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8/2/2019 Chapter 4 Suicide and Social Support
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Chapter 4: Social Support & Suicide 174
Chapter 4
Social Support and Suicide
Definitions of Social Support
Social support is a concept that is generally understood in an intuitive
sense, as the help from other people in a difficult life situation. One of the
first definitions was put forward by Cobb (1976); he defined social support
as the individual belief that one is cared for and loved, esteemed and
valued, and belongs to a network ofcommunication and mutual obligations
Moss (1973) proposes that social support is a "subjective feeling or
belonging, of being accepted, of being loved and of being needed, all for
oneself and not for what one can do".
Shumaker and Brownell (1984) defined social support as social exchanges
in which the provider or recipient perceives positive intent. Accordingly,
Social support providers who aim to promote well being must therefore take
into account not only the type of illness and type of support, but also: the
person most likely to provide a positively perceived supportive behavior.
Also it has been simply defined as the assistance and protection given to
others (shumaker and BrowrelI, 1984; Wortman and Dunkel-Schetter,
1987).
Social support describes the comfort, assistance, and/or information one
receives through formal or informal contacts with individuals or groups
(Wallston ct al., 1983).
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Chapter 4: Social Support & Suicide 175
In MINDFUL(2008) social support was defined as the perceived
availability of people whom the individual trusts and who make one feel
cared for and valued as a person.
Social capital has a variety of definitions (Muntaner and Lynch,1999;
Whitehead and Diderichsen,2001; Durlauf S , 2002), there is general
agreement that the required conditions forsocial capital include the existence
of community networks,civic engagement, civic identity, reciprocity, and
trust. One of the most well known works, Putnams(2000)Bowling Alone,
identifies social associations and networks, norms of reciprocity,and trust as
3 key components of social capital (Kushner H, and Sterk C (2005).
In spite of these widely accepted definitions of social support, there is no
consensus in the literature about the definition. There is a need for further
research, especially about what kind of support is most important for health.
Social Support Concept
Berkman et al., (2000)stated that social integration, social network andsocial support are closely related components of social relationships.
The concept of a social network represents the ties to family, friends,
neighbors, colleagues, and others of significance to the person (Doubova et
al., 2010); there are different types of social networks , the most common
are: a) diverse, with distinct sources of potential support (family, friends,
neighbours, community groups) and with frequent contact; b) focused on
family; c) focused on friends, and; d) restricted in terms of potential sources
of support and frequency of contacts (Fiori et al.,2007,;Fiori et al.,2008)
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Chapter 4: Social Support & Suicide 176
However, when the social network is described in structural terms, like
size, range, density, proximity and homogeneity, social support normally
refers to the qualitative aspects of the social network; within this context,
social support is the potential of the network to provide help in situations
when needed. However, the social network may also be the cause of
psychological problems. Support is accessible to all individual through
social ties with other individuals, groups and the larger community (Lin et
al., 1979).
Whereas the concept of social support mainly refers to the individual and
group level, the concept of social integration can refer to the community
level (Berkman & Glass, 2000). A well integrated community refers to well
developed supportive relationships between people in the community, with
everybody feeling accepted and included. A related concept is social capital,
which is often used as the sum of supportive relationships in the
community(Kawachi & Berkman, 2000). Social integration has been used
to refer to the existence of social ties. Social network refers to the web of
social relationships around individuals. Social support is one of the
important functions of social relationships. Social networks are linkages
between people that may provide social support and that may serve functions
other than providing support (Glanz et al, 2002).
Barnes (1954) was the first to describe patterns of social relationships that
were not explained by families or work groups; social networks are closely
related to social support. Nevertheless, these terms are no theories per se.
Social Support and Social Networks are concepts that describe the structure,
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Chapter 4: Social Support & Suicide 177
processes and functions of social relationships. Social networks can be seen
as the web of social relationships that surround individuals.
