Study finds neighborhood socioeconomic status may play an important role in suicides

Attempted suicide is one of the most significant predictors of completed suicide, which is becoming a leading cause of mortality in the U.S., especially among young adults. While prior research has focused mainly on individual-level risk factors for suicide–such as psychiatric diagnoses, impulsiveness, substance use, and previous suicide attempts—there is little information on risk factors at the community level, including the physical and social environment in which people live.

In a new study, researchers at Boston University Chobanian & Avedisian School of Medicine and Howard University College of Medicine have determined there is a complex interplay between individual and community-level factors that may increase or decrease an individual's vulnerability to suicide. This is one of the few studies to examine community-level risk factors for suicide.

"While the conventional wisdom is that suicide is a death of despair often brought on by adverse circumstances, our study shows this may not be so. What drives suicide risk is likely to be more than individual-level risk and related more to what is happening at the community level and even societal and policy levels," explains corresponding author Temitope Ogundare, MD, MPH, clinical instructor of psychiatry at BU's medical school and a psychiatric resident at Boston Medical Center.

The researchers reviewed the Maryland State Emergency Department Database, which contains information on all emergency department visits that did not result in hospitalizations from January 2018 to December 2020. They identified anyone who had a diagnosis of attempted suicide and collected demographic data and other clinical information.

They then used a metric called the Distressed Community Index (DCI), developed by the Economic Innovation Group, that utilizes seven metrics to quantify socioeconomic risk. Based on the DCI, they stratified neighborhoods of those individuals who had attempted suicide into five levels, from distressed to prosperous.

Using statistical models, they calculated that the risk of attempted suicide was highest in the most prosperous neighborhoods, with the risk increasing as individuals moved up the economic ladder.

According to the researchers, this study raises important questions about community-level risk factors for attempted suicides, including: Are we under-recognizing and undertreating mental health conditions and substance use disorders in distressed neighborhoods? Are people who attempt suicide in distressed neighborhoods not being seen or treated in the emergency department? Does this finding hold across the U.S.?

The researchers believe these findings call for universal suicide screening and prevention strategies. "What drives suicide risk is likely to be more than individual-level risk and related more to what is happening at the community level and even societal and policy levels. We need more research examining risk and protective factors for suicide at those levels," said Oluwasegun Akinyemi, MD, MSc, the study's first author and a senior research fellow at Howard University School of Medicine.

These findings appear online in the journal Frontiers in Public Health.