Study Identifies Social Determinants of Suicide Mortality, Suicide Attempts

A recent study found social determinants of suicide mortality include being involved in the justice system, exposure to parental and others’ suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife unemployment (35 – 65 years).1 Among these, individuals released from incarnation demonstrated the greatest prevalence of suicide mortality.

Annually, > 700,000 people die by suicide, making suicide a major global public health problem.2 Understanding the key social determinants in suicide mortality and suicide risk helps inform clinical practices and policy solutions to prevent suicide.

Investigators aimed to examine the associations of social determinants of health with suicide-related outcomes, such as suicide mortality, suicide attempt, and suicidal ideation in a review of 46 meta-analyses published before July 2023 in PubMed, PsychINFO, Embase, and Web of Science.1

“Currently implemented suicide prevention strategies are primarily focused on clinical-psychiatric prevention and do not adequately address social factors related to suicide,” wrote investigators, led by Peter Jongho Na, MD, MPH, from VA Connecticut Healthcare System in Connecticut. “Thus, the [social determinants of health] identified as the strongest risk factors in this study should be prioritized in national and global public health policy efforts.

The study found social determinants for suicide mortality included justice system-involved individuals in the community, exposure to parental or others’ suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife unemployment (aged 35 – 65 years). Individuals released from incarnation had a 10-fold greater prevalence of suicide mortality compared with the general population (114.5 vs 11.1 per 100,000 persons).

Parental suicide and childhood foster care were associated with > 100% greater risk of suicide mortality. Among middle-aged adults, a single/unmarried status and lower income were linked to a > 100% increase in suicide mortality risk, and being divorced/separated or unemployed were linked to > 200% greater risk.

Essential workers, plant and machine operators, ship’s deck crew, and skilled agricultural, forestry, and fishery workers had > 50% increased risk of suicide mortality. Workplace bullying, workplace violence, financial stress, and unemployment were linked to > 50% increased risk of suicide mortality. Disasters led to a > 20% increase in the prevalence of suicide mortality.

Social determinants of the risk for suicide attempt included the experience of childhood abuse, maltreatment, and sexual assault; gender and sexual minority status; and parental suicide mortality.

The study found the prevalence of suicide attempts was high among the homeless (28.9%; 95% confidence interval [CI], 21.7% - 37.2%), incarcerated female youths (27%; 95% CI, 20% - 34%), and adults (12.2%; 95% CI, 7.1% - 17.2%).

The homeless had a lifetime suicidal ideation prevalence of 41.6% (95% CI, 28.6% - 56.0%). Moreover, the study found the strongest risk factors for suicidal ideation were identifying as bisexual and intimate partner violence in women.

Overall, the social determinants of health with the strongest associations with suicide attempts or suicidal ideation included childhood maltreatment, sexual assault, identification as LGBTQ+, homelessness, and incarceration.

The review revealed protective factors linked to the reduced risk of suicide mortality were religious affiliation and being married. School connectedness was associated with being protective against suicide attempts and suicidal ideation. Managers, senior officials, legislators, and clerical support workers had > 20% lower risk of suicide mortality.

The findings brought insight into what populations should be targeted for suicide prevention. For instance, individuals with a history of justice system involvement or foster care should receive early interventions to prevent antisocial behavior. Multisystemic therapy can promote positive behaviors in at-risk children, troubled teens, and formerly incarcerated adults.

Investigators suggested that there should be policies in place to connect individuals released from jails or children in foster care to mental health services. They emphasized the importance of firearm counseling, including safe storage practices and gun licensing requirements, policies to help with employment, and addressing discrimination toward gender or sexually marginalized groups.

“From a clinical perspective, routine assessment of social constructs that are strongly associated with suicide mortality, suicide attempt, and suicidal ideation should be built in daily clinical practice,” investigators wrote.

The team added how many several social determinants of health are not assessed in clinical settings, such as gender and sexual identity, legal history, exposure to suicide, and firearm accessibility—nor do they have validated measures.

“Therefore, efforts to develop and validate brief and practical standardized assessment measures will be critical in screening and monitoring subpopulations at heightened risk,” investigators concluded.

References

1. Na PJ, Shin J, Kwak HR, et al. Social Determinants of Health and Suicide-Related Outcomes: A Review of Meta-Analyses. JAMA Psychiatry. Published online January 02, 2025. doi:10.1001/jamapsychiatry.2024.4241
2. Suicide. World Health Organization. August 29, 2024. https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed January 3, 2024.