How does social support modify the association between psychological distress and risk of suicide death?

Abstract

Background: Social support (SS) has been reported as a factor preventing suicide death, but whether this association is independent of mental status is unclear. The present study examined the effect modification of SS on the association between psychological distress status and risk of suicide death.Methods: Follow-up data for 43,015 subjects participating in a prospective cohort study were analyzed. At baseline, the subjects were asked about SS and mental status with the Kessler six-item Distress (K6) Scale. A Cox model was used to estimate the multivariate-adjusted hazard ratios (HRs) of suicide death according to two levels of psychological distress (K6 ≤ 4, K6 ≥ 5). The HRs in each SS subtype (emotional and instrumental) were also calculated.Results: There was a significant association between SS and a lower risk of suicide death in the stratum of K6 ≥ 5, with an HR of 0.58 (95% confidence interval, 0.35-0.96).On the other hand, the association with the K6 ≤ 4 strata was not significant.Conclusion: SS appears to be associated with a lower risk of suicide death only among participants with moderate or severe psychological distress. These results imply that early detection of psychological distress and provision of SS is important for preventing suicide death.

Social support, psychological strain, and suicidality: Evidence from Chinese universities

“…Some research suggested that friends and peers are the most important relationships that provide quality social support (Mahon & Yarcheski, 2017). In accordance with previous studies (Otsuka et al, 2022; Zhao et al, 2022), the multiple regression analysis revealed that social support was engaged in lower suicidal behavior. Second, the current study suggested that psychological strain was predictive of suicidal behavior among university students as existing studies (Zhang et al, 2017; Zhao & Zhang, 2018a) indicated.…”

“…Taking all these risk factors into account, it is fair to say a variation of 0.01 in suicidal behavior can be attributed to the protective role played by social support. Third, the moderating effect of social support was documented in previous studies that either examined the moderation effect between psychological stress and suicidality (Otsuka et al, 2022) or between opioid misuse and suicide attempts (Agyemang, 2023).…”

“…Sparks et al (2023) examined the mediating effect of social support on suicide ideation among psychiatric inpatients and suggested that thwarted belongingness and perceived burdensomeness were significantly related to suicide ideation. Otsuka et al (2022) examined the effect of modification of social support on the association between psychological distress and risk of suicide death and they affirmed that social support had a relation with lower suicide death among participants with moderate or low risk of suicide. A systematic review (Hu et al, 2023) researched studies on the moderating effect of social support on suicide risk among patients with mental illness and concluded that both quantitative and qualitative studies supported the negative effect of social support on suicide risk.…”

Interaction between mental disorders and social disconnectedness on mortality: a population-based cohort study

“…8 Although some prior studies have also investigated diminished social connections as a determinant of mortality in the context of mental disorders, these findings have been inconclusive and inconsistent. [9][10][11][12][13][14][15] Understanding the interplay of these risk factors could be of importance to identify groups at high risk of premature death, which can inform targeted prevention efforts and help to shed light on the underlying causal factors in the observed life expectancy gap.…”

“…The majority of prior studies have focused on individuals with depression and are limited by small study populations (<4000 individuals) [9][10][11][12][13][14][15] (for a full overview of previous studies see Supplementary T1 available at https://doi.org/10.1192/bjp.2024.68). To further investigate interaction between mental disorders and diminished social connections on mortality, comprehensive studies based on larger samples are needed.…”