Halle and Wellman (1985) present the interplay between social support,the social network, and psychological health in a model (figure F): The
social network as a mediating construct. This model shows that social
support can be seen as resulting from certain characteristics of the social
network, which are in turn caused by environmental and personal factors.
The model suggests that it is important to distinguish between the structural
and quantitative aspects of the social network on the one side, and social
support on the other (O'Reilly, 1988). However, it may be difficult to
distinguish between the quality of social network and social support.
Figure (F): Social network as a mediating construct(Halle & Wellman,1985)
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Chapter 4: Social Support & Suicide 178
Perceived and Provided Support
Wethington and Kessler, (1986); Olstad et al.(2001) stated that in defining
social support a distinction can be made between the quality of support
perceived (satisfaction) and provided social support. In fact, perceived
support may be more important than the support actually received.
Most studies are based on the measurement of subjectively perceived
support, whereas others aim at measuring social support in a more objective
sense. One could also distinguish between the support received, and the
expectations when in need, and between event specific support and general
support. The definition in terms of a subjective feeling of support raises the
question whether social support reflects a personality trait, rather than the
actual social environment (Pierce et al., 1997; Sarason et al., 1986).
Types of Social Support
Types and sources of social support may vary; House ( 1981) described
four main categories of social support: emotional, appraisal, informational
and instrumental:
1.Emotional support: generally comes from family and close friends
and is the most commonly recognized form of social support. It is
associated with sharing life experiences. It involves the provision of
empathy, love, trust and caring (Thoits, 1995, 1999; Turner et al.,1999).
2.Instrumental support: is the most concrete direct form of social
support, it involves the provision of tangible aid and services that
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Chapter 4: Social Support & Suicide 179
directly assist a person in need and encompassing help in the form of
money, time, in-kind assistance, and other explicit interventions on
the persons behalf. It is provided by close friends, colleagues and
neighbors.
3.Appraisal support: involves transmission of information in the form
of affirmation, feedback and social comparison. This information is
often evaluative and can come from family, friends, co-workers, or
community sources.
4.Informational support: involves the provision of advice, suggestions,
and information that a person can use to address problems.
Determinants of Social Support
Social support is a consequence of the interplay between individual factors
and the social environment. Therefore, factors affecting social support may
be individual or social, or both. Social support may also be partly
determined by genetic factors.
Social support in adulthood may be to some extent genetically determined
(Bergman et al., 1990). However, the strength of this assumed relationship
differs between studies. Bergman and colleagues found that genetic factors
were responsible for 30% of the variance in perceived support. However,
genetics made little contribution to individual differences in the actual
quantity of enacted support.
Furthermore, another study demonstrated only a minor role of genetic
factors in the association between perceived support and depression (Kessler
et al., 1994). In this study, depression was not so much reduced by genetic
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Chapter 4: Social Support & Suicide 180
determinants of social support, but mainly by the stress-buffering effect of
perceived support.
Individual and personality factors that might be associated with perceivedsocial support are interpersonal trust (Rotter, 1967) and social phobia
(Barlow, 1988). Without trusting other people, it is less likely that the
person will perceive support from others, and interact with others in such a
way that social support is provided. People with social phobia have a strong
feeling of anxiety connected to contact with other people.
The position of a person within the social structure will influence the
probability of them receiving social support. The position of a person is
determined by such factors as:
1.Marital status: People who are not married and live alone are less
likely to receive social support than people who are married.
2. Family size: People with many children are likely to receive more
social support than people with few children (Broadhead et al., 1983),
because they have a more extensive family network.
3.Age: Elderly people tend to receive less social support than younger
people (Stephens et al., 1978).
4. Gender: Women tend to receive more social support than men
(MacFarlene et al., 1981).
5. Socio-economic status and migration: People with lower socio-
economic status report less social support than other people (Dalgard
et al., 2006; Dalgard et al., 2007). Social support seems to decrease
the lower the occupational status, unskilled workers reporting the
poorest social support (Marmot et al., 1991).
