Research dating back to Durkheim’s Suicide has linked high suicide rates to low social integration. Less research has examined community vulnerability to suicide clusters—characterized by an unusually high number of suicides in a time and place. In this study, we draw from recent qualitative research to hypothesize that social integration is positively associated with the emergence of suicide clusters, in contrast to the classic Durkheimian hypothesis. To test this hypothesis, we examine the association between three measures of social integration (divorce, Catholic adherence, and residential stability) and a novel measure of suicide clusters in 469 U.S. counties from 2006 to 2019 using data from the American Community Survey (ACS), Centers for Disease Control (CDC), and Religious Congregations and Membership Study (RCMS). We find that while social integration is negatively associated with suicide rates, social integration is positively associated with the emergence of suicide clusters. These findings shed light on the dual nature of social integration as both potentially protective and harmful for suicide.
AbrutynSeth. 2019. “Toward a General Theory of Anomie: The Social Psychology of Disintegration.”European Journal of Sociology60:109–36. doi: 10.1017/S0003975619000043.
2.
AbrutynSethMuellerAnna S.2014a. “Are Suicidal Behaviors Contagious in Adolescence? Using Longitudinal Data to Examine Suicide Suggestion.”American Sociological Review79:211–27. doi: 10.1177/0003122413519445.
3.
AbrutynSethMuellerAnna S.2014b. “Reconsidering Durkheim’s Assessment of Tarde: Formalizing a Tardian Theory of Imitation, Contagion, and Suicide Suggestion.”Sociological Forum29:698–719. doi: 10.1111/socf.12110.
4.
AbrutynSethMuellerAnna S.2016. “When Too Much Integration and Regulation Hurts: Reenvisioning Durkheim’s Altruistic Suicide.”Society and Mental Health6:56–71. doi: 10.1177/2156869315604346.
5.
AbrutynSethMuellerAnna S.OsborneMelissa. 2020. “Rekeying Cultural Scripts for Youth Suicide: How Social Networks Facilitate Suicide Diffusion and Suicide Clusters Following Exposure to Suicide.”Society and Mental Health10:112–35. doi: 10.1177/2156869319834063.
6.
ArgueAmyJohnsonDavid R.WhiteLynn K.1999. “Age and Religiosity: Evidence from a Three-wave Panel Analysis.”Journal for the Scientific Study of Religion38:423–35. doi: 10.2307/1387762.
7.
Association of Statisticians of American Religious Bodies (ARDA). 2022. Religious Congregations and Membership Study, 2000, 2010, 2020 (Counties File). Association of Statisticians of American Religious Bodies. Retrieved November 21, 2022 (https://www.thearda.com/data-archive?fid=RCMSCY).
8.
BakerJoseph O.WhiteheadAndrew L.2016. “Gendering (Non)Religion: Politics, Education, and Gender Gaps in Secularity in the United States.”Social Forces94:1623–45. doi: 10.1093/sf/sov119.
9.
BallerRobert D.RichardsonKelly K.2002. “Social Integration, Imitation, and the Geographic Patterning of Suicide.”American Sociological Review67:873–88. doi: 10.2307/3088974.
10.
BallerRobert D.RichardsonKelly K.2009. “The ‘Dark Side’ of the Strength of Weak Ties: The Diffusion of Suicidal Thoughts.”Journal of Health and Social Behavior50:261–76. doi: 10.1177/002214650905000302.
11.
BandoDaniel H.MoreiraRafael S.PereiraJulio C. R.BarrozoLigia V.2012. “Spatial Clusters of Suicide in the Municipality of São Paulo 1996–2005: An Ecological Study.”BMC Psychiatry12:124. doi: 10.1186/1471-244X-12-124.
12.
BarkanSteven E.2014. “Gender and Abortion Attitudes: Religiosity as a Suppressor Variable.”The Public Opinion Quarterly78:940–50. doi: 10.1093/poq/nfu047.
13.
BarkanSteven E.RocqueMichaelHouleJason. 2013. “State and Regional Suicide Rates: A New Look at an Old Puzzle.”Sociological Perspectives56:287–97. doi: 10.1525/sop.2013.56.2.287.
14.
