2000). Results for suicide attempts and marital status are slightly different. As seen with completions, divorced and single individuals were over-represented among suicide attempters (Schmidtke et al., 1996). However, a study in the Netherlands found the lowest overall rates of attempts were among the widowed (Arensman et al., 1995), perhaps reflecting the lethality of attempts among this cohort (see Chapter 2).

Cultural context provides insight into the role of marital status in suicide. In the United States, Stack (1996) found that among African-Americans, divorce or death of a spouse significantly raised the risk of suicide, but being single did not. The strength of the association between marital status and suicide was less than the effect for whites, which the author suggests is due to stronger family ties.

The impact of marital status also differs for men and women, and varies across the life course. Models that account for gender often have found that divorce increases suicide risk in men only; in women divorce does not seem to exert a strong influence on suicide (e.g., Kposowa, 2000; Pescosolido and Wright, 1990). In Israel, increased divorce rates between 1960 and 1989 were associated with higher suicide rates for men and lower suicide rates for women (Lester, 1997). In contemporary Pakistan, suicides were more prevalent in married than unmarried women (Khan and Reza, 2000). One controlled study (Heikkinen et al., 1995) found that suicides were especially common among never-married men ages 30-39 compared to the general population. Theoretical interpretations of this data frequently echo the suppositions of Durkheim, who proposed that marriage is protective when it is not over- or under-regulating, and provides social integration and support through a strong family network (Durkheim, 1897/1951). For example, reflecting Durkheim’s notion that very early marriage for men is “over-regulating,” high proportions of never-married populations are related to lower suicide rates among young men (Pescosolido and Wright, 1990).

Although the research in this area is incomplete, these results caution against generalizing on the basis of any single sociodemographic factor. Heikkinen and colleagues (1995) suggest that some of the age-related variations in social factors for suicide may be better explained by mental illness and alcohol abuse. An analysis by Qin and colleagues (2000) supported this theory. Controlling for psychiatric hospitalization, they found that marital status was no longer an independent significant suicide risk factor for women. Other research suggests that the quality of the marital bond may be most important; domestic violence seems to increase risk for suicide ideation and attempts across the world (McCauley et al., 1995; Muelleman et al., 1998; Roberts et al., 1997; WHO, 2001). It has also been suggested that when marital ties represent the only or primary source of



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