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Chapter 4: Social Support & Suicide 181
Also the occurrence of social support depends on the opportunities that a
person creates to interact with other people. These opportunities are
determined by a number of contextual variables, such as (Schieflo, 1992):
The existence and availability of social arenas i.e. places where people
can meet, like shopping centres, parks, sport arenas and the like.
Purpose of social interaction. Without a unifying purpose for contact
(e.g. addressing a common problem, playing a game, celebrating an
event), social interaction will be low.
Time spent together. Without enough time, interpersonal relationships
will not develop.
Continuity of relationships. Without continuity social relationships
will easily be disrupted.
Sharing of social norms and values. If people are too different with
respect to social characteristics (such as religious and cultural
preferences), it is less likely that they will develop supportive
relationships.
The structure of the community determines to what extent people live
in a social context that is conducive to social support. In communities
characterized by social disintegration, the level of social support
among people is reduced compared to integrated communities
(Leighton, 1959; Dalgard, 1986). Typical for disintegrated
communities is that the level of social cohesion is low, that peoplelack trust in each other, and that social interaction is low.
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Chapter 4: Social Support & Suicide 182
Effects of Social Support
With respect to health, social support may have direct or indirect (buffer)
effects (Cohen & Syme, 1985):
The direct effect implies that social support has a positive effect on
health, irrespective of life situation
The buffering or indirect effect occurs only when the person is
exposed to stressors, like negative life events and more lasting
adversities. In this instance, social support is supposed to help the
person to cope better with the situation, and hence prevent stress.
There is no theory adequately explaining the link between social
relationships and health .Yet social support also can affect a persons health
through different pathways: behavioral, psychological and physiological
pathways(Berkman & Glass, 2000):
In the health behavioral pathway, social support influences a persons
health behavior. A lack of social support is, for example, associated
with excess smoking (to relieve psychological distress), an unhealthy
diet and a lack of exercise, and less use of health services when ill.
In the psychological pathway social support affects mental health
through such factors as self-esteem and self-efficacy.
The perception of social support strengthens the coping abilities of the
person, and hereby reduces stress and its negative physiologicaleffects on health, for instance through the immune system or the
cardiovascular system. Cassel (1976); Shields (2004) found that
social support served as a protective factor to peoples vulnerability
on the effects of stress on health.
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Chapter 4: Social Support & Suicide 183
Social Support Among Different Cultures
Glazer (2006) stated that propositions regarding the relationship between
social support and culture suggest that people in Anglo and Western
European nations perceived greater emotional support than people in Latin
and Eastern European nations, followed by people in Asian nations. In
addition, Eastern and Western Europeans perceived greater instrumental
support than Latinos and Anglos, who are expected to perceive greater
support than Asians. Westerners tend to view a person as independent and
separate from other people, whereas Asians tend to view a person as
fundamentally connected with others (Markus & Kitayama, 1991; Shweder
& Bourne, 1984; Triandis, 1989). This difference might lead to the
assumption that coping via social support would be especially common
among Asians, because they place emphasis on interconnectedness with
their social group. In fact, however, the opposite may be the case.
The idea that social support involves specific transactions whereby one
individual enlists the help of another in service of his or her problems may
be a particularly Western conceptualization of social support. The
independent view of the self that is prevalent in the Western cultural context
holds that individuals take actions that are oriented toward the expression of
their opinions and beliefs, the realization of their rights, and the achievement
of their goals (Fiske et al., (1998); H. Kim & Markus, (1999). The
conceptualization of social support in terms of explicit transactions
presupposes that it is appropriate to enlist others in meeting those goals.
Thus, stressed individuals may focus primarily on themselves and their goal
of coping with the stress and recruit the time and attention of others in this
process.
