Reflecting on World Suicide Prevention Day which took place over the weekend, Heather McClelland from the School of Health and Wellbeing at Glasgow University explains more about the link between suicide and loneliness and why tackling loneliness is so important.

Heather McClelland is a full-time doctoral research assistant at the School of Health and Wellbeing and is involved in a number of clinical projects predominantly exploring mechanisms associated with suicidal ideation and behaviour and supports for brain injury populations.  Her PhD explored the association between interpersonal factors in relation to suicidal ideation and behaviour (McClelland et al. 20222; McClelland et al. 2021; McClelland et al. 2020; McClelland et al. unpublished).

Loneliness and suicide in context

Approximately 703, 000 people die by suicide every year (WHO, 2021), with around 17% of the Western population believed to experience thoughts of self-harm or suicide at some point in their lifetime (ONS, 2017). Loneliness, on the other hand, is believed to be experienced by approximately 10% of the global population at some point across the lifespan (Surkalim et al., 2022). Given the considerable prevalence of both loneliness and suicidal thoughts and behaviour, it is critical to understand their relationship between them in order to protect our wellbeing and quality of life.

Loneliness, distinct from social isolation, in an emotional state which is not necessarily visible to others. Loneliness can occur regardless of whether the individual is surrounded by acquaintances, or entirely alone. Equally, those who are socially isolated (i.e., alone), may not necessarily feel lonely! Substantial research has explored loneliness in relation to physical and mental health (Valtorta et al., 2016), however recognition and in-depth explorations of loneliness in relation to suicidal thoughts and behaviours have only truly gained traction in recent years. A review of published research identified that loneliness was significantly associated later suicidal thoughts and behaviours, with evidence to suggest that this may be particularly pronounced in young adults and females (McClelland et al. 2020). Although the review had insufficient evidence to identify whether loneliness was associated with suicide death, the findings nonetheless confirmed that loneliness was a significant risk factor of later of suicidal thoughts and behaviour.

Research on loneliness: qualitative data

An argument commonly made of research literature is that studies often reduce experiences of mental health to numbers (e.g., ‘on a scale of 1 to 10, how lonely do you feel?’), with the individuals unique experiences often being lost or ignored. To overcome this, McClelland and colleagues interviewed a number of individuals to understand their experiences of social support and other interpersonal factors prior to their experience of suicide attempt (McClelland et al. 2022). Participants were first asked to describe events which were important to them prior to their suicide attempt, and then were asked about their experiences of social support prior to their attempt. Collectively, the interviews revealed that loneliness was a prominent factor which contributed to most participants suicide attempt.

Interestingly, the interviews also identified that experiences of loneliness originated from various sources, including romantic (often following a recent break-up), family (e.g., parent/ caregiver) or social networks (e.g., friends, community ties). Although different forms of loneliness had long been identified (Weiss, 1973), their unique role in relation to suicidal behaviour was less established (Lasgaard et al., 2011), especially when trying to identify why some lonely people go on to engage in suicidal behaviour, while others do not. Equally, participants expressed feelings of loneliness despite indicating that they had alternative supports were available to them at that time. This finding was also upheld by a larger, subsequent study (McClelland et al. 2021), where loneliness was found to be significantly associated with suicidal thoughts, even when social support was controlled for. That is, when all social support is equal, loneliness was still found to have a significant and unique association with suicidal thoughts. This illustrates that, in those experiencing thoughts of suicide, it really is possible to feel lonely in a crowd, with such experiences having a potentially devastating impact on both ones mental and physical wellbeing. Furthermore, the latest research has indicated that although all forms of loneliness must be recognised as significant (family, romantic and social), romantic loneliness may have the most harmful association with suicidal thoughts (McClelland et al. unpublished).

The importance of social support

Despite these findings between loneliness and suicidal thoughts and behaviours, evidence-based suicide prevention strategies (e.g., safety plans), highlight the importance of social support as a protective against self-harm. Many campaigns emphasise the value of listening to another’s experience of suicidal thoughts, without judgement or interruption, as an effective way to support mental health and prevent suicidal behaviour. Although prevention and intervention strategies continue to be challenging, the role of a sympathetic ear, and showing others that their life is valued, is vital in the on-going efforts to reduce with both loneliness and suicide.

References

Lasgaard, M., Goossens, L., Bramsen, R. H., Trillingsgaard, T., & Elklit, A. (2011). Different sources of loneliness are associated with different forms of psychopathology in adolescence. Journal of Research in Personality, 45(2), 233-237.

McClelland, H., Evans, J. J., Nowland, R., Ferguson, E. and O’Connor, R. C. (2020) Loneliness as a predictor of suicidal ideation and behaviour: a systematic review and meta-analysis of prospective studies. Journal of Affective Disorders, 274, pp. 880-896. (doi: 10.1016/j.jad.2020.05.004)

McClelland, H., Evans, J. J. and O’Connor, R. C. (2021) Exploring the role of loneliness in relation to self-injurious thoughts and behaviour in the context of the integrated motivational-volitional model. Journal of Psychiatric Research, 141, pp. 309-317. (doi: 10.1016/j.jpsychires.2021.07.020)

McClelland, H., Evans, J. J. and O’Connor, R. (2022) A qualitative exploration the experiences and perceptions of interpersonal relationships prior to attempting suicide in young adults. International Journal of Environmental Research and Public Health, 19(13), 7880. (doi: 10.3390/ijerph19137880)

McClelland, H., Evans, J. J. and O’Connor, R. The Association of Family, Social and Romantic Loneliness in Relation to Suicidal Ideation and Behaviour (unpublished)

ONS (2017): Self harm and suicidal thoughts and attempts – GOV.UK Ethnicity facts and figures (ethnicity-facts-figures.service.gov.uk)

Surkalim et al., 2022: The prevalence of loneliness across 113 countries: systematic review and meta-analysis | The BMJ

Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), 1009-1016.

Weiss, R. S. (1973). The study of loneliness. Loneliness: The experience of emotional and social isolation, 8-29.

WHO (2021): https://www.who.int/news-room/fact-sheets/detail/suicide