Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: a nine-year follow up of the UK Biobank cohort

Shaw, R. , Cullen, B. , Graham, N., Lyall, D. , Mackay, D. , Okolie, C., Pearsall, R., Ward, J., John, A. and Smith, D. (2021) Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: a nine-year follow up of the UK Biobank cohort. Journal of Affective Disorders, 279, pp. 316-323. (doi: 10.1016/j.jad.2020.10.026) (PMID:33096330)

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Abstract

Background: The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design. Methods: Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes. Results: For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16). Limitations: Loneliness and emotional support were operationalized using single item measures. Conclusions: For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Ward, Dr Joey and Shaw, Dr Richard and Cullen, Dr Breda and Pearsall, Dr Robert and Smith, Professor Daniel and Mackay, Professor Daniel and Lyall, Dr Donald and Graham, Dr Nicholas
Authors: Shaw, R., Cullen, B., Graham, N., Lyall, D., Mackay, D., Okolie, C., Pearsall, R., Ward, J., John, A., and Smith, D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Journal of Affective Disorders
Publisher:Elsevier
ISSN:0165-0327
ISSN (Online):1573-2517
Published Online:14 October 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of Affective Disorders 279: 316-323
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
302957Mental Health Data PathfinderDaniel SmithMedical Research Council (MRC)MC_PC_17217HW - Mental Health and Wellbeing