BilsenJohan. 2018. “Suicide and Youth: Risk Factors.”Frontiers in Psychiatry9:1–5. doi: 10.3389/fpsyt.2018.00540.
15.
BlakelyTonyCollingsSunnyAtkinsonJune. 2003. “Unemployment and Suicide. Evidence for a Causal Association?”Journal of Epidemiology and Community Health57:594–600. doi: 10.1136/jech.57.8.594.
16.
BozzayMelanie L.LiuRichard T.KleimanEvan M.2014. “Gender and Age Differences in Suicide Mortality in the Context of Violent Death: Findings from a Multi-state Population-based Surveillance System.”Comprehensive Psychiatry55:1077–84. doi: 10.1016/j.comppsych.2014.03.017.
17.
BreaultKevin D.1986. “Suicide in America: A Test of Durkheim’s Theory of Religious and Family Integration, 1933-1980.”American Journal of Sociology92:628–56. doi: 10.1086/228544.
18.
CameronA. ColinTrivediPravin K.2022. Microeconometrics Using Stata, Volume : Cross-sectional and Panel Regression Methods. 2nd ed. College Station, TX: StataCorp LLC.
19.
Centers for Disease Control (CDC). 1988. “CDC Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters.” Retrieved September 4, 2021 (https://www.cdc.gov/mmwr/preview/mmwrhtml/00001755.htm).
Centers for Disease Control Prevention (CDC). 2022b. “Underlying Cause of Death, 1999-2020.” Retrieved February 21, 2022 (https://wonder.cdc.gov/ucd-icd10.html).
23.
ChangShu-SenStucklerDavidYipPaulGunnellDavid. 2013. “Impact of 2008 Global Economic Crisis on Suicide: Time Trend Study in 54 Countries.”BMJ347:f5239. doi: 10.1136/bmj.f5239.
24.
CohenPhilip N.2014. “Recession and Divorce in the United States, 2008-2011.”Population Research and Policy Review33:615–28. doi: 10.1007/s11113-014-9323-z.
25.
ColemanJames S.1988. “Social Capital in the Creation of Human Capital.”American Journal of Sociology94:S95–120. doi: 10.1086/228943.
26.
CollinsRandall. 2004. Interaction Ritual Chains. Princeton, NJ: Princeton University Press.
27.
CurtinSally C.HedegaardHolly. 2019. Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2017. National Center for Health Statistics. Washington D.C.: Centers for Disease Control and Prevention. Retrieved November 21, 2021 (https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2017.pdf).
28.
DenneyJustin T.WadsworthTimRogersRichard G.PampelFred C.2015. “Suicide in the City: Do Characteristics of Place Really Influence Risk?”Social Science Quarterly96:313–29. doi: 10.1111/ssqu.12165.
29.
DurkheimÉmile. 1897 [1952]. Suicide: A Study in Sociology. Translated by SpauldingJ. A. Edited by SimpsonG.London: Routledge & Kegan.
30.
de VausDavidMcAllisterIan. 1987. “Gender Differences in Religion: A Test of the Structural Location Theory.”American Sociological Review52:472–81. doi: 10.2307/2095292.
31.
FontanellaCynthia A.SamanDaniel M.CampoJohn V.Hiance-SteelesmithDanielle L.BridgeJeffrey A.SweeneyHelen AnneRootElisabeth D.2018. “Mapping Suicide Mortality in Ohio: A Spatial Epidemiological Analysis of Suicide Clusters and Area Level Correlates.”Preventive Medicine106:177–84. doi: 10.1016/j.ypmed.2017.10.033.
32.
GearingRobin EdwardAlonzoDana. 2018. “Religion and Suicide: New Findings.”Journal of Religion and Health57:2478–99. doi: 10.1007/s10943-018-0629-8.
33.
GirardChris. 1993. “Age, Gender, and Suicide: A Cross-national Analysis.”American Sociological Review58:553–74. doi: 10.2307/2096076.
34.
GouldM. S.WallensteinS.KleinmanM. H.O’CarrollP.MercyJ.1990. “Suicide Clusters: An Examination of Age-specific Effects.”American Journal of Public Health80:211–12.
35.
