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- Title
Association Between Social Integration and Suicide Among Women in the United States.
- Authors
Tsai, Alexander C.; Lucas, Michel; Ichiro Kawachi; Kawachi, Ichiro
- Abstract
<bold>Importance: </bold>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.<bold>Objective: </bold>To estimate the association between social integration and suicide.<bold>Design, Setting, and Participants: </bold>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.<bold>Exposures: </bold>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.<bold>Main Outcomes and Measures: </bold>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.<bold>Results: </bold>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.<bold>Conclusions and Relevance: </bold>Women who were socially well integrated had a more than 3-fold lower risk for suicide over 18 years of follow-up.
- Subjects
UNITED States; SUICIDE &; psychology; SOCIAL isolation; SOCIAL participation; STATISTICAL correlation; LONGITUDINAL method; MARITAL status; MULTIVARIATE analysis; QUESTIONNAIRES; RESEARCH funding; SELF-evaluation; SUICIDE; PSYCHOLOGY of women; DATA analysis; SOCIAL support; DISEASE incidence; PROPORTIONAL hazards models; DATA analysis software; DESCRIPTIVE statistics; PSYCHOLOGY
- Publication
JAMA Psychiatry, 2015, Vol 72, Issue 10, p987
- ISSN
2168-622X
- Publication type
journal article
- DOI
10.1001/jamapsychiatry.2015.1002