Interaction Domains and Suicide: A Population-based

Panel Study of Suicides in Stockholm, 1991-1999

Peter Hedström, Singapore Management University and University of Oxford
Ka-Yuet Liu, Columbia University
Monica K. Nordvik, Stockholm University

This article examines how suicides influence suicide risks of others

within two interaction domains: the family and the workplace. A
distinction is made between dyad-based social-interaction effects
and degree-based exposure effects. A unique database including

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all individuals who ever lived in Stockholm during the 1990s is
analyzed. For about 5.6 years on average, 1.2 million individuals
are observed, and 1,116 of them commit suicide. Controlling
for other risk factors, men exposed to a suicide in the family (at
work) are 8.3 (3.5) times more likely to commit suicide than non-
exposed men. The social-interaction effect thus is larger within
the family domain; yet work-domain exposure is more important
for the suicide rate because individuals are more often exposed
to suicides of coworkers than family members.

As Bearman (1991) noted, an important insight in Durkheim’s classic

study of suicide was his recognition that the structure of social relations
is important for explaining variations in suicide rates. These insights were
only partly explored in Durkheim’s own work, however, and lack of relevant
data means that we still know far too little about how the social structures
in which individuals are embedded influence their suicide risks and the
suicide rates in society at large.
In this article we focus on one specific aspect of this: how suicides
among those with whom a focal individual interacts influence his/her
own suicide risk, and how such processes are conditioned by the social
structures in which they take place. Although we are primarily interested in
the structural aspects of suicides, we will pay a great deal of attention to
individual-level processes. Such processes are essential for understanding
why we observe what we observe, and when it comes to empirically

This research has been supported by grants from The Swedish Council for Working Life
and Social Research and the NEST/Path Finder initiative of the European Community, the
DYSONET and MMCOMNET projects. We wish to thank Yvonne Åberg, Peter Bearman,
Francois Collet, Fredrik Liljeros and the referees for their useful comments. Direct
correspondence to Peter Hedström, School of Social Sciences, Singapore Management
University, Singapore 178903, e-mail: phedstrom@[Link], or Nuffield College, New
Road, Oxford OX1 4RB, United Kingdom, e-mail: [Link]@[Link].
© The University of North Carolina Press Social Forces 87(2), December 2008
714 • Social Forces 87(2)

assessing the importance of network effects it is essential to control for

potentially confounding individual-level factors.
Our approach thus differs from what in the suicide literature is often
referred to as a “sociological” or “Durkheimian” approach to suicide
research, an approach that focuses on associations between suicide rates
in different population groups and various properties of these groups.1
Methodological developments during the past few decades as well as
the increased availability of data sets with detailed information on the
individuals at risk and their local social environments, allows for more
precise analyses of the social-structural aspects of suicide. Rather than

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focus exclusively on macro-level patterns, we focus on the links between
micro and macro, i.e., on how individuals’ suicide risks are affected
by characteristics of their social environments, and on how the social
domains in which suicides take place influence the extent to which others
are exposed to and influenced by them.
As will be discussed below, a range of studies suggest that exposure
to the suicide of another person is likely to increase the suicide risk of the
exposed individual. The data used have not always been ideal, however.
Ecological studies have the shortcoming of not adequately controlling
for individual-level risk factors, and in most ecological studies it is not
known who has actually been exposed to the suicide of another person
(Baron and Reiss 1985). With their small sample sizes and cross-sectional
designs or short follow-up periods, many individual-level analyses lack the
power to detect how suicides affect the suicide risks of others.
We have access to a unique Swedish database that allows us to
overcome some limitations of previous studies. The database is a panel
including all adults who ever lived in the greater Stockholm metropolitan
area during the 1990s. It includes detailed socio-demographic information
on all these individuals, including causes of death for all who died during
this period of time. In addition, and of crucial importance for this study, it
contains information that allows us to identify co-workers, relatives and
family members of a suicide.
The article also makes a theoretical contribution by highlighting the
importance of two types of network effects: a dyad-based social-interaction
effect and a degree-based exposure effect. We show that focusing on one
of these effects at the expense of the other can easily lead to a biased
understanding of the role that networks play in explaining suicide rates
and other macro-level outcomes.

Network Effects

Suicide risks have been linked to a range of medical and biological factors
including various psychiatric disorders and personality characteristics (see
 Interaction Domains and Suicide • 715
[Link]-Exposure
Figure Suicide-Exposure Effects
Effects from
Froman
anAction-Theory
Action-theory Perspective
Perspective

Beliefs of Individual j
Risk that Individual j
Suicide of Individual i Desires of Individual j Decides to Commit
Suicide
Opportunities of
Individual j