HawCamillaHawtonKeithNiedzwiedzClairePlattSteve. 2013. “Suicide Clusters: A Review of Risk Factors and Mechanisms.”Suicide and Life-Threatening Behavior43:97–108. doi: 10.1111/j.1943-278X.2012.00130.x.
36.
HillNicole T. M.TooLay San (Tiffany)SpittalMatthew J.RobinsonJo. 2020. “Understanding the Characteristics and Mechanisms Underlying Suicide Clusters in Australian Youth: A Comparison of Cluster Detection Methods.”Epidemiology and Psychiatric Sciences29:1–10. doi: 10.1017/S2045796020000645.
37.
HoogheMarcVanhoutteBram. 2011. “An Ecological Study of Community-level Correlates of Suicide Mortality Rates in the Flemish Region of Belgium, 1996-2005: Suicide Rates in Belgium.”Suicide and Life-Threatening Behavior41:453–64. doi: 10.1111/j.1943-278X.2011.00047.x.
38.
JohanssonLarsLindqvistPerErikssonAnders. 2006. “Teenage Suicide Cluster Formation and Contagion: Implications for Primary Care.”BMC Family Practice7:32. doi: 10.1186/1471-2296-7-32.
39.
JohnsonAsal M.WoodsideJoseph M.JohnsonAllenPollackJacqueline M.2017. “Spatial Patterns and Neighborhood Characteristics of Overall Suicide Clusters in Florida from 2001 to 2010.”American Journal of Preventive Medicine52:e1–7. doi: 10.1016/j.amepre.2016.07.032.
40.
JoinerThomas E.2005. Why People Die by Suicide. Cambridge, MA: Harvard University Press.
41.
JonesLoring. 1989. “The Relationship Between Unemployment and Divorce.”Journal of Divorce12:99–112. doi: 10.1300/J279v12n01_06.
42.
KaplanAmitHerbstAnat. 2015. “Stratified Patterns of Divorce: Earnings, Education, and Gender.”Demographic Research32:949–82. doi: 10.4054/DemRes.2015.32.34.
43.
KassemAhmed M.CarterKris K.JohnsonChristoper J.HahnChristine G.2019. “Spatial Clustering of Suicide and Associated Community Characteristics, Idaho, 2010–2014.”Preventing Chronic Disease16:180429. doi: 10.5888/pcd16.180429.
44.
KleimanEvan M.2015. “Suicide Acceptability as a Mechanism of Suicide Clustering in a Nationally Representative Sample of Adolescents.”Comprehensive Psychiatry59:17–20. doi: 10.1016/j.comppsych.2015.02.002.
45.
KohlerUlrichKarlsonKristian BerntHolmAnders. 2011. “Comparing Coefficients of Nested Nonlinear Probability Models.”The Stata Journal: Promoting Communications on Statistics and Stata11:420–38. doi: 10.1177/1536867X1101100306.
46.
KowalskiGregory S.FaupelCharles E.StarrPaul D.1987. “Urbanism and Suicide: A Study of American Counties.”Social Forces66:85–101. doi: 10.2307/2578901.
47.
KulldorfMartin. 2022. “SaTScan.” TM User Guide for Version10.1.
48.
Kyung-SookWooSangSooShinSangjinShinYoung-JeonShin. 2018. “Marital Status Integration and Suicide: A Meta-analysis and Meta-regression.”Social Science & Medicine197:116–26. doi: 10.1016/j.socscimed.2017.11.053.
49.
LawlerEdward J.ThyeShane R.YoonJeongkoo. 2009. Social Commitments in a Depersonalized World. New York: Russell Sage Foundation.
50.
LesterDavid. 1996. “The Impact of Unemployment on Marriage and Divorce.”Journal of Divorce & Remarriage25:151–54. doi: 10.1300/J087v25n03_09.
51.
LesterDavid. 1997. “The Role of Shame in Suicide.”Suicide and Life-Threatening Behavior27:352–61. doi: 10.1111/j.1943-278X.1997.tb00514.x.
52.
LewinsohnPeter M.RohdePaulSeeleyJohn R.BaldwinCarol L.2001. “Gender Differences in Suicide Attempts From Adolescence to Young Adulthood.”Journal of the American Academy of Child & Adolescent Psychiatry40:427–34. doi: 10.1097/00004583-200104000-00011.
