Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: a nine-year follow up of the UK Biobank cohort

Abstract

Background: The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design. Methods: Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes. Results: For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16). Limitations: Loneliness and emotional support were operationalized using single item measures. Conclusions: For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective effects of cohabitation.

Suicide in the Province of Foggia: Retrospective Study and Analysis of the Difference between Men and Women

“…Our data agree with other studies showing a higher incidence of suicide rate in the elderly over the 80s and the youth group [17]. Regarding the 30-59 age group of males, the suicide numbers may be due to their social role or the loss of jobs and economic problems [26], and to the loneliness of living alone [27]. The reasons that lead males in the 80-89 years age group to commit suicide are mainly linked to the condition of living alone and widowing [28] or to the presence of various disabling pathologies [29].…”

Suicide mortality among the elderly population in Italy: A nationwide cohort study on gender differences in sociodemographic risk factors, method of suicide, and associated comorbidity

“…Results obtained for suicide mortality according to living arrangement are consistent with previous findings. Living alone was demonstrated to increase suicide risk in late life, 13,18 especially among men 19 . Elderly individuals living in close relationships are less prone to experience social isolation and low social support, resulting in less exposure to the burden of loneliness and stressful life events like retirement or widowing.…”

“…Most studies investigating the association between sociodemographic factors and suicide among older adults have mainly focused on individuals aged <75 years 12,13 . However, the improvement in health conditions of older people and the consequent increase in longevity indicate that the threshold for old age should be higher than 65 years and likely set at 75 years.…”

The interaction between coping styles with relationship breakdowns, loss, and conflict and the frequency of self-harm thoughts and behaviours: a longitudinal analysis of 21,581 UK adults

“…8, 9 In the UK Biobank study, a lack of emotional support explained longitudinal associations between living alone and later death by suicide in men (but not women). 27 Conversely, higher emotional support is associated with reduced likelihood of self-harm thoughts. 28…”