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Jacobs, Brewer and Klein-Benheim 1999). Although such factors typically
operate “behind the back” of the individuals, suicide researchers such as
Shneidman (1969) have long suggested that suicide should be seen as a
purposeful act aimed at solving one’s problems. It is useful to explicitly
analyze suicides as intentional actions because by adopting an action
perspective we are better positioned to understand the mechanisms
through which interactions with others are likely to influence a focal
individual’s suicide risk (see also Michel and Valach 1997).
Actions have been conceptualized and analyzed in numerous ways,
but a common denominator among most of these approaches is a view
according to which actions are seen and analyzed as a joint product of
reasons and opportunities.2 As suggested by Davidson (1980), Elster (1983)
and others, the cause of an action can be seen as a specific constellation of
desires, beliefs and opportunities in the light of which the action appears
reasonable and understandable. Beliefs and desires are mental events that
can be said to cause an action in the sense of providing reasons for the
action; they have a motivational force that allows us to understand and, in
this respect, explain the action.
As illustrated in Figure 1, to the extent that the suicide of one person
(“Individual i”) influences the suicide risk of another person (“Individual j”),
this influence must be mediated via the beliefs, desires or opportunities of
the latter person (see also Hedström 2005). In order to better understand
why and when network effects are likely to be important, it is essential to
specify clearly the mechanisms that are likely to be at work (see Hedström
and Swedberg 1998 for a general argument to this effect).
One belief-based interaction mechanism that has received some attention
is concerned with how exposure to the suicide of another person may change
the focal person’s beliefs about how others are likely to react were he to
commit suicide. For example, if a suicide generates considerable sympathy
towards the deceased individual, this may change the focal person’s beliefs
about how others are likely to react to his suicide in such a way that he
716 • Social Forces 87(2)

becomes more prone to commit suicide (see Cutler, Glaeser and Norberg
2001; Hankoff 1961). The mechanism is exemplified by the remark made
by a 13-year-old boy during the funeral of someone who committed suicide:
“How nice it would be to have all those people crying and making a fuss
over me.” (Hezel 1985:120)3 It is this mechanism that explains why most
media guidelines suggest that “glorification” of suicide and sensational
mass media reporting should be avoided (CDC 1994; WHO 2000).
Suicides of others may also influence the focal person’s beliefs about
his ability to commit suicide. As we know from research within numerous
other areas of life, the availability of social models is one key source of

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self-efficacy (Bandura 1994). Seeing that people similar to ourselves
succeed in performing a particular type of action tends to strengthen our
beliefs in our own ability to perform the same type of action. According
to Linehan et al. (1983), for example, such beliefs (what they refer to as
“courage”) are important for explaining why some suicidal individuals, but
not others, decide to take their own lives. Thus, the suicides of others
may increase the focal individual’s suicide risk by changing the focal
person’s self-efficacy beliefs.
Desire-related interaction mechanisms also are likely to be of importance.
In almost every culture, there is a strong normative pressure against
committing suicide (Farberow 1975).This may dissuade some individuals
from committing suicide who in another normative context would have
done so. In most areas of life, such normative pressures tend to be density
dependent in the sense that the strength of the normative pressure against
doing X is a negative function of the number of other people already doing
X (see Hedström 2005). This implies that an increased exposure to the
suicides of others will reduce the normative pressure against committing
suicide, thereby increasing the suicide risk.
In addition to these belief- and desire-related interaction mechanisms,
it also seems important to consider so-called “trigger mechanisms” or
events that change the cognitive status of an action alternative from being
a mere theoretical possibility to a consciously reflected upon alternative.4
As argued by Åberg (2003), each day of our lives we are faced with an
almost infinite number of possible action alternatives, but we consciously
reflect upon only some of them. In order to explain why individuals do
what they do, it is often essential to take into consideration events that
change the cognitive status of different action alternatives. Suicide is a
theoretical possibility for any of us, but rarely is it a consciously reflected
upon alternative (see Rudd 2000). The suicide of another person may
act as a trigger that causes a shift in perspective and turns suicide into
a more salient decision alternative (see Ward and Fox 1977). In this way
the suicides of some can influence the decision-making processes and
suicide risks of others.
 Interaction Domains and Suicide • 717

Previous Research on Exposure Effects

Previous research (Agerbo 2005; Qin, Agerbo and Mortensen 2002;

Runeson and Åsberg 2003) clearly suggest that high suicide risks are
associated with family histories of suicidal behavior. Less is known about
the mechanisms that may contribute to this. In addition to the mechanisms
discussed above, familial transmission of psychiatric disorder is likely to
be important (Egeland and Sussex 1985). Results from twin and adoption
studies furthermore suggest an important genetic component to suicide
(Brent and Mann, 2005). Much higher levels of concordance have been