53.
LiuRuth X.2006. “Vulnerability to Friends’ Suicide Influence: The Moderating Effects of Gender and Adolescent Depression.”Journal of Youth and Adolescence35:454–64. doi: 10.1007/s10964-006-9028-7.
54.
Martinez-AlesGonzaloHernandez-CalleDanielKhauliNicoleKeyesKatherine M.2020. “Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention.”Current Topics in Behavioral Neurosciences46:1–23. doi: 10.1007/7854_2020_158.
MizeTrenton D.2019. “Best Practices for Estimating, Interpreting, and Presenting Nonlinear Interaction Effects.”Sociological Science6:81–117. doi: 10.15195/v6.a4.
57.
MokrosHartmut B.1995. “Suicide and Shame.”The American Behavioral Scientist38:1091–1103.
58.
MoodCarina. 2010. “Logistic Regression: Why We Cannot Do What We Think We Can Do, and What We Can Do About It.”European Sociological Review26:67–82. doi: 10.1093/esr/jcp006.
59.
MorrisonJames L.1987. “Youth Suicide: An Intervention Strategy.”Social Work32:536–37. doi: 10.1093/sw/32.6.536.
60.
MościckiE. K.1994. “Gender Differences in Completed and Attempted Suicides.”Annals of Epidemiology4:152–58. doi: 10.1016/1047-2797(94)90062-0.
61.
MuellerAnna S.AbrutynSeth. 2016. “Adolescents under Pressure: A New Durkheimian Framework for Understanding Adolescent Suicide in a Cohesive Community.”American Sociological Review81:877–99. doi: 10.1177/0003122416663464.
62.
MuellerAnna S.AbrutynSethPescosolidoBerniceDiefendorfSarah. 2021. “The Social Roots of Suicide: Theorizing How the External Social World Matters to Suicide and Suicide Prevention.”Frontiers in Psychology12:621569. doi: 10.3389/fpsyg.2021.621569.
63.
NäherAnatol-FieteRummel-KlugeChristineHegerlUlrich. 2020. “Associations of Suicide Rates With Socioeconomic Status and Social Isolation: Findings From Longitudinal Register and Census Data.”Frontiers in Psychiatry10:898. doi: 10.3389/fpsyt.2019.00898.
64.
Ngamini NguiAndreApparicioPhilippeMoltchanovaElenaVasiliadisHelen-Maria. 2014. “Spatial Analysis of Suicide Mortality in Québec: Spatial Clustering and Area Factor Correlates.”Psychiatry Research220:20–30. doi: 10.1016/j.psychres.2014.07.033.
65.
NiedzwiedzClaireHawCamillaHawtonKeithPlattStephen. 2014. “The Definition and Epidemiology of Clusters of Suicidal Behavior: A Systematic Review.”Suicide and Life-Threatening Behavior44:569–81. doi: 10.1111/sltb.12091.
66.
PescosolidoBernice A.GeorgiannaSharon. 1989. “Durkheim, Suicide, and Religion: Toward a Network Theory of Suicide.”American Sociological Review54:33–48. doi: 10.2307/2095660.
67.
PeduzziPeterConcatoJohnKemperElizabethHolfordTheodore R.FeinsteinAlvan R.1996. “A Simulation Study of the Number of Events per Variable in Logistic Regression Analysis.”Journal of Clinical Epidemiology49(12):1373–79. doi: 10.1016/S0895-4356(96)00236-3.
PortesAlejandro. 1998. “Social Capital: Its Origins and Applications in Modern Sociology.”Annual Review of Sociology24:1–24. doi: 10.1146/annurev.soc.24.1.1.
70.
RaleyR. KellySweeneyMegan M.WondraDanielle. 2015. “The Growing Racial and Ethnic Divide in U.S. Marriage Patterns.”The Future of Children25:89–109. doi: 10.1353%2Ffoc.2015.0014.
71.
RobinsAleeFiskeAmy. 2009. “Explaining the Relation between Religiousness and Reduced Suicidal Behavior: Social Support Rather Than Specific Beliefs.”Suicide and Life-Threatening Behavior39:386–95. doi: 10.1521/suli.2009.39.4.386.
