In this article, we’ll explore the relationship between the social determinations of health (SDOH) and suicide. If you read the news, or pay attention to current events related to public health, you’ve most likely heard about the problem of suicide in the U.S. With the exceptions of two years – 2019 and 2020 – rates of suicide have increased for all demographic groups over the past twenty years.
According to data published by the Centers for Disease Control (CDC), in the year 2022, suicide was the second leading cause of death for people ages 10-14 and 20=34, as well as the third leading cause of death for people ages 15-19.
To ensure the health and wellness of individuals in our local communities, and protect vulnerable individuals nationwide, it’s important to understand all the factors associated with suicide, with a focus on the factors that both increase risk of suicide and decrease risk of suicide, known as risk factors and protective factors, respectively.
Experts recognize a set of factors that impact suicide risk known as the social determinants of health (SDHO). Here’s how the Department of Health and Human Services (HHS) define the SDOH:
“The social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
There SDOH fall into five specific categories:
- Economic Factors
- Educational Opportunities
- Health Care
- Neighborhood and Environment
- Community Factors
Each category has a different impact of overall health and wellness, including physical health and mental health. Physical issues related to the SDOH include chronic illness and premature mortality, while mental health issues associated with the SDOH include increased rates of clinical mental health disorders, including suicidality.
The Social Determinants of Health (SDOH) and Suicide: New Research
The review paper Social Determinants of Health and Suicide-Related Outcomes: A Review of Meta-Analyses, published in January 2025, reviewed evidence from 46 meta-analyses with data from millions of patients collected over the past fifteen years.
The research team organized their efforts around answering this question:
Which social determinants of health are most strongly associated with suicide risk?
To clarify the terms we use above, a meta-analysis is a study that reviews all the available data on a specific topic up to that point in time. Therefore, meta-analyses can give us big picture ideas about what’s going on with the topic at hand. A review of meta-analyses takes this concept one step further: a review of meta-analyses is really a meta-analysis of meta-analyses, which means they can take big picture data and give us greater perspective and understanding than a single meta-analysis.
The review we’ll discuss in this article, as we mention above, analyzes data from millions of patients to assess any connection between the SDOH and suicidality, specifically suicide mortality, suicide attempts, and suicidal ideation. In this article, we’ll focus on suicide mortality and suicide attempts. Before we share the results, we’ll quickly review the latest available data on suicide fatalities. Below, for the purposes of comparison, we’ll look at two time periods, twenty years apart: 2001-2003 and 2021-2023
Long-Term Data: Suicide Fatalities in the U.S.
2001-2003:
- 2001: 30,622
- 2002: 31,655
- 2003: 31,484
2021-2023:
- 2021: 48,080
- 2022: 49,437
- 2023: 49,380
On average, the data shows a twenty-year increase – (2001 to 2003) – (2021 to 2023) – of around 56 percent. That increase, combined with the disturbing increases among pre-teens and adolescents, drives the current inquiries into what things may cause suicide and suicidality, such as the social determinants of health.
Suicide Mortality: Which Social Determinants of Health Are Associated with Increased Risk?
The research team assessed the impact of the various social determinants of health on suicide mortality, i.e. death by suicide. Here’s what they found:
The Social Determinants of Health and Suicide Mortality
Data shows strong associations between the following SDOH and overall suicide mortality:
- Incarceration
- Non-carceral involvement with the justice system, i.e. parole, probation, pending issues
- Exposure to another person dying by suicide
- Easy access to guns
- Divorce (medium to strong associations)
- Suicide of parent
- Living in foster care during childhood
Strong associations among middle-aged individuals (35-65) between the following SDOH and suicide mortality:
- Being single/unmarried
- Low income
- Divorce
- Unemployment
Strong associations between SDOH and suicide mortality, by occupation:
- Manual laborers
- Plant/machine operators
- Ship deck workers/crew
- Service/sales workers
- Skilled workers in:
- Agriculture
- Forestry
- Fisheries
In addition, the following workplace/work-related factors increase suicide mortality risk:
- Bullying
- Violence
- Financial stress
Those are the SDOH that increase risk of suicide mortality. The researchers also analyzed which SDOH decreased risk of suicide mortality. The following SDOH function as protective factors against suicide mortality.