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reported between monozygotic than between dizygotic twins (e.g., Roy
and Segal 2001), and Fu et al.’s (2002) large-scale twin study suggests
that genetic factors account for as much as 36 percent of the variation in
suicide ideation and 18 percent of the variation in suicide attempts. The
remaining variation nevertheless is substantial, which suggests that non-
genetic factors also are of considerable importance.
Turning to the effect of exposure to suicides of non-family members,
studies on the time-space clustering of suicides provide some indirect
evidence on the importance of exposure effects. For example, Gould et al.
(1990) found significant time-space suicide clusters among young people
in the United States and estimated that such clusters accounted for about
5 percent of all teenage suicides.
Another source of indirect evidence on exposure effects is the research
on the effects of mass media reports on suicides. Phillips (1974) conducted
the first large-scale study of mass media effects on suicide. He examined
monthly statistics on suicides in the United States from 1947 through 1968
and found that the publication of front-page newspaper articles on suicides
led to subsequent increases in the number of suicides (Phillips 1979,1980).
Although some studies have failed to replicate these findings (e.g., Horton
and Stack 1984; Kessler et al. 1989), results from a large number of studies
have converged in support of the existence of a systematic association
between media reports on suicides and subsequent suicide rates (Pirkis
and Blood 2001; Stack 2000). In particular, suicide risks appear to be more
influenced by reports of celebrity suicides than non-celebrity suicides: a
recent meta-analysis of 419 studies showed that studies which looked at
celebrity suicides were more than five times as likely to report an imitation
effect than the others (Stack 2005). One possible reason for why copy-cat
suicides are more likely after celebrity suicides is that such stories are
more widely reported and therefore reach large audiences, but it may also
reflect that people identify more strongly with well-known persons than
with those they know nothing about. 
Case studies of suicides in schools have similarly found that a suicide
typically leads to elevated rates of suicide and suicide attempts (Brent et
718 • Social Forces 87(2)

al. 1989; Poijula, Wahlberg and Dyregrov 2001). Studies using survey data
also suggest the existence of such effects (Bearman and Moody 2004;
Cerel, Roberts and Nilsen 2005; Hazell and Lewin 1993; Ho et al. 2000;
Lewinsohn, Rohde and Seeley 1994).

Interaction Domains and Suicides

The research summarized in previous sections thus suggests that a
systematic causal relationship is likely to exist between the suicides of
some and the suicide risks of others. Exposures, triggering events and

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the like are not randomly distributed in the population, however; in order
to understand why some individuals are more likely than others to commit
suicide, it appears essential to also consider the social structure in which
the individuals are embedded.
To clarify, consider the hypothetical ego-centered network in Figure
2. Person ℯ is directly tied to 10 other individuals (in reality the relevant
ego networks are much larger than this, of course). Given the interaction
mechanisms discussed above, if this person were to commit suicide, we
would expect it to directly affect the suicide risks of the alters.
The total effect of e’s suicide on the suicide rate, Ie, will depend on the
number of alters who become aware of e’s suicide and the effect that e
has on each of these alters. If we let pea represent the influence of e on
each of the ne alters to which e is directly linked, the total direct influence
of e is equal to5
ne

∑
I e = � peaea
a =1

Person-to-person networks such as that in Figure 2 are particularly useful

to focus on when patterns of interaction are fairly stable over time. But
as suggested by Hedström (2005), this is not always the case. Individuals
move between neighborhoods, schools, workplaces, etc., and during any
given period of time, individuals typically interact only with a subset of the
potential interaction partners in each domain. The amount of time devoted
to interactions with people at work, for example, may be more or less
stable over time, even though the specific people we interact with may
vary a great deal. Similarly, the influence that people at work have on us
may be more or less stable over extended periods of time, although the
specific people who exercise this influence may vary a great deal. In cases
like these, when the focus is on dynamic processes that unfold in networks
that themselves are changing over time, it is often more appropriate and
analytically more straightforward to focus on so-called catnets. Following
White (1965:3), a catnet is a network describing the relations that exist
between social categories, a category being a “bunch of people alike in
 Interaction Domains and Suicide • 719

Figure 2. Hypothetical
Figure Ego-centered
2. Hypothetical Network
Ego-Centered Network

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== Family
== Neighbor

== Co-worker

some respect.” Figure 3 contains an ego-centered domain-specific catnet

representation of the person-to-person network of Figure 2.
In this hypothetical example there are thus three relevant categories or
interaction domains, and the influence of e’s suicide on the suicide rate,
Ie, can be expressed as follows:
K

∑
I e = � p ekek ×
k =1
� neekk

where k indexes the domain, K the possible number of domains, peek k the
average influence of individual e upon those in domain k, and n ek ek the
number of individuals in domain k that are tied to e (excluding e).
The value of Ie shows the extent to which the effect of a suicide is
amplified by the social structure. If Ie is greater than zero we have a
positive social multiplier, and the greater Ie is the more amplified the
effect of e’s suicide will be. The extent of amplification depends upon the
specific combination of peek k and nek values. Individuals in certain domains,

Figure 3. Ego-Centered Catnet Representation of Figure 2

Figure 3. Ego-centered Catnet Representation of Figure 2

Domain 2: Work
n2 = 5
pe2

Domain 1: Family Domain 3: Neighborhood

n1 = 1 n3 = 4
pe1 e pe3
720 • Social Forces 87(2)

the immediate family for example, are likely to be greatly affected by

e’s suicide (the peek
k value is likely to be high for this domain), but the
number of individuals in this domain (nek) is likely to be rather low. In
other domains the opposite pattern will hold; the peek k values will be low
and the nek values will be high. Previous studies of exposure effects have
typically considered only a single domain and, as a consequence, they
have not been able to consider the variation and co-variation in the peekk and
nek values. In the empirical analyses presented below, we focus on how
these parameter values differ between the family domain and the work
domain. From a public-health perspective it is the specific combination of

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values that matters. That is to say, even if the peek
k -value is low, the public
health effect can be considerable if the nek-value is high, implying that
many individuals are exposed. And vice versa if the nek-value is low.