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Chapter 4: Social Support & Suicide 184
In contrast, Asians tend to view a person as primarily a relational entity,
interdependent with others. In these cultural contexts, social relationships,
roles, norms, and group solidarity typically are more fundamental to social
behavior than an individuals needs. This interdependent view of the self
holds that a person should conform to social norms and respond to group
goals by seeking consensus and compromise; as such, personal beliefs and
needs are secondary to social norms and relationships (Fiske et al., (1998);
H. Kim & Markus, (1999).
In Asian cultural contexts, because emphasis is placed on maintaining
harmony within the social group, any effort to bring personal problems tothe attention of others or enlist their help may risk undermining harmony
and/or making inappropriate demands on the group (Taylor et al., 2004).
There is some research on social support transactions and their effects in
Asian countries. The research has largely focused on specific stressors, such
as managing a mentally retarded child (Shin, 2002) or caring for an elderly
parent (Ng, 2002). Many of these studies are exploratory surveys that
provide descriptions of support needs without examining cultural influences.
Nonetheless, several findings are consistent with the above reasoning.
Research shows that European Americans are more likely to report needing
and receiving social support than are Asians and Asian Americans (Hsieh,
2000; Shin, 2002; Wellisch et al.,1999). Moreover, one study (Liang &
Bogat, 1994) found that received social support had negative buffering
effects for Asians (i.e., it made Asians feel more stressed).
Taylor et al. (2004) research highlights the importance of considering
culture in order to understand why and how people seek the advice and
comfort of others when facing stressors. It reveals that there are significant
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Chapter 4: Social Support & Suicide 185
cultural differences in the use of an important resource for managing
stressful events, namely, social support. Whereas European Americans
explicitly recruit their social networks for help and solace in coping with
stressful events, Asians and Asian Americans do so to a lesser extent
Taylor et al. (2004) research also shows that social support seeking takes
place within a cultural context in which people by and large understand and
live according to a particular view of their relationships. The decision to
seek or not to seek social support is guided by the norms and concerns of a
given culture. If what comes to a persons mind when he or she is
considering seeking social support are the faces of concerned family andfriends, then it may be a bit hard to say help out loud.
Conservatism vs. Autonomy culture values likely explains variations in
social support. People in Autonomous cultures reported greater emotional
support and less instrumental support than people in Conservative cultures
(Glazer, 2006)
Mental Health and Social SupportLarge number of studies suggest that poor social support is associated with
mental health problems, such as depression (Brown & Harris, 1978; House,
1981; Schaefer et al., 1981; Dalgard et al.,1995). Low level of perceived
support is associated with ill-health (both e.g. depression and somatic
diseases (MINDFUL, 2008)
Lehtinen et al. (2005) conducted a study which revealed the strong
association between mental health and social support. Strong link between
social support and mental health has also been found in many other studies
(Julian et al., 1992; Dalgard et al., 1995; Kendler et al., 2000, Sohlman B,
2004). The most interesting finding ofLehtinen et al.(2005) study, however,
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was the evidence that the level of social support predicted the state ofpositive mental health in between-country comparisons.
Countries with the highest level of social support (i.e. Sweden and Ireland)
tend to report the lowest levels of psychological distress and vice versa
(EORG, 2003). A significant association between strong social support and
positive mental health, in the sense of coping resources, like energy and
vitality, was found (EORG, 2003; Lehtinen et al., 2005).
Okasha (2005) stated that eastern cultures emphasize social integration
more than autonomy (i.e., the family and not the individual is the unit of
society). An Egyptian study was carried out to determine the effect offamilies expressed emotions and patients perception of family criticism in
predicting depression and to evaluate trans-cultural differences in
assessment of these measures. The results showed that criticism level that
best differentiated relapsers and nonrelapsers was much higher than
previously reported in Western studies (Okasha et al., 1994)
Cavalheri (2010) found that a new paradigm for treatment and
management of the mentally ill through deinstitutionalization, rehabilitation
and psychosocial reintegration. In this model, the ways they are treated have
been transformed, and the object of treatment is no longer the disease and
became the life; the suffering of the individual and their relationship to the
social body. So the emphasis is not focused more on the healing process but
the project of "invention of health" and "social reproduction of the patient
The living with the disease, physical or psychiatric, is very difficult and
stressful for the family group, which worsens when it tends to be prolonged,
repeated displays of acute manifestations and, especially, is experienced as
disabling and stigmatizing that generates overhead of a physical, emotional
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Chapter 4: Social Support & Suicide 187
and economic, altering the family dynamics and compromising health, social
life, relationship between members, leisure, financial status, domestic
routine, work performance, and countless other aspects of living (Melman,
2001; Pegoraro and Caldanha, 2006)
To address these issues have been suggested family interventions, through
educational activities for informational purposes, extension of emotional
resources and coping skills to intervene in particular situations, beyond
deconstruction of representations prejudiced about mental illness. It is
therefore relevant to the role of mental health services to host and prepare
them in expanding their capabilities (Mao, 2003).