SDOH and Suicide Mortality: Protective Factors
- Identification with specific religion/spiritual practice
- Work related protective factors:
- Managers/senior officials associated with decreased risk
- Clerical support workers associated with decreased risk
- Other demographic factors:
- Immigrant/refugee status associated with decreased risk
Next, the research team assessed the impact of the various social determinants of health on suicide attempts.
Suicide Attempts: Which Social Determinants of Health Are Associated with Increased Risk?
Here’s what the researchers found:
The Social Determinants of Health and Suicide Attempts
Data shows strong associations between the following SDOH and overall suicide attempts:
- Identification as LGBTQIA+
- Chronic childhood abuse
- Sexual assault
Moderate associations among youth and young adults between the following SDOH and suicide attempts:
- Any sexual abuse
- Exposure to another person dying by suicide
- Previous suicide attempts
- Childhood physical, sexual, or emotional abuse
- Parent dying by suicide
Data showed weak to moderate associations between the following SDOH and suicide attempts among youth and young adults:
- Emotional and physical neglect and/or abuse
- Any experience of interpersonal violence
- Maltreatment during childhood
- Experiencing bullying
- Experience of dating violence
- Exposure to violence in community
The following factors also showed a weak to moderate association with increased risk of suicide attempts:
- Workplace bullying
- Workplace violence
- Low parental education
- Divorce of parents
Those are the SDOH that increased risk of suicide mortality. As they did with suicide mortality, the researchers analyzed which SDOH decreased risk of suicide attempts. The following SDOH function as protective factors against suicide attempts.
SDOH and Suicide Attempts: Protective Factors
- School connectedness
- Identification with specific religion/spiritual practice
Let’s be clear: those aren’t the only protective factors against suicide attempts, they’re the specific social determinants of health associated with decreased risk of suicide attempts. There are a number of other protective factors that reduce both suicide mortality and suicide attempts. To learn more about protective factors for suicidality, click here.
How Can We Address the Ongoing Problem of Suicide?
First, we never ignore suicidal behavior.
That includes thinking about suicide, talking about suicide, and attempting suicide. If someone you know is at immediate risk of harm, call 911 or go to the emergency room immediately. If someone you know is in a mental health crisis but not at imminent risk of harm:
CALL 988 FOR THE NATIONAL MENTAL HEALTH EMERGENCY AND SUICIDE HELP LINE
NEVER IGNORE SUICIDALITY.
We’ll close this article with a list of priorities for addressing suicidality vis a vis the social determinants of health, as identified by the authors of the study we discuss throughout this article. The researchers suggest the following:
- Increase support for incarcerated individuals and people who live in foster care during childhood.
- Expand support and programs for suicide loss survivors, i.e. people who lose a loved one to suicide.
- Increase programs that promote safe firearm storage and overall firearm safety. Restricting access to lethal means significantly reduces risk of suicide attempts and suicide mortality.
- Expand employment opportunities for all people. Data indicates unemployment and low income increase risk of suicide attempts and suicide mortality.
- Reduce discrimination at school and in the workplace. Reducing the restriction of rights for LGBTQIA+ people may reduce the elevated rates of suicide attempts and suicide mortality in this and other institutionally marginalized demographic groups.
These suggestions all make logical sense, and align with common-sense perspectives on mental health and wellness. When we address inequities – especially those associated with adverse childhood experiences and economic hardship – we increase the ability of all individuals to meet their potential and live a life of their choosing. In some cases, the SDOH work against people. When we can change that, and find ways to make the SDOH work for people, then we can make progress on reducing a host of negative outcomes, up to and including suicidality.
Gianna Melendez
Jodie Dahl, CpHT