Abstract
Summary: The effect of exposure to risk factors for suicidal behavior varies from place to place and from period to period. This may be due to contextual influences, which arise if individuals' suicide risk depends not only on their personal exposure to risk or protective factors, but also on how these are distributed in their social, cultural, economic, or even physical environments. There has been relatively little explicit attention in suicide research for such contextual influences even though they are an important component of the cross-level bias, which can arise when aggregate level associations are assumed to also apply in individuals and vice versa. Contextual effects are conceptually related to the issues of social selection vs. causation, population density, and network effects. Because of a lack of prospective multilevel research, it is unclear exactly which mechanisms underlie the phenomenon that the distribution of risk factors in an individual's context may affect their suicide risk above and beyond their personal exposure. A number of mechanisms, like deviancy amplification, formalization of restraints, and buffering effects of social support are proposed. Contextual effects may result in a concentration of suicide risk in persons when the risk factors they are exposed to become rare—whether spontaneously or through focused prevention. This has important but mostly overlooked implications for population-based prevention strategies.
References
Attitudes, personality and behavior.. Birmingham: Open University Press (1988).
Medically treated suicide attempts: A four year monitoring study of the epidemiology in the Netherlands.. Journal of Epidemiology and Community Health, (1995). 49, 285–289
Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: A case-control study.. American Journal of Psychiatry, (1996). 153, 1009– 10014
Attempted suicide in West-London; rates across ethnic communities.. Psychological Medicine, (1999). 29(5), 1125–1130
Methodological issues relevant to epidemiologic investigations of suicidal behavior of adolescents.. Epidemiologic Reviews, (1995). 17(1), 228–239
Interactional analysis of suicidal behavior.. Journal of Consulting and Clinical Psychology, (1979). 47, 653–669
Statistical methods in cancer research. Vol.1: The analysis of case-control studies.. Lyon: IARC (1980).
Social origins of depression: A study of psychiatric disorder in women.. London: Tavistock (1978).
Trends and patterns in suicide in England & Wales.. International Journal of Epidemiology, (1995). 24(Suppl.3), s45–s52
Depression, hopelessness and suicidal behavior in Chinese and American psychiatric patients.. American Journal of Psychiatry, (1989). 146, 339–344
Psychologie du suicide.. Paris: Alcan (1947).
Economic stress and suicide: Multilevel analyses. Part 2) Cross-level analyses of economic stress and suicidal ideation.. Suicide and Life-Threatening Behavior, (1989). 19, 337–351
Suicide: A study in sociology (translated by J.A. Spaulding & G. Simpson).. Illinois: Free Press (1951).
Suicide and overdose among opiate addicts.. Addiction, (1996). 91, 321–323
A theory of cognitive dissonance.. Illinois: Row Peterson (1957).
Mortality among injecting drug users: A critical reappraisal.. Journal of Epidemiology Community Health, (1993). 47, 59– 63
Status integration and suicide.. Eugene: University of Oregon Press (1964).
Suicide after discharge from psychiatric in-patient care.. Lancet, (1993). 342, 283–286
Schizophrenia and social class.. British Journal of Psychiatry, (1963). 109, 785–802
Suicidal ideation in a random community sample: Attributable risk due to depression and psychosocial and traumatic events.. Austalian and New Zealand Journal of Psychiatry, (2000). 34(1), 98–106
Ecological bias, confounding and effect modification.. International Journal of Epidemiology, (1989). 18, 269–274
Attempted suicide in Oxford and Utrecht.. British Journal of Psychiatry, (1994). 165, 73–78
Prevention of suicide: Aspirations and evidence.. British Medical Journal, (1994). 308, 1227–1233
Values, morals and modernity: The values, constraints and norms of European youth.. In M Rutter, DJ Smith (Eds.), Psychosocial disorders in young people: Time trends and their causes (pp.324-387). Chichester: Wiley (1995).
Attempted suicide in Europe: Findings from the WHO-Multicenter study on parasuicide by the WHO regional office for Europe.. Leiden: DSWO-Press (1997).
Coming to terms with the terms of risk.. Archives of General Psychiatry, (1997). 54, 337–343
Zelfmoord: statistisch-sociologische verkenningen.. Van Gorcum & Co.: Assen (1960).
Social pathology.. New York: McGraw Hill (1951).
Schizophrenia and city life.. Lancet, (1992). 340, 137–140
Strategies for preventing suicide.. British Journal of Psychiatry, (1997). 171, 351–354
Ecological approaches; rediscovering the role of the physical and social environment.. In LF Berkman, I Kawachi (Eds.), Social epidemiology (pp.332-348). Oxford: Oxford University Press (2000).
Psychiatric illness and risk factors for suicide in Denmark.. Lancet, (2000). 355(9197), 9–12
Unemployment and mortality; comparsion of the 1971 and 1981 census samples.. British Medical Journal, (1987). 294, 86–90
The social and epidemiological context of suicidal behavior.. Groningen: Van Denderen (1997).
Tolerance of suicide, religion and suicide rates; an ecological and individual-level study in 19 western countries.. Psychological Medicine, (1997). 27, 1165–1171
Ethnic minority suicide: A small area geographical study in south London.. Psychological Medicine, (1999). 29, 429–436
Ethnic density and deliberate self-harm: A small area study in South-east London.. Journal of Epidemiology and Community Health, (2001). 55(2), 85–90
Alcohol and suicide; a comparative analysis of France and Sweden.. Addiction, (1995). 90, 1463–1490
The impact of intravenous drug use on mortality of young adults in Rome, Italy.. British Journal of Addiction, (1993). 87, 1637–1641
The social context of religious integration and suicide: Pursuing the network explanation.. Sociological Quarterly, (1990). 31, 337–357
Parasuicide and unemployment.. Br J Psychiatry, (1986). 149, 401–405
The strategy of preventive medicine.. Oxford: Oxford Medical Publications (1992).
The dissonant religious context and emotional disturbance.. American Journal of Sociology, (1962). 68(1), 1–10
Ethnicity in psychiatric epidemiology; need for precision.. British Journal of Psychiatry, (1997). 171, 305–308
The collectivity of drinking cultures: A theory of the distribution of alcohol consumption.. British Journal of Addiction, (1985). 80, 83–99
Pugh TF. Fit of individual and community characteristics and rates of psychiatric hospitalization.. American Journal of Sociology, (1967). 73, 331–338
Prevalence of suicide ideation and suicide attempts in nine countries.. Psychological Medicine, (1999). 29, 9–17
The cry of pain.. London: Pengui (1997).