social integration and support, the dissolution of the marriage will have an especially strong effect on increasing suicide risk (Pescosolido and Wright, 1990). Integration of individual-level variables is necessary to understand the confluence of these factors.

Parenthood

Being a parent, particularly for mothers, appears to decrease the risk of suicide. In a prospective study of over 900,000 women followed for 15 years, Hoyer and Lund (1993) noted that both having children and the number of children decreased the risk of suicide. Across countries, having a young child appears to be a significant protective factor for women (de Castro and Martins, 1987; Qin et al., 2000). Pregnant women have a lower risk of suicide than women of childbearing age who are not pregnant (Marzuk et al., 1997).

Family Discord and Connectedness

Discord within the family also has an impact on suicide. Increases in the suicide rates in Ireland between 1970 and 1985 were correlated with a general decline in social cohesion as marked by a fall in the marriage rate and rise in the number of separated couples (Kelleher and Daly, 1990). A study in Scotland (Cavanagh et al., 1999) demonstrated that among patients with mental disorders, family conflict increased the risk of suicide by about a factor of 9. The effect of domestic discord also can influence the suicide rate for children and adolescents. Adolescents who had lived in single parent families or who were exposed to parent–child discord were more likely than matched controls to complete suicide (Brent et al., 1994; see also the case of young Canadians, Trovato, 1992). Furthermore, Tedeschi (1999) found that exposure to trauma, such as violence, predicts poor outcomes in children, especially if parental responses are inadequate (Bat-Aion and Levy-Shiff, 1993; Garbarino and Kostelny, 1993) (see also Chapter 5). But if parental physical and mental health are sound, children can do surprisingly well even in the face of terrorism (Freud and Burlingham, 1943; Miller, 1996).

On the other hand, some researchers (Borowsky et al., 2001; Resnick et al., 1997) have noted that perceived parental and family connectedness significantly protected against suicidality for youth. Other studies also demonstrated a protective effect of family connectedness and cohesion on suicidal behavior among American Indian and Alaska Native youth (Borowsky et al., 1999), Mexican American teenagers (Guiao and Esparza, 1995), and a largely white sample of adolescents (Rubenstein et al., 1989).



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