The Impact of Social Connectedness on Suicide Risk in Adults in Middle to Later Life

University Of Rochester, Rochester NY

Investigators

Abstract

Suicide rates among adults in the U.S. are a significant public health problem. Suicide rates increase with age, yet mechanisms that account for elevated rates among adults in middle to later-life are not well-understood. The Interpersonal Theory of Suicide proposes that life stressors increase suicide risk by impacting two specific forms of social disconnection – low belonging and perceived burden on others and that changes in these states are the most proximal determinants of suicidal behavior. However, the role daily, and even hourly, changes in social connection have in promoting belonging or alleviating perceived burden for adults in mid- to late-life, over and above changes in daily stress levels and mood, has not been comprehensively examined. This study builds on our team’s descriptive and interventional work on social connection in suicide prevention, which indicates that social engagement is a unique predictor of a sense of mattering to one another and a group. In line with institute priorities to identify mechanisms leading to interventions to promote health, our objective is to examine the role that social engagement (i.e., behaviors throughout the day that are social/relational) has in promoting belonging or alleviating perceived burden, and thereby decreasing suicide risk in adults. We propose an observational study of n = 200 adults in mid-to later life (age 40+) who report elevated suicide risk (past year suicide ideation or lifetime suicide attempt) in which subjects complete baseline interviews (to obtain histories of suicide ideation and behavior), 14 days of smartphone-based ecological momentary assessment and passive sensing of social behavior (including social engagement and suicide risk) at baseline and 3-months, and a qualitative interview with a subset (n=50) of subjects to contextualize findings. Aim 1 is to examine whether daily social engagement predicts daily fluctuations in social connection (mattering, loneliness, belonging, and perceived burden) while controlling for daily stressors and mood. We hypothesize that days with greater social engagement will be associated with clinically meaningful increases in social connection even when controlling for stressor frequency and intensity (i.e., stress buffering effect of social connection), and that greater social engagement during the day will predict evening and next morning increases in social connection. Aim 2 examines whether social engagement predicts daily variations in suicide risk (suicide ideation, depression severity) via social connection. We hypothesize that lower social engagement during the day will predict evening and next morning suicide risk via changes in social connection. Aim 3 is to identify what aspects of social engagement (e.g., group, one-on-one) are most helpful in reducing suicide risk via qualitative interviews to inform translation to intervention. Understanding mechanisms whereby social factors alleviate suicide risk can inform optimization of suicide prevention interventions targeting social connection for adults in middle to later life.