The Stockholm Database

The database we use in this study contains information on the entire adult
population (age range 18-64) in the larger Stockholm metropolitan area
for each year throughout the 1990s. Statistics Sweden assembled it by
merging various administrative and population registers. The data is of
high quality and missing values are virtually nonexistent. Constructing
a database like this is only possible in a country where all government
registers use the same identifying keys, in this case a personal ID number,
and when government authorities regularly register a large amount of
information about the individuals they come into contact with.
The database includes a range of demographic and socio-economic
information, information on both current and past family relations as
well as several generations of kinship relations derived from parent-
child information. It also includes information on places of work which
will be used to link individuals to each other. The data used in this study
consists of all individuals in the database who lived and worked in the
Stockholm metropolitan area at some point during the years 1991-1999,
and were in the age-range 18-64 at that point in time. In total, 1,195,098
individuals are included in the analyses, and each individual is observed
over an average of 5.6 years.
The outcome variable of interest refers to suicides and not to suicidal
ideations. Information from the National Cause of Death Register was
used to identify the suicide cases. We follow the usual practice in
suicide epidemiology and define a suicide on the basis of the following
cause-of-death codes: E950-E959 or E980-E989 for the years 1991-1996
(International Classification of Diseases, 9th revision) and X60-X84, Y87.0,
or Y10-Y34 for the years 1997-1999 (International Classification of Diseases,
10th revision). Because we use lagged independent variables, the suicides
 Interaction Domains and Suicide • 721
Figure 4a. Number of Individuals at Risk
Figure 4a. Number of Individuals at Risk
500000
450000
400000
Number of Individuals at Risk

350000
300000
Women
250000
Men

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200000
150000
100000
50000
0
92 93 94 95 96 97 98 99
Year

Figure
Figure4b.
[Link]
NumberofofSuicides
Suicides
140

120

100
Number of Suicides

80
Women
Men
60

40

20

0
92 93 94 95 96 97 98 99
Year
722 • Social Forces 87(2)

that we seek to explain took place from 1992 through 1999. All in all 1,116
suicides took place in the study population during these years.
Figure 4a and 4b shows how the number of suicides and the number
of individuals at risk changed during the 1990s. About 400,000 men and
400,000 women were at risk each year and between 54 and 118 men and
46 and 59 women committed suicide each year.

Methods

Since the events to be analyzed are recorded on an annual basis only, a

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discrete-time event history approach is used. We estimate the parameters
of the following type of model:

where pit equals the hazard rate, or the conditional probability that
individual i will commit suicide during year t , given that s/he was alive
at the beginning of year t, and α, γk, ,  and λ are logistic regression
coefficients to be estimated. xikt are individual-level risk attributes likely
to influence an individual’s suicide risk. Fit-1 is a variable measuring the
number of suicides that took place in individual i’s family during the
preceding year, and Wit-1 is a variable measuring the number of suicides
that took place in the individual’s workplace during the preceding year.
Family members were identified in two steps. First we identified the focal
individual’s partner, mother, father, siblings, children, grandparents and
grandchildren. Then we identified the mother, father, siblings, children,
grandparents and grandchildren of the family members identified in the
first step. All the individuals identified in these two steps were regarded
as family members of the focal individual.6 “Workplace” is defined as
the specific establishment in which the individual worked at the end of
November during the preceding year.
Before the parameters of the above model are estimated, the units
must be changed from persons to “person years” so that each person
contributes as many observations as the number of years that he
was at risk (see Allison 1982). For example, an individual who entered
our population in 1998 will only contribute one observation, while an
individual who entered in 1994 will contribute five observations. The set
of 1,195,098 persons included in these analyses contributed a total of
6.65 million person years.
The set of right-hand variables included in the analysis was guided by
findings from prior research. As background information to the event-
history analyses, these variables are described in tables 1a and 1b.
 Interaction Domains and Suicide • 723

Above we discussed in some

detail the reasons for including
the exposure variables. Let us
Women also in a highly telescoped manner
99.74
.25
.01

1.54

.05
.00
5.25

.79
.15
99.95
92.28

Table 3: Estimates of the Public-Health Effects of Suicide Exposures and Selected Comparison Events Measured in
mention a few words about why
Distribution (%)

the control variables described

in Table 1b were included in the
analysis. As far as age and gender
99.75
.25
.00

.77
4.14

.41
.04
99.95
.05
.00
94.64
Men

are concerned, Girard (1993) and

many others have shown that

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they are systematically related
to suicide risks even when
Exposures
Number of

controlling for a host of other

0
1
2

1
2
3
4
0
1
2
0

factors. The family type variables

are similarly included because
previous research has shown that
Standard Deviation

Women
.053

living alone is associated with an

.22
.44

elevated suicide risk (Heikkinen et

al. 1995). Having young children
has been found to be associated
Table 1a: Description of Exposure Variables Included in the Analysis