Social Support and Suicide
Since the late-nineteenth century, scholars have investigatedhow structural
elements within a communitywhat is nowcalled social supportrelate to
suicide (Winfree and Jiang , 2010).CDC (2007) listed family and community support in the list of protective
factors from suicide.
Research dating back over 100 years suggests that social fragmentation
may influence suicide as Durkheim recognized the importance of anomie
(social fragmentation) in influencing suicide (Durkheim, 1897, 1952).
Durkheims work on suicide has been cited as evidencethat modern life
disrupts social cohesion and results in a greaterrisk of morbidity and
mortality including self-destructivebehaviors and suicide (Kushner and
Sterk, 2005), and a growing body of evidence supports his view that lack of
social support by family or community is believed to be a risk factor for
suicide and emotional and psychological support in friends and family
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Chapter 4: Social Support & Suicide 188
members helps as a safeguard against suicide (Lester, 1988; Whitley et al.,
1999; Smith et al., 2004; Masocco et al., 2009).
In deed "The notion that social cohesion is related to the health ofa
population,"Kawachi et al. (1997) wrote, "is hardly new. One-hundredyears
ago, Emile Durkheim demonstrated that suicide rates were
higher in
populations that were less cohesive".
For Durkheim,
social cohesion,
especially traditional family life, providedthe best protection against self-
destructive behavior (Baudelot and Establet, 1984).
According to Durkheims theory, social isolation and household Size,
disintegration, and disconnectedness lead to suicide. As a proxy for socialisolation, variables such as household size and proportion of one-person
households are used (Chen et al., 2009)
Neumayer,s (2003) study shows that household size has a significantly
negative effect on female suicide rates and an insignificantly negative effect
on male suicide rates.
Burr et al. (1994) used the proportion of one-person households in a
metropolitan area as the indicator of social isolation and shows a positive
relationship between the proportion of one-person households and suicide
rates.
Daly and Wilson (2006)showed that as per U.S. aggregate data, the share of
married people had a significantly negative impact on suicide rates in both
1990 and 2000, whereas that of single/never married people had a
significantly positive impact on suicide rates in the individual level data.
Chuang and Huang (2003) used the proportion of widowed population in
each region in Taiwan as the indicator of social isolation and shows that its
impact is significantly negative on the total suicide and female suicide rates
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Chapter 4: Social Support & Suicide 189
but not on the male suicide rate. It is surprising that a region with a greater
proportion of widows has a significantly lower suicide rate. The researchers
argue that the existing widowed population may include those who have
been widowers for some time and have built enough resilience; therefore,
they are at less risk for suicidal behavior than widowers who have just lost
their husbands. Daly and Wilson (2006) also found that the share of
widowed people had a negative relationship with suicide rate in U.S.
counties in 1990 and 2000; however, they provided no explanation for it.
Neumayers (2003) research results on wide range of socialexplanatory
variables based on Durkheimian
sociological theory in estimation
of suiciderates in a large panel of up to
68 countries during the period 1980 to 1999;
suggestthat economic and social factors affect cross-country differences
in
suicide rates in accordance with theory. More importantly this suggests that
the vastmajority of the existing literature, which typically fails to
control for
national cultures of suicide and suggests socioeconomicfactors as important
determinants of suicide, can still be expectedto come to valid results.
