title: Association Between Social Integration and Suicide Among Women in the United States.
abstract: OBJECTIVE
  Suicide is one of the top 10 leading causes of mortality among middle-aged women. Most work in the field emphasizes the psychiatric, psychological, or biological determinants of suicide.
  
  
  OBJECTIVE
  To estimate the association between social integration and suicide.
  
  
  METHODS
  We used data from the Nurses' Health Study, an ongoing nationwide prospective cohort study of nurses in the United States. Beginning in 1992, a population-based sample of 72 607 nurses 46 to 71 years of age were surveyed about their social relationships. The vital status of study participants was ascertained through June 1, 2010.
  
  
  METHODS
  Social integration was measured with a 7-item index that included marital status, social network size, frequency of contact with social ties, and participation in religious or other social groups.
  
  
  METHODS
  The primary outcome of interest was suicide, defined as deaths classified using the codes E950 to E959 from the International Classification of Diseases, Eighth Revision.
  
  
  RESULTS
  During more than 1.2 million person-years of follow-up (1992-2010), there were 43 suicide events. The incidence of suicide decreased with increasing social integration. In a multivariable Cox proportional hazards regression model, the relative hazard of suicide was lowest among participants in the highest category of social integration (adjusted hazard ratio, 0.23 [95% CI, 0.09-0.58]) and second-highest category of social integration (adjusted hazard ratio, 0.26 [95% CI, 0.09-0.74]). Increasing or consistently high levels of social integration were associated with a lower risk of suicide. These findings were robust to sensitivity analyses that accounted for poor mental health and serious physical illness.
  
  
  CONCLUSIONS
  Women who were socially well integrated had a more than 3-fold lower risk for suicide over 18 years of follow-up.
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, MA 02114, USA.|Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA.|Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.affiliation: Department of Social and Preventive Medicine, Université Laval, Québec City, Québec G1V 2M2, Canada.|Population Health and Optimal Health Practices Research Unit, Centre Hospitalier Universitaire de Québec Research Centre, Québec City, Québec G1V 2M2, Canada.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Lucas
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012934:Social Isolation / Q000523:psychology*; D058992:Social Participation / Q000523:psychology*; D012944:Social Support; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014930:Women / Q000523:psychology*