.051
Men
Table 1a: Description of Exposure Variables Included in the Analysis

.21
.33

with lower suicide risks, especially

among women (Qin, Agerbo
.00049
Women

and Mortensen 2003), but the

.0027

.11

protective effect appears to

Mean

decrease with the age of the

child (Cantor and Slater 1995).
Table 3 had < 100 where it should have been � 100

.00046
.0025
Men

.070

The country-of-birth variables are

Women

included because Johansson et

-6.43
-1.78

-10.16
-6.82
-6.64
.00

al. (1997) found that foreign-born

410
Number of exposures to

Number of exposures to

Number of exposures to
suicide at workplace in

Swedes had higher suicide risks

suicide at workplace

than the native born. Lorant et al.

Definition

-2.63
-6.45

-1.44
-.78
-3.86
-5.68
Men
suicide in family

(2005) found that low educated

706

men had higher suicide rates than

highly educated men, and having
a low income has similarly been
found to be associated with a
Actual Number of Suicides

� 100 employees
� 100 employees
Number of Suicides

Workplace exposure

higher risk of suicide (Qin, Agerbo

Exposure to suicide at

Exposure to suicide at
Exposure Variables

Exposure to suicide in

Removing Effect of:

workplace with more
than 100 employees

than 100 employees

and Mortensen 2003). Permanent

Family exposure
workplace with less

disability or sickness has similarly

Widowhood

been found to be associated with

Divorce

an increased suicide risk (Lewis

family

and Sloggett 1998), and so has

sickness-related absence from
 Table 1b: Description of Control Variables Included in the Analysis
Table 1b: Description of Control Variables Included in the Analysis
Distribution (%)

Results
Variable Name Definition Men Women
Family type Dummy variables distinguishing between:
Couple living together 50.4 50.3
One-person unita 11.9 18.22
Other 37.7 31.46
724 • Social Forces 87(2)

Children aged 0-3 years At least one child aged 0-3 living at home 13.3 13.6
Children aged 4-15 years At least one child aged 4-15 living at home 25.0 28.55
Country of birth Dummy variables distinguishing between:
Sweden 84.55 84.55
Finland 4.14 6.31
Denmark, Norway, Iceland .77 .83
Easter Europe other than former Yugoslavia 1.30 1.62
Australia, New Zealand, Oceania .00 .03
Other 9.24 6.67
Early retirement Retired early due to a medical reason 1.9 3.1
Social welfare recipient Received social welfare benefit 5.2 5.3
Divorce Divorced less than 5 years ago 3.5 3.6
Widow(er) Became widow(er) less than 5 years ago .15 .36
Unnatural death in family Exposed to unnatural death of family
member due to injury, homicide, or war .03 .04
be the case with widowhood (Agerbo 2005; Luoma and Pearson 2002).7

the effects that have been adjusted for the effects of the other covariates.8
report both the unadjusted bivariate associations between each covariate

the exposure variables, and unless specifically noted, the discussion refers to
The logistic regression results are presented in tables 2a and 2b, and we
work (Qin, Agerbo and Mortensen 2003). Research on negative life events

1994; Zisook, Chentsova-Dutton and Shuchter 1998), and this also appears to
such as unnatural deaths and divorces similarly suggest that exposure to
such events tends to elevate the suicide risk (Heikkinen, Aro and Lonnqvist

the effects of all the other covariates. We start by summarizing the effects of
and the risk of committing suicide, and the adjusted ones which control for

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 Interaction Domains and Suicide • 725

We included family size and

workplace size in the model to

1-8453
Women control for the possible effects of

0-8.7

0-7.4
18-65

0-27
0-18
the size of the interaction domain.
Range

We had not expected to find an

effect of family size, but we had

1-8453
0-8.7

0-8.8
18-65

0-29
0-18
Men

anticipated the possibility of

finding a positive workplace size
effect because it seemed plausible
Standard Deviation
Women

that it could be the proportion

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.46
12.4
5.4

1.9

3.8
1392.0 rather than the absolute number
of suicides that mattered. The
results are the reverse, however.
.52
Men
12.2
5.4

1.7

3.8
986.9

We find that individuals from

large families run a higher risk of
committing suicide than indivi­
b This category may include cohabiting couples who do not have any children in common.
Women

category may include cohabiting couples who do not have any children in common.

duals from smaller families, and

10.0
39.8

1.0

8.8
1.1

558.5

that the size of the workplace

Mean

has no independent effect on the

.73

suicide risk after controlling for the

Men

10.0
39.7

396.8
1.2

8.7

other covariates in the model (and

distinguishing between exposure
Logged amount (100’s SEK) due to illness or

in workplaces with more and with

Number of family members in the extended
Logged total disposable income (in base-

less than 100 employees).

family (not including the focal individual)
Number of employees at the workplace

The exposure variables behave

more or less as expected. This
One base-amount is approximately equal to 33,000 SEK
base-amount is approximately equal to 33,000 SEK

is particularly true for exposure

work related injuries received

within the family. The odds ratios

are extremely high for women as
well as for men, suggesting an
Years of education

amountsb) in year t
Age in November

eight- to nine-fold elevated risk for

those who have been exposed to
the suicide of a family member.9
It is important to keep in mind
that this “social-interaction effect”
is likely to be upwardly biased,
1392.0 is aligned now.