Houle et al. (2005) conducted a study is to investigate whether socialsupport may constitute a protective factor for attempted suicide among men
and, if so, to identify the most important sources and forms of support.
Results indicated that the men who attempted suicide perceive less support;
and are less satisfied with the support they received following the stressful
event that occurred.These results are in the same direction as those reportedin previous studies (Sokero et al. 2003;Botnick et al. 2002; Eskin, 1995,
Lewinsohn et al. 1993;Veiel et al., 1988).
Tangible support (lend money, temporary shelter, helping to move, for
example) and the assurance of its value (valuing the individual, recognizing
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Chapter 4: Social Support & Suicide 190
his skills, for example) are forms of are the forms of support that appear to
be of most importance. This study highlights the importance of social
support in the prevention of suicidal behavior among men (Houle et al.,
2005).
Social support was found to have a significant independent protective
effect on suicide (Chen et al., 2006). The association between poor social
integration and suicide is robust and largely independent of the presence of
mental disorders (Dubersteinet al., 2004), negative correlation between
societal suicide rates and social integration was found by (Shah, 2008).
Studies indicate that people living in deprived areas generally have highsuicide rates (Gunnell et al., 1995; Bunting and Kelly, 1998; Whitley et al.,
1999). A review of the risk of suicide in the homeless showed increased
suicide mortality among the homeless persons (Nordentoft, 2007).Other
analyses suggest that the proportion of single person households in an area
may be the strongest predictor of suicide (Ashford and Lawrence, 1976;
Saunderson et al, 1998).
Zhang et al. (2010) stated that risk factors among suicide victims include
lower level of social support. Recent research on suicide in China reveals
increasing rates of suicide duo to high number of rural, young females who
experience acute interpersonal crises and then commit suicide (LawandLiu
,2008)
As a general rule, suicide rates are highest among relatively more prosperous
countries, particularly those which have developed rapidly. Within these
countries, suicide rates are highest for sub-groups that have remained socio-
economically disadvantaged. And this has been associated with a heightened
risk of suicide among those remaining in rural settings, perhaps because of
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Chapter 4: Social Support & Suicide 191
economic hardship, lack of social support and isolation (Vijayakumar et al.,
2008).
On the contrary and in contrast to Durkheim; Steinmetz (1894) found that
women living in the most socially integrated societies had a greater
incidence of suicide than men. Johnson (1979) suggestedthat women most
submerged in the family display the greatestfemale suicidal behavior. Her
views have been affirmed by recentreports that the highest rates of suicide
in the world are foundamong rural Chinese women (Law and Liu, 2008).
This reinforcesthe conclusion of historian Roger Lane,
who found that
contrary
to Durkheims assumptions, increases in suicide rates
were linked tosocial integration. Lane found that as 19th-century
Philadelphia urbanized,
its suicide rate grew proportionallygreater than its homicide rate. Lane
reasoned that the increasingincidence of suicide in late-19th-century cities
served as abarometer of social integration because suicide, unlike homicide,
indicated internalization of social anger (Kushner and Sterk, 2005).
Kunitzs (2004)study on the effect of over-integration in the family in the
southwestern United States supports the viewsof Johnson and Lane. Social
relations within extendedfamilies, Kunitz found, often resulted in negative
health outcomes,including significantly higher rates of depression and self-
destructivebehaviors.
A study in England over 30 years period bySchapira et al. (2001) showedthat nearly threefold increase in the number living
alone in the general
population was associated with a marked fall in suicide among them,
suggesting that the social disorganisationof urban areas with high suicide
rates found by Sainsbury (1955) did not occur . However, living alone was
still associated with a significantly increased suicide risk.
