Social Status and Suicidal Activity Among Psychiatric Patients: Moderating Effects of Gender, Race and Psychiatric Diagnosis

Abstract

The relationship between suicide and social class has proved to be complex. Durkheim predicted suicide rates would increase with social status, while others thought the opposite. Results have been mixed. In some studies, suicidality has increased with increasing social status, and in other studies, the two variables have had an inverse relationship. These studies have been primarily conducted on general non-psychiatric populations The present study, in contrast, examines this relationship on a 20-year prospective longitudinal sample of 400 psychiatric patients (differentiated by psychiatric diagnosis) after index hospitalization. Of these, 160 patients show some sign of suicide risk (87 cases of suicidal ideation, 41 of suicide attempts, and 32 suicide completions). A complicated pattern emerges across psychiatric diagnosis, gender, and race. The great majority of patients show no statistically significant relationship between social status and suicide risk. At the maximally different extremes, however, a dramatic difference does emerge. White women diagnosed with nonpsychotic depression show a positive relationship between social status and suicide risk (p < .01) while black men diagnosed with schizophrenia show a negative relationship between these 2 variables (p < .02). The relationship between social status and suicidality among psychiatric patients varies across race, gender, and psychiatric diagnosis. More research needs to be done on this complex and important topic, especially with regard to samples of psychiatric patients. The role of anomie should be studied.

Keywords:

• diagnosis
• gender
• race
• social status
• suicide

AUTHOR NOTE

Kalman J. Kaplan, Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.

Martin Harrow, Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.

Correspondence concerning this article should be addressed to Kalman J. Kaplan, Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor (M/C 912), Chicago, IL 60612, USA. E-mail: [email protected]

ACKNOWLEDGMENTS

The authors would like to thank Robert Faull for his help in sorting and analyzing the original data in this study and Wenzel J. Rahming for his help in the review of the literature on the relationship between social status and suicide.

Notes

1 Specifically, Stack (1982b) emphasizes that that the increasing levels of education attained by African Americans since the late 1960s had not been accompanied by a comparable observable aggregate gain in the labor market, creating a situation of anomie (Durkheim, (1897/1951)).

Additional information

Funding

The authors would like to acknowledge the support of Dr. Les Sandow and the Portes Foundation in providing funds to begin to study the relationship between social status and suicide. The collection and analysis of data in this research was supported, in part, by USPHS grants MH26341 and MH068688 from the National Institute of Mental Health, USA to Dr. Harrow, a grant from the Foundation for Excellence in Mental Health Care (Dr. Harrow) and a grant to Dr. Kaplan from the Portes Foundation.