Midlife suicide: A systematic review and meta-analysis of socioeconomic, psychiatric and physical health risk factors.

Suicide is an increasing contributing cause of mortality in middle-aged adults; however, knowledge to guide prevention is limited. This first systematic review and meta-analysis of studies on midlife suicide has provided an overview of published research on this issue and synthesized the evidence on socioeconomic and physical and mental health factors associated with this mortality. Using PRISMA guidelines MEDLINE, Embase, PsycINFO, Scopus and Web of Science were searched for English-language publications that involved persons aged 35 to 65, used individual-level data, and reported prevalence of exposure(s) or relative risks. The search identified 62 studies on midlife suicides and associated factors (28 for SES, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence of exposure in suicide decedents was 57.8% for psychiatric disorder, 56.3% for low income, 43.2% for unemployment, and 27.3% for physical illness. The associated pooled risk ratio was 11.68 (95% confidence intervals: 5.82-23.47) for psychiatric illness of any type, 12.59 (8.29-19.12) for mood disorders, 3.91 (2.72-5.59) for unemployment, 3.18 (2.72-3.72) for being separated or divorced, 2.64 (2.26-3.10) for cancer, 2.50 (0.96-6.38) for central nervous system illness, and 2.26 (1.16-4.41) for low income. In conclusion, midlife suicide is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. Future investigations should consider the interactions between risk factors, the intersectionality of sex and ethnicity, and include data from low- and middle-income countries.

Women's suicide in low-, middle-, and high-income countries: Do laws discriminating against women matter?

BACKGROUND: Women's suicide is a serious public health issue in low- and middle-income countries (LMIC). This study explored whether institutional discrimination against women, as manifested in formal and informal laws, is relevant to country's income-level variability in women's suicide mortality. It also examined which discriminatory laws are associated with LMIC women's suicides. METHODS: Scores on laws discriminating against women, across 176 countries, were obtained from the Gender, Institutions and Development Database. Male-to-female (M/F) 2017 suicide ratios were the index of women's propensity for suicide. The mediating role of laws discriminating against women on the association between country's income level and M/F suicide ratio was analysed by bootstrapping method. Regression analyses examined which discriminatory laws were associated with LMIC women's suicide rates. RESULTS: LMIC had significantly smaller M/F suicide ratios than high-income countries. Institutional discrimination mediated the association between country's income-level and M/F suicide ratio (total effect: ß = -0.13, 95% CI [ -0.26, -0.01]; direct effect: ß = -0.06, 95% CI [ -0.20, 0.08]; indirect effect: ß = -0.07, 95% CI [ -0.15, -0.02]). In LMIC, higher levels of discrimination against women in laws about access to productive and financial resources (ß = -0.69, p < 0.001), civil liberties (ß = -0.60, p < 0.001), and in family law (ß = -0.57, p < 0.001) were associated with smaller M/F suicide ratios after controlling for male suicide rates and sex ratios at birth. CONCLUSIONS: The relatively high suicide rates recorded among women in LMIC might be related to the higher level of institutional discrimination women experience in these countries. In LMIC, where, by law, women had restricted access to productive and financial assets and to justice, and/or unequal rights with regard to citizenship, household-responsibilities, divorce, and inheritance, M/F suicide ratios were lower-that is, women's suicide rates were higher. Suicide theory, research, and prevention targeting women should incorporate social-context and social-justice perspectives.

A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Phyllis Bronstein (1939-2012).

This article memorializes Phyllis Bronstein (1939-2012). Bronstein was a feminist scholar, social and clinical psychologist, and activist for social justice. At the University of Vermont, she engaged almost 100 undergraduates in her research teams, mentored the research and professional development of 43 graduate students, and trained over 90 clinical psychology students in the feminist family therapy program she developed. Bronstein published over 45 chapters and journal articles, and three edited books. One stream of her scholarship focused on sociocultural factors in parenting, child and adolescent development, with studies conducted in the United States and Mexico. Bronstein is perhaps best known for two volumes on the integration of multicultural and gender issues into the psychology curriculum, coedited with Kathryn Quina and published by the American Psychological Association. Bronstein's third stream of scholarship addressed sexist, racist, and ageist practices in academic and clinical professions.

The long-lasting impact of adolescents' deviant friends on suicidality: a 3-year follow-up perspective.

BACKGROUND: During adolescence, friends are increasingly important for support and values. Do friends also have a long-term impact on suicidality? This study explored the role of friendship problems (e.g., social isolation) and deviant friends during late adolescence on suicidal ideation and behavior 3 years later. METHOD: Participants were 295 community adolescents (59% Mexican-American; 41% European-American) from the United States. Information about their suicidal ideation and behavior, depression, friendship problems, and deviant friends was collected at baseline and at a 3-year follow-up. RESULTS: Having deviant friends was a better predictor of suicidality than having friendship problems, with variability by sex and ethnicity. Having deviant friends predicted suicidal ideation among Mexican-American adolescents. Having friends who were disconnected from school was a risk factor for suicidal ideation among European-American adolescents but a protective factor for suicidal behavior among Mexican-American adolescents, especially boys. Depression played more of a mediating role between friendship factors and suicidality for European-American than for Mexican-American adolescents. CONCLUSIONS: This study's findings suggest an influence of adolescents' deviant friends on suicidality 3 years later. They also call for the cultural and gender grounding of suicide theory, research and prevention.

A systematic review of social factors and suicidal behavior in older adulthood.

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

Friendship factors and suicidality: common and unique patterns in Mexican American and European American youth.

Research suggests a link between friendships and suicidality among U.S. youth, but this link has not been confirmed across ethnicities. The relationship between friendships and suicidality among Mexican American and European American adolescents was examined in this study. Specifically, the role of friendship problems (i.e., social isolation, poor quality friendships) and problematic friends (i.e., friends who were disconnected from school, delinquent friends) was explored. Participants were 648 community youth. Friends' school disconnection was related to Mexican American girls' suicidal ideation, while friends' delinquency was associated with European American youth suicidal behavior. Friendship factors were no longer associated with suicidality after controlling for suicidality correlates such as depression. These findings indicate that the relationship between friendships and suicidality varies by gender and ethnicity. They also suggest a dominant role of depression.

Friendships and suicidality among Mexican American adolescent girls and boys.

Friendship factors have been implicated in adolescent suicidality, but this relationship has not been verified across ethnicities. This study examined suicidality and friendship problems (i.e., social isolation, poor friendship quality, friends' school disconnection, and friends' delinquency) among Mexican American adolescents, an understudied, vulnerable group in terms of suicidality. Three hundred thirty-eight community adolescents, two-thirds of whom were educationally at-risk, participated in the study. Suicidal ideation and behavior rates were high, particularly among girls. Friends' school disconnectedness increased girls' odds for suicidal ideation by 13%. This association was even greater for girls in good academic standing. Friendship problems were not associated with suicidality in boys. Ethnic identity was a minor factor in suicidal ideation, and only for girls. These findings confirm, among Mexican American adolescents, the role of gender in the relationship between friendship and suicidality.