اثرات زمانی جداسازی در افکار و رفتارهای خودکشی

Divorce has been identified as a risk factor for suicide. However, little research has been conducted on the time trajectory of the influence of relationship separation on suicidal outcomes. This study aimed to assess the effects over time of relationship breakdown and separation on suicidality. Data were drawn from 6616 Australian adults participating in the PATH through Life Project, a population-based longitudinal study. Suicidal ideation was reported by 406 participants (6.1%), and 99 (1.5%) reported a suicide plan or attempt in the past year. The effects of separation on suicidality were strongest soon after separation, with a nearly three-fold increase in ideation (adjusted OR = 2.73, p < 0.001) and an eight-fold increase in plans/attempts (adjusted OR = 7.75, p < 0.001) in the two years following separation, gradually diminishing subsequently. The period up to four years before a separation was also found to be a time of increased risk for suicidal thoughts and behaviours, while marriage was protective. Separation is a strong risk factor for suicidality and mental health services should target recently separated individuals.

It has been established in a number of studies that divorce is a risk factor for suicide, particularly in males (Cantor and Slater, 1995, Ide et al., 2010 and Kposowa, 2000). A review by Stack (2000) reported that 86% of cross-sectional studies with individual-level data that tested the effects of divorce reported a positive association with suicide deaths. A landmark study by Weissman et al. (1999) found that rates of suicidal ideation are elevated up to three-fold among individuals who have experienced separation or divorce. Completed suicide is also more common in separated people, particularly young males (Ide et al., 2010 and Wyder et al., 2009). However, the bulk of the literature has focused on ‘divorce’ as an indicator of current marital status, which is likely to be temporally distal from the often lengthy process of relationship breakdown. The influence of marital separation on suicidal outcomes over time has not been established (Ide et al., 2010). Jacobson and Portuges (1978) studied separation effects by categorising individuals into groups of pre-separation, recent separation and long-term separation, to examine suicidality among 238 community mental health patients (Jacobson and Portuges, 1978). They found a non-significantly increased risk of suicidal thoughts or behaviours in recently separated and long-term separated individuals compared to individuals who had discussed separation but remained partnered. A more recent retrospective study of deceased individuals reported that divorce in the year previous to death increased the odds of suicide by 60%, compared to a 30% increase for individuals who had divorced less recently (Stack and Scourfield, 2013). Previous longitudinal research has also identified the transition period leading into separation and divorce as a time of increased risk for general mental health problems (Wade and Pevalin, 2004). The present study aimed to better delineate the effects over time of relationship breakdown and separation on suicidality in a large community-based sample. Specifically, using longitudinal data to identify the timing of marital separation, we assessed whether the periods before and after a separation were times of increased risk for suicidal thoughts and behaviours, including suicide plans or attempts.