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Cited by 127Suicide and Self-Harm StudiesHealth disparities and outcomesHealth and Well-being Studies

Association Between Social Integration and Suicide Among Women in the United States

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Tsai, Alexander C., Lucas, Michel, Kawachi, Ichiro·2015·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2015.1002PMC PMC4598291
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Abstract

IMPORTANCE: Suicide is one of the top 10 leading causes of mortality among middle-aged women. Most work in the field emphasizes the psychiatric, psychological, or biological determinants of suicide. OBJECTIVE: To estimate the association between social integration and suicide. DESIGN, SETTING, AND PARTICIPANTS: We used data from the Nurses' Health Study, an ongoing nationwide prospective cohort study of nurses in the United States. Beginning in 1992, a population-based sample of 72 607 nurses 46 to 71 years of age were surveyed about their social relationships. The vital status of study participants was ascertained through June 1, 2010. EXPOSURES: Social integration was measured with a 7-item index that included marital status, social network size, frequency of contact with social ties, and participation in religious or other social groups. MAIN OUTCOMES AND MEASURES: The primary outcome of interest was suicide, defined as deaths classified using the codes E950 to E959 from the International Classification of Diseases, Eighth Revision. RESULTS: During more than 1.2 million person-years of follow-up (1992-2010), there were 43 suicide events. The incidence of suicide decreased with increasing social integration. In a multivariable Cox proportional hazards regression model, the relative hazard of suicide was lowest among participants in the highest category of social integration (adjusted hazard ratio, 0.23 [95% CI, 0.09-0.58]) and second-highest category of social integration (adjusted hazard ratio, 0.26 [95% CI, 0.09-0.74]). Increasing or consistently high levels of social integration were associated with a lower risk of suicide. These findings were robust to sensitivity analyses that accounted for poor mental health and serious physical illness. CONCLUSIONS AND RELEVANCE: Women who were socially well integrated had a more than 3-fold lower risk for suicide over 18 years of follow-up.

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  • Thwarted belongingness may deter help-seeking, amplify sensitivity to social rejection, and impair social integration, all of which enhance suicidal ideation and behavior.

    “A perceived lack of reciprocally caring relationships, also known as thwarted belongingness, may deter help-seeking (41), amplify sensitivity to social rejection (42), and impair social integration (43), and all enhance suicidal ideation and behavior.”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [43]

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Authors
Tsai, A. C., Lucas, M., & Kawachi, I.
Affiliations
  • Harvard University (US)
  • Centre hospitalier universitaire de Québec (CA)
  • Brigham and Women's Hospital (US)
Corresponding author
Tsai, Alexander C.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2015-10-01
Volume
72
Issue
10
Pages
987
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2015.1002
PMC
PMC4598291
OpenAlex
W1925558682
Cited by
127
References
106
Citations by year
2026: 5 · 2025: 11 · 2024: 8 · 2023: 18 · 2022: 7 · 2021: 18 · 2020: 12 · 2019: 12 · 2018: 10 · 2017: 18 · 2016: 6 · 2015: 2
FWCI
14.88
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • National Institute of Mental Health (K23MH096620)
  • National Cancer Institute (UM1CA186107)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
Keywords
social integration, suicide, middle-aged women, social networks, social ties, religious participation, marital status, interpersonal relationships, Nurses' Health Study, suicide risk factors
MeSH terms
Aged, Female, Humans, Middle Aged, Prospective Studies, Social Isolation, Social Support, Suicide, United States, Women, Cohort Studies, Incidence, Multivariate Analysis, Proportional Hazards Models, Marital Status, Social Participation

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