1. From a cohort study, male heath professionals who were classified in the highest categories of social integration had the lowest relative hazard of suicide.
Evidence Rating Level: 2 (Good)
Study Rundown: Suicide is one of the top ten leading causes of death in men and rates continue to increase. Despite research into the biomedical nature of suicide, little is known about the contribution of social aspects of individuals with regards to suicide risk. To test this, the authors conducted a 24-year cohort study among men in health professions. Social integration was measured by a 7-item index which included questions regarding marital status, social ties, and sources of social participation. Those men in the highest and second highest categories of social integration had a statistically significant decrease in the hazard of suicide. Additionally, a high category of social integration also conferred a small decrease in the hazard of cardiovascular disease-related death. The major limitation of this study is that it could not adjust for the potential confounding of mental health status and social integration.
In-Depth [prospective cohort]: From 34,901 responders, 708,945 person-years of follow-up were compiled in this study with 147 total suicides. The study participants, all men, included dentists, optometrists, osteopathic physicians, pharmacists, podiatrists, and veterinarians. In those in the highest and second highest categories of social integration, the adjusted hazard ratio (AHR) for suicide was 0.41 (95% CI, 0.24-0.69) and 0.52 (95%CI, 0.30-.91), respectively. This decreasing trend was maintained for each category of social integration (p<0.001). Although all-cause mortality was also slightly decreased in those with higher social integration (p=0.018 for trend), only cardiovascular-related death remained significantly decreased (p=0.004 for trend) after removing those with serious illness at baseline. This study was limited in that it was not able to differentiate between accidental deaths and suicide, nor was it able to adjust for the potential interactions between mental health status and social integration. However, this study provides evidence for the potentially important role of social factors in preventing suicide in men.
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