Abstract
Research has shown that people who have never been married, divorced, or widowed are at an increased risk of suicide compared with those who are married, but we have little knowledge as to how this elevated risk is modified by socioeconomic factors, and little research has studied the risk among persons enduring a marital separation. This study addressed these issues with individual-level data from Norwegian national registers. All suicide cases in people above 18 years that took place in the period 1992–2012 (n = 11 051) were compared with living controls (185 685) matched on sex and age via a nested case control design, and suicide risk associated with marital status was assessed with conditional logistic regression. The results showed that, compared with a status of being married, suicide risk was highly associated with a status of being never married, separated, divorced, or widowed, even after adjustment for income-level, educational attainment, centrality of residence, and immigration status. The strongest effect was seen for a separated status; compared to the married, separated persons were fully 6.06 times more apt to die by suicide, and the effect was strongest in the 30 days following a separation. The observed significant associations remained but differed in strength by sex and age, and there were significant deviations by personal socioeconomic status. Most notably, the increased risk was higher for never-married persons with low educational attainment or income. However, most interaction effects (10/16) did not yield significant results. In conclusion, suicide risk is strongly associated with a single status of any form with the highest risk during a marital separation, but the increased risk varies in strength according to individual-level factors. The stress and loss of support induced by marital dissolution are important contributing risk factors for suicide, and persons with low income may be especially vulnerable.
Highlights
Social bonds and attachments play critical roles in human func tioning; people thrive under strong long-lasting relationships and feel distressed when these are threatened or broken (Baumeister & Leary, 1995)
This study aims to fill the above mentioned knowledge gaps by uti lizing individual data interlinked from several Norwegian population registers for persons who died from suicide during 1992–2012 and comparison subjects that were matched to the cases on sex and age via a nested case-control design
Suicide risk associated with marital status and differences by sex and age Results from the crude conditional logistic regression analysis, controlled for sex and age through matching (Table 1), showed that
Summary
Social bonds and attachments play critical roles in human func tioning; people thrive under strong long-lasting relationships and feel distressed when these are threatened or broken (Baumeister & Leary, 1995). Marital unions are arguably the strongest bonds formed by non-kin and are associated with reduced risks of physical and psychiatric disorders (Kiecolt-Glaser & Newton, 2001; Williams et al, 1992), higher well-being, and increased financial satisfaction (Stack & Eshleman, 1998). Being married may increase the likelihood of having a confidant (Lowenthal & Haven, 1968) and reduce the risk of loneliness (Stack, 1998). Dur kheim’s theory of social integration proposes that social ties reduce the likelihood of egoistical suicide by subverting individualistic tendencies through identity, shared values, and obligations (Durkheim, 1897). According to Joiners interpersonal theory of suicide, thwarted belonging is one of the necessary psychological factors seen on the pathway to suicide (Van Orden et al, 2010)
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