may have overcontrolled for mental illness, thus diminishing the role of social factors, although these may be just as important. The authors suggest that lack of social integration might itself constitute some of the vulnerability, as well as be a precipitating stressor, in a stress–diathesis model of suicide. Despite the epidemiologic focus of this study, its findings remind all clinicians that the identified social factors are important predictors of suicide risk and deserve the same interventional attention as diagnosis and psychological vulnerabilities in our patients at risk for suicide.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (President-Elect)


Reader Comments (1)

Yvette Cramer BA RN Other Healthcare Professional, Psychiatry

How true is the saying "man is not supposed to live alone." A crisis of despair,alienation can make the future look bleak. With families living at great distance and men have probably moved frequently throughout their lives making it hard to have a social base. A significant number in our population no longer use the church as a focus. I wonder if having a hobby or sport helps.(I guess that would be included in social contacts) Was employment, and finances evaluated?
Not being treated for mental illness keeps them out of a safety net.
I have done a lot of triage and crisis work and these men would not fall in this safety net. How did they kill themselves and did they leave any warning?
One point of interest is people diagnosed with depression who are being treated have better outcomes if there are supports. The Recovery Model for seriously mentally take supports as a big part of recovery too.
I think having a screening of one or two questions about suicide when people visit their GP may help. I do not think all clinics have this protocol but some do.

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