Benefits for illness or work

Table 1b: Continued

however. The suicide propensities

Table 1b continued

of two members of the same

Educational level

family are likely to be associated

Workplace size
related injuries

because of common ancestry as

Family size

well as unmeasured common

Income

a Notes:

environmental influences. Such

Notes:
CA,

One
This
Age

factors are not properly captured

b
a
Table 2a: Parameter Estimates of Discrete Event-History Models. Men.
Table 2a: Parameter Estimates of Discrete Event-History Models for Men
Men
n = 601,245; N = 3,338,578
Unadjusted Adjusted
Variable b OR 95%CI b OR 95%CI
Number of Exposures to Suicide
In family 2.22*** 9.21** 3.00-28.25 2.12*** 8.33*** 2.70-25.64
726 • Social Forces 87(2)

At workplace with � 100 employees 1.48*** 4.38** 2.06-9.31 1.25*** 3.50*** 1.62-7.56
At workplace with � 100 employees .11 1.11 .91-1.36 .01 1.01 .78-1.31
Age
Years .06** 1.06** 1.01-1.11 .09*** 1.09*** 1.04-1.15
Years2/1000 -.00 999.5 999.0-1.00 -.80** 999.2* 998.6-999.8
Family Type
Couple 1.00
1-person 9.98*10-1*** 2.71*** 2.30-3.20 1.19*** 3.28*** 2.61-4.14
Other .24 1.27 .96-1.68 .69*** 2.00*** 1.45-2.75
Children
No 1.00 1.00
Aged 0-3 yrs -.86*** .42*** .30-.59 -.25 .78 .54-1.13
Aged 4-15 yrs -.77*** .46*** .37-.58 -.35* .70* .54-.92
Education Level
Years of education .03 1.03 .98-1.08 -.04 .96 .92-1.00
Years of education2/1000 -.04*10-1* 996.5* 993.4-999.6 2.69 1002.7 999.7-1005.7
Early Retirement
No 1.00 1.00
Yes 1.58*** 4.87*** 3.75-6.34 .79*** 2.21*** 1.62-3.02
Benefits for Illness or Work Related Injuries (logged) .28*** 1.33*** 1.29-1.36 .23*** 1.25*** 1.21-1.30
Social Welfare Recipient

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No 1.00 1.00
Yes 9.97*10-3*** 2.72*** 2.18-3.39 .61*** 1.85*** 1.45-2.35
Level of Income
Logged annual amount -.16* .86* .76-.97 -.35*** .70*** .64-.78
Divorcee
No 1.00 1.00
Yes .57*** 1.77*** 1.30-2.42 .04 1.04 .74-1.44
Widow/Widower
No 1.00 1.00
Yes 1.77*** 5.87*** 2.63-13.13 1.03* 2.80* 1.25-6.30
Unnatural Death in Family
No 1.00 1.00
Yes 1.48 4.41 .62-31.36 1.48 4.40 .61-31.50
Country of Birth
Sweden 1.00 1.00
Finland .47** 1.60** 1.19-2.17 .32* 1.37* 1.01-1.87
Denmark/Norway/ Iceland .63* 1.87* 1.00-3.50 .66* 1.93* 1.04-3.60
Eastern Europe other than Yugoslavia -.40 .67 .29-1.49 -.51 .60 .27-1.35
Australia/New Zealand/Oceania - - - - - -
Other -.10 .91 .69-1.19 -.08 .92 .69-1.23
Family Size .01 1.01 .99-1.03 .07*** 1.07*** 1.05-1.10
Workplace Size .00 1.00 .99-1.00 .00 1.00 .99-1.00
Constant -11.69***
Pseudo R2 .05
-2LL 701.51
Note: Estimated coefficients (b), odds ratios (OR) and confidence intervals for the odds ratios (CI). n = number of individuals and N =
number of person years.
Interaction Domains and Suicide • 727

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Table 2b: Parameter Estimates of Discrete Event-History Models. Women.
Table 2b: Parameter Estimates of Discrete Event-History Models for Women
Women
n = 593,853; N = 3,308,271
Unadjusted Adjusted
Variable b OR 95%CI b OR 95%CI
Number of Exposures to Suicide
In family 2.28*** 9.79*** 2.41-38.11 2.20** 9.01** 2.23-36.30
728 • Social Forces 87(2)

