Living Alone With Depression, Anxiety May Up Suicide Risk

TOPLINE:

Living alone and having both depression and anxiety was associated with a 558% increase in risk for suicide compared with living with others and without these conditions, a new population-based study showed.

METHODOLOGY:

• Researchers assessed data for more than 3.7 million adults (mean age, 47.2 years; 56% men) from the Korean National Health Insurance Service (NHIS) from 2009 through 2021 to determine the associations among living arrangements, mental health conditions (depression and anxiety), and risk for suicide.
• Living arrangements were categorized as either living alone (for ≥ 5 years) or living with others. Depression and anxiety were determined using NHIS claims.
• The primary outcome was death by suicide, identified using national death records; the mean follow-up duration was 11.1 years.
• Suicide cases were identified on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

TAKEAWAY:

• Overall, 3% of participants had depression, 6.2% had anxiety, and 8.5% lived alone. The mortality rate was 6.3%, with suicide accounting for 0.3% of all deaths.
• Compared with individuals living with others and without either depression or anxiety, those living alone and with both conditions had a 558% increased risk for suicide (adjusted hazard ratio [AHR], 6.58; 95% CI, 4.86-8.92; P < .001).
• Living alone and having depression only was associated with a 290% increased risk for suicide (AHR, 3.91), whereas living alone with anxiety only was associated with a 90% increased risk for suicide (AHR, 1.90).
• The association between living alone and risk for suicide was greater among middle-aged individuals (40-64 years) with depression (AHR, 6.0) or anxiety (2.6), as well as in men (AHRs, 4.32 and 2.07, respectively).

IN PRACTICE:

“These findings highlight the importance of considering living arrangements in individuals with depression or anxiety, especially for specific demographic groups, such as middle-aged individuals and men, in suicide risk assessments. Targeted interventions addressing these factors together are crucial to mitigate risk,” the investigators wrote. 

SOURCE:

The study was led by Daa Un Moon, MD, Charité Universitätsmedizin Berlin, Berlin, Germany. It was published online on March 26 in JAMA Network Open. 

LIMITATIONS:

The observational design prevented the establishment of causality among living arrangements, psychiatric conditions, and risk for suicide. Although living arrangements were assessed annually, researchers could not track dynamic changes during follow-up or assess the period of living alone between assessments. The group living together included diverse arrangements that may have had different associations with the risk for suicide. Psychosocial factors, including previous suicide attempts and stressful life events were not included in the study. Additionally, reliance on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for psychiatric conditions may have led to potential underreporting or misclassification due to the lack of systematic mental health assessments. Cultural and healthcare system–related differences in South Korea may have limited the generalizability of the findings to other populations. 

DISCLOSURES:

This study was funded by grants through programs supported by the Ministry of Science and Information and Communication Technology. The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.