Families, Resources, and Suicide: Combined Effects on Mortality

Mortality is a social process (Cockerham, 2007; Phelan, Link, Diez-Roux, Kawachi, & Levin, 2004). Substantial bodies of research document the effects of social support and household relationships on health and mortality prospects in general (Berkman & Glass, 2000; Carr & Springer, 2010; Hughes & Waite, 2002; Umberson & Montez, 2010), showing that risks of death and some forms of ill health decrease with increased social ties and more supportive relationships. Research focusing on domestic relationships and suicide are robust, well documented, and wide ranging. Married persons are less likely than unmarried persons to commit suicide (Kposowa, 2000; Kposowa, Breault, & Singh, 1995), as are persons in larger families than persons in smaller families (Denney, Rogers, Krueger, & Wadsworth, 2009) and persons with children than persons without children (Denney, 2010; Qin, Agerbo, & Mortensen, 2003). Indeed, although families do not always exert positive effects on health (Seeman, 2000), individual propensity to suicide is related to how households are configured, and living in households with other relatives is generally protective (Denney, 2010; Qin et al., 2003).Other social and economic characteristics provide resources that are leveraged to lengthen life. Advantaged groups are positioned to purchase better health, have access to the latest technological advances and knowledge about healthy living, and have incentives to practice healthy habits (Glied & Lleras- Muney, 2008; Pampel, Krueger, & Denney, 2010). Specifically, employment and higher educational attainment extend life by creating additional networks of social support and integration (Berkman & Glass, 2000; House, Landis, & Umberson, 1988; Link & Phelan, 1995). Contemporary research on suicide has shown there is increased risk for the unemployed (Stack, 2000a) and for individuals who are not active in the workforce (Denney et al., 2009). Recent empirical work on education and suicide, however, is quite limited and has produced inconsistent findings (Denney et al., 2009; Kposowa et al., 1995; Stack 2000b).Despite conceptually clear links between familial and social and economic factors and suicide, research has focused on their independent effects, ignoring important ways in which they might combine to influence risk. The objective of this study was to illuminate how household formations combine with employment and educational attainment to influence suicide, a leading cause of adult mortality accounting for nearly 36,000 deaths in the United States in 2009 (Kochanek, Xu, Murphy, Minino, & Kung, 2011).THE COMBINED INFLUENCE OF HOUSEHOLDS WITH EMPLOYMENT AND EDUCATION: POTENTIAL MECHANISMSHouseholds broadly represent an individual's immediate social environment, the daily arena for social support and integration. Households can include spouses, friends, children, other relatives, and even hired caretakers; in this article, the terms household, family, and living arrangements are used interchangeably. The theoretical work connecting how core elements of household living arrangements, employment, and education-such as social support and integration-influence suicide suggests they may combine in unique ways. Households and employment may combine through a process of compensation, meaning that positive attributes from one factor override negative attributes from the other. Households and education also may combine through a process of reinforcement, meaning that positive attributes on both factors work together to further reduce mortality risks.Independence: Important but SeparateFirst, the effects of social support and integration garnered both in the home and through work and education might be distinct enough to create important but separate effects on suicide. To date, this is the approach taken by themajority of researchers concerned with the topic (Denney, 2010; Gibbs, 2000; Gibbs & Martin, 1964). …