At workplace with � 100 employees -.08 .92 .14-6.09 -.19 .83 .12-5.55
At workplace with � 100 employees .24** 1.28** 1.08-1.51 .10 1.11 .86-1.42
Age
Years .05 1.06 .99-1.12 .08* 1.09* 1.02-1.16
Years2/1000 -.42 999.6 998.9-1.00 -.92* 999.1* 998.3-999.9
Family Type
Couple 1.00 1.00
1-person 1.21*** 3.36*** 2.68-4.21 1.22*** 3.40*** 2.55-4.53
Other .55*** 1.73*** 2.68-4.21 .50** 1.65** 1.18-2.31
Children
No 1.00 1.00
Aged 0-3 yrs -1.18*** .31*** .19-.50 -.81** .45** .26-.76
Aged 4-15 yrs -.73*** .48*** .37-.63 -.42* .66* .47-.91
Education Level
Years of education .00 1.00 .94-1.07 -.08** .92** .87-.98
Years of education2/1000 -1.22 998.8 995.7-1002.9 4.95* 1005.0* 1000.9-1009.1
Early Retirement
No 1.00 1.00
Yes 1.92*** 6.84*** 5.32-8.80 1.11*** 3.05*** 2.23-4.15
Benefits for Illness or Work Related Injuries (logged) .32*** 1.38*** 1.33-1.44 .28*** 1.32*** 1.26-1.39
Social Welfare Recipient

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No 1.00 1.00
Yes 1.26*** 3.54*** 2.73-4.59 .96*** 2.60*** 1.95-3.47
Level of Income
Logged annual amount -.03 .97 .80-1.18 -.29** .75** .61-.92
Divorcee
No 1.00 1.00
Yes .83*** 2.29*** 1.60-3.29 .38 1.47 .99-2.15
Widow/Widower
No 1.00 1.00
Yes 1.93*** 6.91*** 3.69-12.95 1.15*** 3.15*** 1.64-6.05
Unnatural Death in Family
No 1.00 1.00
Yes 2.62*** 13.77*** 3.43-55.25 2.47*** 11.80*** 2.89-48.17
Country of Birth
Sweden 1.00 1.00
Finland .70*** 2.01*** 1.49-2.72 .69** 1.99** 1.42-2.80
Denmark/Norway/ Iceland 0.29 1.26 .47-3.37 .31 1.37 .51-3.67
Eastern Europe other than Yugoslavia .94*** 2.57*** 1.55-4.24 .89** 2.44** 1.44-4.11
Australia/New Zealand/Oceania 2.04* 7.70* 1.08-54.82 2.41* 11.12* 1.62-76.28
Other -.61* .54* .32-.93 -.54 .59 .34-1.02
Family Size .01 1.01 .99-1.03 .08*** 1.08*** 1.05-1.11
Workplace Size .09*10-4** 1.00** 1.00-1.00 .00 1.00 .99-1.00
Constant -12.38***
Pseudo R2 .08
-2LL 652.85
Note: Estimated coefficients (b), odds ratios (OR) and confidence intervals for the odds ratios (CI). n = number of individuals and N =
Note: Estimated
number of personcoefficients
years. (b), odds ratios (OR), and confidence intervals for the odds ratios (CI). n = number of individuals and N =
number of person years.
*p < .05; **p <.01; ***p < .001
Interaction Domains and Suicide • 729

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730 • Social Forces 87(2)

by our control variables, and this is likely to inflate the estimate of the
family-based social-interaction effect.
Exposure at work is only significant for men, and only in workplaces
with fewer than 100 employees. The effect of workplace exposure
is not of the same magnitude as that of family exposure, but it is
nevertheless considerable (OR = 3.50). The workplace exposure effect
is unconfounded by genetic and other shared factors, and thus is likely
to be caused by the type of social mechanisms discussed above. The
reason for the absence of an effect in larger workplaces most likely does
not mean that small and large workplaces differ from one another in this

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respect. More likely, it simply reflects the fact that in large workplaces
the relevant reference group is not the workplace as a whole but some
smaller department or subsection that we cannot identify in our data.
As far as the reasons for the lack of a significant workplace effect among
women, we can only speculate because the data does not allow for further
analyses. Gender differences in workplace attachment appear to be one
plausible reason. Although Swedish women are more likely to work than are
women in many other countries, they still bear the main household and child-
care responsibilities (Hall 1992), which may lead to a weaker attachment to
the workplace, and work is typically more important for men’s self-identities
than for women’s (Girard 1993; Neugarten and Hagestad 1976).
As far as we know, this is the first study that systematically examines
the effect of suicide exposures in the workplace. One possible objection
to the way in which we have interpreted these results is that they may, at
least in part, reflect unmeasured differences between workplaces in the
exposure to other types of risk factors – stress levels, for example – which
could possibly generate a spurious exposure effect. To partially control
for that possibility we re-estimated the models in Table 2, including 58
industry dummies to partially control for unobserved heterogeneity. The
results of these analyses were in every essential respect identical to those
reported in Table 2 and they thus give further weight to the exposure-
interpretation of the results reported here.
If we then turn to the control variables, their effects are more or less
as we would expect them to be. As previous research suggests, age is
systematically associated with the suicide risk. The partial effect estimates
suggest that the suicide risk gradually increases with age and that it is as
highest at the age of 44 for men and 41 for women.
As expected, coupled individuals, men as well as women, have lower
suicide rates than singles. On the basis of these data we cannot tell whether
this is a “protective effect” of the family arrangement as such or a selection
effect due to suicidal individuals being less likely to be coupled.
Also as expected, having children living at home appears to be
associated with lower suicide risks for men as well as for women. For
 Interaction Domains and Suicide • 731

men, the effect is significant only for children in the older age category,
while for women we find the expected pattern of a declining “protective”
effect with the age of the child.
Contrary to much of previous research, we find that the net effect of
years of education is positive for women (this can be seen by plotting the
combined effect of the educational variables). That is, women’s suicide
risk increases with increasing education, all else being equal. For men, the
point estimates suggest the same pattern, but these estimates are not
significantly different from zero.10
The variables that serve as proxies for health-related problems – early

