Suicidal behaviour, social networks and psychiatric diagnosis

Abstract

Summary. The aim of this investigation was to examine the relationship between social network deficits and the occurrence of suicidal behaviour, and to describe the short-term interpersonal consequences of a suicidal attempt. Two questionnaires, concerned with the extent and self-perceived adequacy of social network, formed the basis of a structured interview. Fifty-two suicide attempters were interviewed within 48 hours of their attempt, and again six weeks later, and undertook a weekly self-rating task. A group of 52 non-suicidal individuals of comparable age, sex, social class, and marital and employment status underwent the same interview programme. The results indicate that the social networks of suicide attempters are impaired relative to non-suicidal individuals, and that improvement in the social network following an attempt is limited to attempters with no formal psychiatric disorder, and to measures of perceived adequacy and satisfaction. The findings add support to the importance of psychiatric assessment of the nature and the adequacy of the social network in relation to suicidal individuals.Theoretical and research evidence indicates a relationship between disrupted social networks and the occurrence of suicidal behaviour. The behaviour has been variously attributed to increasing social isolation (Jacobs and Teicher 1967), to disturbances in close relationships (e.g. Richman 1970, 1972), and to the impairment of interpersonal communication (e.g. Fawcett et al. 1969).A process of progressive social isolation from meaningful relationships has been detailed by Jacobs and Teicher (1967) in the life histories of adolescent suicide attempters. A history of chaotic and excessively mobile family life, repeated rejection experiences (Shrut 1968), and closed family systems which prevent the potentially suicidal member from making outside contacts (Rosenbaum and Richman 1970) has been documented by clinical studies. Information on home sharing, interpersonal relationships, and occupational and social activity indicates that suicide attempters have poor contacts with family, friends, and the wider community, and that a great many are without any form of personal contact (Bille-Brahe and Wang 1985).Existing relationships are also impaired. Clinical interviews with suicide attempters and their relatives reveal an almost universal pattern of family involvement in the pressures that initiate the suicidal act (Rosenbaum and Richman 1972). Assessment of communication patterns indicates that the quality of interpersonal communication between spouses deteriorates as the degree of suicidal behaviour in one partner increases (Bonnar and McGee 1977). Chronically disrupted relationships, marital isolation, and distorted communication all characterise the high risk attempter (Fawcett et al. 1969).Consideration has also been given to the importance of social network variables consequent to the act. Follow-up studies of attempters have noted the frequency of the attempter's desire to effect some interpersonal change via suici...

Life events, social support, coping strategies, and quality of life in attempted suicide: A case‑control study

“…There is evidence that social network among suicide attempters are weaker than in nonsuicidal individuals. [7] Life events can alter the social support system in terms of size, frequency of interaction and stability, and such changes may be associated with suicidal behaviors.…”

Suicidal behaviors in depressed men with a family history of suicide: Effects of psychosocial factors and age

“…Psychosocial factors such as impairm ent of social support and exposure to m ultiple negative life events have been reported to increase odds of suicide attempts and suicidal ideation (Bagley & Ram say, 1985;Hart et al, 1988;Heikkinen et al, 1994;Paykel et al, 1975;Vilhjalm sson et al, 1998). H owever, their increm ental contribution to the already high odds of attempts or ideation m ay be m inim al in this sam ple, particularly if one of the com m on risk factors (fam ily history of suicide or attempted suicide) has a signi® cant psychosocial com ponent.…”

“…In non-clinical studies, several dim ensions of social support have been identi® ed as correlates of suicide attempt: sm all non-fam ily social networks (Veiel et al, 1988), perception of the social network as unavailable or inadequate (Hart et al, 1988;Lyons, 1985), im paired social integration (BilleBrahe & W ang, 1985), low er levels of instrumental support and psychological support from fam ily (Veiel et al, 1988) and low levels of subjective support (H art et al, 1988). Low scores on a cum ulative social support m easure in inpatients admitted following a suicide attem pt predicted increased risk of reattem pt in a longitudinal study by Johnsson F ridell et al (1996).…”

“…T he lack of asso ciation between any m easure of social support w ith attem pted suicide in this sam ple app ears som ewhat surprising in view of the num ber of studies that have reported such asso ciations. H ow ever, m ost of those studies used non-clinical sam ples (Bille-Brahe & W ang, 1985;Hart et al, 1988;Lyons, 1985;Veiel et al, 1988). The absence of a relationship between any m easure of social support and one-year history of attempted suicide in this group of high-risk m en is consistent with results of two clinical studies (Bronisch & Hecht, 1987;M ullis & Byers, 1987) in w hich both cases and controls were drawn from a high-risk group (psychiatric inpatients).…”

Suicide

“…Absence of social support is especially relevant in terms of predicting suicidality (e.g., Hart, Williams, & Davidson, 1988;Lyons, 1985). Increased social support for the suicidal person reduces the likelihood of suicide and increases the likelihood of obtaining social support after an attempted suicide (Maris, 1992).…”