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Suicide in Asia is a significant and complex phenomenon. The
epidemiological profile of suicide in Asian countries differs from the typical
profile reported in the scientific literature, because the latter has generally
been gleaned from studies conducted in European countries and the United
States of America. This may be explained, at least in part, by the complex
web of socio-economic, cultural and religious factors in Asian countries
(Vijayakumar et al., 2008)
In their study on suicide in the Asian region(Vijayakumar et al., 2008)
included three South Asian countries (India, Sri Lanka, and Thailand),
belonging to the WHO South-East Asia Region, and one country belongingto the WHO Eastern Mediterranean Region (Pakistan), and eight countries
(Australia; China; Japan; Malaysia; New Zealand; the Republic of Korea;
Singapore; Viet Nam; and China, Hong Kong, Special Administrative
Region [Hong Kong SAR]),belonging to the WHO Western Pacific Region.
(Vijayakumar et al., 2008) found that with the exception of Australia and
New Zealand, which share similarities with European countries and the
United States of America, participating Asian countries; have traditionally
been characterized by the dominance of extended family systems,
dependence on the family, and the fact that family loyalty overrides
individual concerns these factors may help to explain some of the patterns of
suicide that are characteristic of these countries; the role of the family seems
to be changing. Being married, for example, appears to be less protective
against suicide in developing Asian countries than it is in Europe and the
United States of America, with studies in China and India finding that single
individuals are no more vulnerable to suicide than their married counterparts
(Phillipset al., 2002)
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Weissman et al. (1999) assessed suicide ideation and attempts in 9
different countries; the United States, Canada, Puerto Rico, France, West
Germany, Lebanon, Taiwan, Korea and New Zealand, results revealed that
while the rates of suicide ideation varied widely by country, the rates of
suicide attempts were more consistent across most countries. The variations
were only partly explained by variation in rates of psychiatric disorders and
divorce or separation among countries.
The convergence of socio-demographic effects on suicide appears to vary
across cultures. For instances, an epidemiological study in Japan found that
suicide rates were higher in people where marriage was more common anddivorce was less common (Chandler and Tsai, 1993); a Pakistan study also
revealed that more married women committed suicide than did unmarried
women (Khan and Reza,2000) .
Brown (2001) stated that an increase in suicides in developing countries was
observed, with loss of tradition, social cohesion, and spontaneous social
support. The culture of these countries became more individualistic and so
making the people more vulnerable to suicide.
Faupel et al. (1987) show that the percentage of people living alone has the
most negative effect on suicide rates in the most urban counties as compared
to the middle urban or least urban counties.
Nevertheless, a reading of Durkheims evidence supportsthe opposite
conclusion, that is, that the incidence of suicideis greatest among those most
subsumed in social groups. Durkheimsdata revealed that the highest suicide
rates were found amongthose who were most socially integrated (Kushner,
1995).
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Chapter 4: Social Support & Suicide 194
Bille-Brahe et al. (1999) surprisingly found that suicide attempters in their
study agree in feeling that their needs for support were met to a great extent.
While consistent with many studies, lived alone (Duberstein et al., 2004;Heikkinen et al.,1997) and never married (Kposowa ,2000; Qin et al., 2003)
were found to be significant risk factors for the middle-aged suicides .
Wong et al. (2008) in their study found that a few protective factors
including social support and social problem-solving ability, did not achieve
statistical significance among adults aged 3049years. However, they were
found statistically significant as risk factors.
While Winfree and Jiang (2010) foundthat feeling safe at school was
oneof the most consistent protective factors in their study about youthful suicide
andsocialsupport.
A study led by Cook et al. (2002) proved that the strong religious faith
and social support of older African Americans may be key factors in why
they die by suicide far less often than whites. While Wiktorsson et al. (2010)
found that attempted suicide in the elderly was associated with being
unmarried and living alone. Lower social interaction patterns and lower
perceived social support were significantly related to suicidal ideation as
found by (Rowe et al., 2006), neither objectively determined size of social
network nor instrumental support was associated with suicidal ideation;
concluding that subjective social support is a potentially modifiable risk
factor for suicide in later life (Rowe et al., 2006).
