Yale School of Medicine and VA Connecticut Healthcare System researchers compared social determinants of health in relation to the risk of suicide, a major global public health issue and one of the leading causes of death in the United States.
Their study, published online January 2 in JAMA Psychiatry, found that major risk factors for suicide mortality included justice system involvement, exposure to others’ suicide, firearm accessibility, divorce, foster care experience, release from incarceration, and midlife unemployment.
In contrast, religious affiliation was identified as a protective factor against suicide mortality, according to the study. Childhood maltreatment, sexual assault, and gender and sexual minority status were strong risk factors for suicide attempt and suicidal ideation.
In all, the researchers compared 46 meta-analyses on social determinants and suicide risk.
“While there is an abundance of research on the impact of various social influences on suicide risk, there is limited research comparing how these factors relate to each other in terms of their contribution to suicide risk,” said Peter Jongho Na, MD, MPH, assistant professor of psychiatry, and the study’s lead author.
The suicide rate in the U.S. has risen by 40 percent in the past two decades despite numerous efforts to combat it. Among children ages 15 to 19, suicide is the second leading cause of death and is the leading cause of death for 14- to 15-year-olds.
While there is no single cause for suicide, it most often occurs when risk factors, including socio-environmental, cultural, familial, and neurobiological factors increase the likelihood of an attempt, according to studies.
Current suicide prevention strategies primarily focus on clinical and psychiatric interventions and do not adequately address the environmental social factors associated with suicide. The new study sought to compare a wide range of social determinants of health in relation to suicide risk to inform suicide prevention policies.
“While we know there is no one cause for suicide, understanding how overlapping social drivers, life events and other risk factors, including environmental, historical and health-related factors can together impact someone’s suicide risk is critical to prevention,” said Christine Moutier, MD, chief medical officer of the American Foundation for Suicide Prevention, and co-author of the study. “We will continue to drive and advocate for more research to inform tailored clinical intervention and policy solutions to protect those more likely to face these risk factors.”
“Considerable evidence has shown that social drivers have a significantly greater impact on mental health compared to traditional medical risk factors. Thus, assessing and targeting social drivers of health can be very useful for developing suicide prevention strategies," said Dilip Jeste, MD, director of the Global Research Network on Social Determinants of Mental Health, and senior author of the study.
“These findings provide new insights into priorities for national and global suicide prevention policy efforts,” said Maria Oquendo, MD, MPH, chair of psychiatry and Ruth Meltzer professor of psychiatry at the Perelman School of Medicine, University of Pennsylvania, and co- author of the study. “For example, tailoring interventions for justice system-involved individuals and implementing policy measures addressing the strongest risk factors, such as gun licensing requirements, may be critical.”
Other study authors include Robert Pietrzak, PhD, MPH, director of the Translational Psychiatric Epidemiology Laboratory of the National Center for PTSD, and professor of psychiatry and public health at Yale School of Medicine.
Funding for the study was provided by the U.S. Department of Veterans Affairs.