72.
RobinsonJoTooLay San (Tiffany)PirkisJaneSpittalMatthew J.2016. “Spatial Suicide Clusters in Australia between 2010 and 2012: A Comparison of Cluster and Non-cluster among Young People and Adults.”BMC Psychiatry16:417. doi: 10.1186/s12888-016-1127-8.
73.
RothLouise MarieKrollJeffrey C.2007. “Risky Business: Assessing Risk Preference Explanations for Gender Differences in Religiosity.”American Sociological Review72:205–20. doi: 10.1177/000312240707200204.
74.
StackSteven. 2000. “Suicide: A 15-year Review of the Sociological Literature Part II: Modernization and Social Integration Perspectives.”Suicide and Life-Threatening Behavior30:163–76. doi: 10.1111/j.1943-278X.2000.tb01074.x.
75.
StrangDavidMeyerJohn W.1993. “Institutional Conditions for Diffusion.”Theory and Society22:487–511. doi: 10.1007/BF00993595.
76.
StrangDavidSouleSarah A.1998. “Diffusion in Organizations and Social Movements: From Hybrid Corn to Poison Pills.”Annual Review of Sociology24:265–90. doi: 10.1146/annurev.soc.24.1.265.
77.
SuggMargaret M.WoolardSarahLawrimoreMargaretMichaelKurt D.RunkleJennifer D.2021. “Spatial Clustering of Suicides and Neighborhood Determinants in North Carolina, 2000 to 2017.”Applied Spatial Analysis and Policy14:395–413. doi: 10.1007/s12061-020-09364-1.
78.
The Jed Foundation. 2017. Jed’s Comprehensive Approach to Mental Health Promotion and Suicide Prevention for Colleges and Universities. New York: The Jed Foundation.
79.
TooLay San (Tiffany)PirkisJaneMilnerAllisonSpittalMatthew J.2017. “Clusters of Suicides and Suicide Attempts: Detection, Proximity and Correlates.”Epidemiology and Psychiatric Sciences26:491–500. doi: 10.1017/S2045796016000391.
80.
TorglerBennoSchalteggerChristoph. 2014. “Suicide and Religion: New Evidence on the Differences Between Protestantism and Catholicism.”Journal for the Scientific Study of Religion53:316–40. doi: 10.1111/jssr.12117.
81.
TrovatoFrank. 1986. “Interprovincial Migration and Suicide in Canada, 1971-78.”International Journal of Social Psychiatry32:14–21. doi: 10.1177/002076408603200102.
82.
TsaiAlexander C.LucasMichelKawachiIchiro. 2015. “Association between Social Integration and Suicide among Women in the United States.”JAMA Psychiatry72:987–93. doi: 10.1001/jamapsychiatry.2015.1002.
83.
U.S. Census Bureau. 2022. American Community Survey 5-Year Estiamtes Public Use Microdata Sample. Retrieved November 21, 2022 (https://data.census.gov/mdat/#/).
84.
VittinghoffEricMcCullochCharles E.2007. “Relaxing the Rule of Ten Events per Variable in Logistic and Cox Regression.”American Journal of Epidemiology165(6):710–18. doi: 10.1093/aje/kwk052.
85.
WilsonBenSmallwoodSteve. 2008. “Age Differences at Marriage and Divorce.”Population Trends132:17–25.
86.
WongDavid W. S.2021. “Issues in the Current Practices of Spatial Cluster Detection and Exploring Alternative Methods.”International Journal of Environmental Research and Public Health18:9848. doi: 10.3390/ijerph18189848.
87.
WooldridgeJeffrey M.2013. Introductory Econometrics: A Modern Approach. 5th ed.Mason, OH: South-Western Publishing.
88.
WrayMattColenCynthiaPescosolidoBernice. 2011. “The Sociology of Suicide.”Annual Review of Sociology37:505–28. doi: 10.1146/annurev-soc-081309-150058.
89.
YeomYunho. 2021. “Analysing Spatial and Temporal Dynamics of Suicide in South Korea: An Application of the Dynamic Spatial Panel Data Model.”Geospatial Health16:1. doi: 10.4081/gh.2021.964.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
