Living Alone and Suicide Risk: A Complex Problem Requiring a Whole Population Approach

Death by suicide is one of the great challenges in public health. Suicide is a tragedy that affects not only the deceased individual but also everybody to whom that individual was connected. Yet, despite the link between death by suicide and social integration being long recognized and many efforts to reduce suicide rates in recent decades,1 the age-adjusted rate of suicide in the United States increased from 10.5 per 100 000 in 1999 to 13.9 in 2019.2 Before the pandemic, suicide was the 10th leading cause of death in terms of all-age mortality; in comparison, ageadjusted rates for the top three causes of death are 161.5 per 100 000 for heart disease, 146.2 for cancer, and 49.3 for unintentional injuries. Suicide is even more important among those younger than 65 years, ranking as the fifth leading cause of death.2 The US suicide rate is not atypical, with the suicide rate for other high-income countries being 13.7 per 100 0003 Thus, identifying how to best target interventions to address suicide is a global priority.In this issue of AJPH, Olfson et al. (p. 1774) describe who dies alone and how. The strongest associations between living alone and risk of suicide are for those with the most advantaged social positions, as indicated by education, income, and ethnicity. Looking at the results in additional detail provides more information. Among adults living with others, suicide rates decline with increasing income and education levels. Conversely, there is little evidence of any differences in suicide rates by income or education among people living alone, a finding that cannot be explained by chance.