Beliefs About Suicide Acceptability in the United States: How Do They Affect Suicide Mortality?

Abstract

Societies develop cultural scripts to understand suicide and define conditions under which the act is acceptable. Prior empirical work suggests that such attitudes are important in understanding some forms of suicidal behavior among adolescents and high-risk populations. This study examines whether expressions of suicide acceptability under different circumstances are predictive of subsequent death by suicide in the general U.S. adult population and whether the effects differ over the life course. The study uses 1978-2010 General Social Survey data linked to the National Death Index through 2014 (n = 31,838). Cox survival models identify risk factors for suicide mortality, including attitudinal and cohort effects. Expressions of suicide acceptability are predictive of subsequent death by suicide-in some cases associated with a twofold increase in risk. Attitudes elevate the suicide hazard among older (>55 years) adults but not among younger (ages 33-54) adults. Fully-adjusted models reveal that the effects of attitudes toward suicide acceptability on suicide mortality are strongest for social circumstances (family dishonor; bankruptcy). Results point to the role of cultural factors and social attitudes in suicide. There may be utility in measuring attitudes in assessments of suicide risk.