Tuesday, January 04, 2005

Social Integration Predicts Suicide Over and Above Mental Disorders

This is another one of those posts that I have been meaning to write for a while.  As fate would have it, I encountered the following two items at about the same time.  They were written a month apart, but time does funny things in cyberspace:

Item #1 -- from PsychiatrySource.com
Social integration predicts suicide over and above mental disorders
24 Nov 2004
The association between family and social involvement and the risk of suicide is robust and largely independent of the presence of mental disorders, report US investigators, who say their findings could enhance the identification and treatment of vulnerable individuals.

To determine whether poor social integration amplifies the risk of suicide after taking into account the effects of mental disorders and employment status, the researchers, from the University of Rochester Medical Center in New York, compared 86 individuals who had attempted suicide and 86 people who had not, all of whom were aged 50 years or older.

Multivariate analysis showed that people who had attempted suicide were less likely than those who had not to have ever been married, to have had children, and to be living with their family.

With regard to social integration, participants with suicidal behavior were less involved in religion, showed less interaction with a social network, and had a low engagement in community activities, compared with individuals who were not suicidal. [...]

Item #2 -- from Mousemusings:
Place to Be
December 22, 2004

[...] That’s the first part: The suicides I have known have almost all been about love promised and not delivered. Let me be very clear: It is not the fault of the lover who could not love him or her enough. It is the fault of the entire community and culture for being unable and unwilling to support revolutionary love. The suicides I have known have mostly been in Gringolandia, where there is no support for love, where “the problem club” recruits daily, where the “self help” and addictionology industries prey on weak gringo minds selling the bullshit that a human being is a nation-state, that the human has “borders” or “boundaries” and has to “set those boundaries.” The "professionals" who peddle those inhuman theories have their fingers on the trigger, too. [...]
Statistics show that the lowest rates of suicide occur among Black women and Latinas.  Among Hispanics, the highest rates are for the elderly, followed by the group from ages 10-34; it is much higher for Latinos than Latinas. (link)  It is very high among gay and lesbian youth of any ethnicity. (link)

What this shows is that social factors are more important that mental illness diagnosis.  It suggests, but does not prove, that the role of medication in the prevention of suicide is very limited.  I can imagine that antidepressant medication might even be perceived by the person as an intervention that misses the point -- potentially increasing the sense of alienation. 

That's one of those hypotheses that seems plausible, but would be difficult to test.  In fact, I'm having a hard time coming up with a way to design a study that would 1) test the hypothesis adequately, and 2) be ethical to conduct, not to mention 3) be feasible without a multi-million-dollar grant. 

Another problem with trying to study it would be this: what would you do with the results.  There are interventions that can reduce the effect of social isolation, but they are very expensive to operate.  It is doubtful that anyone could figure out how to fund such a thing.  Insurance companies don't want to pay for interventions that are not biomedically-based; the government sure isn't going to do it, and most churches or other community organizations don't have the expertise. 

I guess what it boils down to is this: if we want to have a real impact on suicide rates, we are just going to have to try to be nice to each other.  Concepts such as tolerance and diversity are more that nice ideas.  Such values could save lives.