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Reducing Suicide: A National Imperative
Those who enjoy close relationships with others cope better with various stresses, including bereavement, rape, job loss, and physical illness (Abbey and Andrews, 1985; Perlman and Rook, 1987), and enjoy better psychological and physical health (IOM, 2001; Sarason et al., 1990). Studies have documented that social support can attentuate severity of depression and can speed remission of depression in at-risk groups such as immigrants and the physically ill (Barefoot et al., 2000; Brummett et al., 1998; Shen and Takeuchi, 2001). Studies of youth at risk for adverse outcomes, including suicide, have demonstrated that social support potently buffers the effects of negative life events (Carbonell et al., 1998; O’Grady and Metz, 1987; Vance et al., 1998).
As mentioned above, completed suicide occurs more often in those who are socially isolated and lack supportive family and friendships (e.g., Allebeck et al., 1988; Appleby et al., 1999; Drake et al., 1986). Studies from across sundry countries and ethnic groups show that suicide attempts and ideation among youths and adults correlate with low social support (De Wilde et al., 1994; Eskin, 1995; Hovey, 1999; Hovey, 2000a; Hovey, 2000b; Ponizovsky and Ritsner, 1999), with one study suggesting that perceived social support may account for about half the variance in suicide potential for youth (D’Attilio et al., 1992). Research has demonstrated that social support moderates suicidal ideation and risk of suicide attempts among various racial/ethnic groups, abused youths and adults, those with psychiatric diagnoses, and those facing acculturation stress (Borowsky et al., 1999; Hovey, 1999; Kaslow et al., 1998; Kotler et al., 2001; Nisbet, 1996; Rubenstein et al., 1989; Thompson et al., 2000; Yang and Clum, 1994).
Evidence suggests different mechanisms of support’s influence. Social support sometimes represents part of a protective process that increases self-efficacy and thereby reduces suicidal behavior (Thompson et al., 2000). At other times social support more directly reduces suicidality via reducing psychic distress (Schutt et al., 1994). Furthermore, family and friendship support appear to play somewhat different roles in protecting against suicidality (Rubenstein et al., 1989; Veiel et al., 1988); men and woment may differ in use and types of social support (Heikkinen et al., 1994; Mazza and Reynolds, 1998).
Effective treatment for suicidality, whether medical or psychosocial, involves human contact and support (see Chapter 7). Recent suicide prevention programming to increase social support and other positive variables (e.g., Thompson et al., 2000) builds on emerging evidence suggesting a greater ameliorative effect of increasing protective factors than reducing risk (Borowsky et al., 1999; Vance et al., 1998).