Strong Social Ties Protect Men From Suicide

Being socially connected to others appears to protect men against suicide, according to a new study.

“Social integration acts as a safety net to lower the risk of suicide among men. We speculate that men who are more socially well integrated may have greater access to emotional support and have more opportunities for social engagement and reinforcement of meaningful social roles,” Alexander Tsai, MD, PhD, Assistant Professor of Psychiatry at Harvard Medical School in Boston, told ConsultantLive.

Suicide is one of the 10 leading causes of death among men in the United States, and suicides among middle-aged men are increasing. Current trends in research and prevention efforts usually emphasize the psychiatric, psychological, or biological aspects of what drives suicidal thinking and suicidal behavior. However, research has shown that a substantial proportion of suicides occur in the absence of a formally diagnosed mental disorder, suggesting that a deeper understanding of factors driving suicide is needed, he said.

Dr Tsai and colleagues analyzed data from the Health Professionals Follow-up Study, an ongoing prospective cohort study of nearly 35,000 men aged 40 to 75 years, to examine the relationship between social integration and suicide mortality over 24 years of follow-up. They measured social integration with a 7-item index that included marital status, social network size, frequency of contact, religious participation, and participation in other social groups.

Over more than 700,000 person-years of follow-up, there were nearly 150 suicides. The incidence of suicide decreased with increasing social integration.

Three components-marital status, social network size, and religious service attendance-showed the strongest protective associations. Social integration also was inversely associated with all-cause and cardiovascular-related mortality, but accounting for competing causes of death did not substantively alter the findings.

“Men who were socially well-integrated had a more than 2-fold reduced risk for suicide over 24 years of follow-up,” Dr Tsai said.

The study lacked information on participants’ mental well-being. Some suicides also could have been misclassified as accidental deaths, he noted.

Dr Tsai added: “The seminal studies about social integration and suicide are based on macro-level data, for example, examining the level of social integration across counties or states and the correlations with suicide rates in those jurisdictions, but these are subject to the well-known ‘ecological fallacy’-just because there is an association at the county or state level does not necessarily imply that an individual with poor social integration is also more likely to commit suicide.”

A fuller understanding of the role of social interaction is important in understanding suicide. “The bottom line is that we should be approaching suicide as a public health issue relevant to a broad range of medical practitioners and public health specialists, not just a narrow mental health issue relevant only to psychiatrists like myself,” Dr Tsai said. “It is important for primary care physicians to recognize that their most socially isolated patients are at elevated risk of committing suicide.”

The researchers published their results in the July 14, 2014, issue of Annals of Internal Medicine.