The relationship between marital status and risk for suicidal thoughts, plans, and attempts: Evidence for a growing association.

Abstract

Background: Suicide is a public health crisis. Marital status has long been associated with a reduced suicide risk, though the culture and prevalence of marriage has changed substantially over previous decades. This report investigates whether the association of marriage and risk changed from 2008 to 2019.

Methods: Using data from the National Survey of Drug Use and Health (NSDUH), the association between marital status and risk of suicidal thoughts, plans and attempts in the previous year are analyzed. Interaction effects (time by marital status by sex) are tested in hierarchical regression models.

Results: Unadjusted data show that unmarried individuals are approximately three times more likely than married individuals to think about, plan, and/or attempt a suicide (all ps < .001) at any given point in time. This relationship holds after controlling for age, sex, race, income, religious observance, and education. The protective association of marriage is growing (with a year by married status odds ratio of 0.95-0.97 [p < .01]), a trend driven by the never married (as opposed to divorced or widowed individuals); never-married individuals are at increasing risk over time (all p < .001) for all outcomes observed (suicidal thoughts, plans, attempts).

Conclusion: The protective association of marriage against risk of suicidal thoughts, plans and attempts is growing at a time when many young people have de-prioritized marriage as an important life goal. Increased clinical attention may be warranted for individuals who are not married, especially those who have other significant risk factors for suicide.