Suppapitiporn et al., (2004); Holma et al., (2010) found that depressed
patients who attempted suicide were more likely to report fewer of friends
and a lower level of social support.
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Chapter 4: Social Support & Suicide 195
Social environment factors including deficits in family functioning, lower
levels of family adaptability and family cohesion, deficits in social support
and lower levels of social embeddedness were associated strongly with
suicide attempts and increased the relative rate of suicide attempts among
low-income African American men and women (Compton et al.,2005;Kaslow et al., 2005).
Assessment of patient's support network as well as their perception of
available social support should be included in the evaluation of depressed
patients particularly in those with substance use disorder and intervention to
prevent suicide should focus more on increasing their capacity to obtainsocial resources and modulating their perception (Suppapitiporn et
al.,2004).
RehkopfandBuka (2006) found that analyses at the community level are
significantly more likely to demonstrate lower rates of suicide among higher
socio-economic areas. Also measures of area poverty and deprivation were
most likely to be inversely associated with suicide rates.RehkopfandBuka(2006) concluded that the heterogeneity of associations is mostly accounted
for by study design features that have largely been neglected in literature.
Wong et al., (2008) further added that these inconsistent findings suggest
that the relationship between social factors and suicide is equivocal when
cultural issues were taken into account.
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Rehkopf%20DH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Buka%20SL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Rehkopf%20DH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Rehkopf%20DH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Buka%20SL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Buka%20SL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Buka%20SL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Rehkopf%20DH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Buka%20SL%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Rehkopf%20DH%22%5BAuthor%5D8/2/2019 Chapter 4 Suicide and Social Support
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Chapter 4: Social Support & Suicide 196
Summing Up
Social support is defined as the individual belief that one is cared for and
loved, esteemed and valued, and belongs to a network of communication and
mutual obligations.
The concept of a social network represents the ties to family, friends,
neighbors, colleagues, and others of significance to the person, there are
different types of social networks , the most common are:
a) Diverse, with distinct sources of potential support (family, friends,
neighbors, community groups) and with frequent contact;b) Focused on family
c) Focused on friends, and
d) Restricted in terms of potential sources of support and frequency of
contacts.
There are four main categories of social support: emotional, appraisal,
informational and instrumental.
Social support is a consequence of the interplay between individual factors
and the social environment e.g. age, sex, marital status, etc... Social support
may also be partly determined by genetic factors. However, when the social
network is described in structural terms, like size, range, density, proximity
and homogeneity, social support normally refers to the qualitative aspects of
the social network.
Social support affects a persons health through different pathways:
behavioral, psychological and physiological pathways.
Current research highlights the importance of considering culture in order to
understand why and how people seek the advice and comfort of others when
facing stressors. It reveals that there are significant cultural differences in the
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Chapter 4: Social Support & Suicide 197
use of an important resource for managing stressful events, namely, social
support. Whereas European Americans explicitly recruit their social
networks for help and solace in coping with stressful events, Asians and
Asian Americans do so to a lesser extent. There was evidence that the level
of social support predicted the state of positive mental health in between-
country comparisons.
Countries with the highest level of social support (i.e. Sweden and Ireland)
tend to report the lowest levels of psychological distress and vice versa.
Large number of studies suggested that poor social support is associated
with mental health problems, such as depression.Despite the extensive literature, there have been widely divergent findings
regarding the direction of the association between socio-economic
characteristics and suicide rates, with high-quality studies finding either a
direct relation (higher rates of suicide in higher socio-economic areas), an
inverse relation (lower rates of suicide in higher socio-economic areas) or no
association.
Durkheims work on suicide has been cited as evidencethat modern life
disrupts social cohesion and results in a greaterrisk of morbidity and
mortality including self-destructivebehaviors and suicide, and a growing
body of evidence supports his view that lack of social support by family or
community is believed to be a risk factor for suicide and emotional and
psychological support in friends and family members helps as a safeguard
against suicide.