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disability retirement and illness and work related injuries – behave as
expected. Individuals who received such benefits had clearly elevated risks.
The same is true for the two deprivation-related variables. The regression
coefficient associated with the social-welfare variable is positive, and the
regression coefficient of the income variable is negative.
Having gone through a divorce in the past five years, somewhat
surprisingly given previous research findings, does not appear to significantly
elevate the risk for either sex. It should be emphasized that this refers to the
partial effect of divorce, however. As the results of the bivariate unadjusted
analyses show, those who had experienced a divorce had a significantly
higher suicide risk than those who had not experienced a divorce. Hence,
these results suggest that the two groups differ from one another in relevant
respects, and after controlling for these differences, the divorce experience
is no longer significantly related to the suicide risk.
Having become a widow or widower in the past five years is associated
with an elevated risk for men as well as for women, and this is also true
for those who experienced an unnatural death in the family. This latter
variable is associated with a sharply elevated risk for women. The point
estimate is high also for men, but the test suggests that the estimate is
not significantly different from zero.
Finally, and as expected, immigrants from several different nations
have elevated suicide risks as compared to those born in Sweden. With
data like this it is not possible to assess to what extent this is a result
of the immigration and assimilation experience as such, or whether it
reflects individual differences between immigrants and native Swedes
not picked up by the variables included the model. For our purpose, this
is not a major concern, however, because we only included country
of birth as a control variable to reduce the risk of the estimates of the
exposure effects becoming confounded.
To assess the overall importance of networks it is not sufficient to examine
only social-interaction effects like those in Table 2, one must also take into
account the number of individuals who are exposed. This is particularly
important when comparing domains such as these that differ widely in size
732 • Social
Table Forces 87(2)of the Public-Health Effects of Suicide Exposures and Selected Comp
3: Estimates
Number
Table of Suicides
3: Estimates of the Public-Health Effects of Suicide Exposures and
Selected Comparison Events Measured in Number of Suicides
Men Women
Actual Number of Suicides 706 410
Removing Effect of:
Family exposure -2.63 -1.78
Workplace exposure -6.45 -6.43
� 100 employees -5.68 .00
� 100 employees -.78 -6.64
Widowhood -3.86 -6.82

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Divorce -1.44 -10.16
Unnatural deaths in family -.77 -1.83

and average degree. On average, the suicides being studied here resulted in
2.9 family members being exposed, while suicides at small workplaces, here
defined as workplaces with less than 100 employees, resulted in 15.3 other
individuals being exposed.11 Table 3 displays results taking into account
both the dyad-based interaction effects of Table 2 and the degree-based
effect, i.e., the number of individuals being exposed to each suicide.
The first row of Table 3 shows the actual number of suicides that took
place, and this is identical to the number of suicides predicted by the
logistic regression models. The second row shows what the number of
suicides would have been according to the logistic models had no one
been exposed to the suicide of a family member (or, equivalently, the
number of suicides being observed if family-based exposure had no effect
on the suicide risk). These estimates suggest that we would then have
observed three fewer male suicides and two fewer female suicides than
we actually observed. These public-health effects may seem surprisingly
small given the considerable social-interaction effects shown in Table 2.
Although one should treat these estimates with great caution and not
pay too much attention to the exact magnitude of the estimates, they
illustrate the importance of the distinctions introduced earlier. Although
the social-interaction effects, what we referred to as peekk , are substantial,
the collective public health effect is rather modest because the networks
within the family domain are such that not many individuals are exposed;
the nek values are low within the family domain.
The third row of Table 3 performs the same kind of counterfactual thought
experiment for workplace exposure. Since the effects were significant only
for men, we focus exclusively on the public health effect among men. Had
no one been exposed to a suicide in the workplace, these estimates suggest
that there would have been six to seven fewer male suicides than actually
was observed. A significant effect is found only in the smaller workplaces,
but as argued above, this is most likely due to poor measurement of the
 Interaction Domains and Suicide • 733

relevant reference groups in the larger workplaces. Had we been able to

identify the relevant reference groups in the larger workplaces, undoubtedly
the estimated public-health effect would have been considerably higher
since more than 40 percent of employees work in such workplaces. For
reasons such as these one should not pay much attention to the exact
figures, but even with these caveats in mind, the results clearly suggest that
it is important to consider the workplace when seeking to explain suicide
rates. Although the peekk value for the work domain was much lower than for
the family domain, the public-health effect of exposure in the work domain
was much greater because of its higher nek value.

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The last three rows of Table 3 are included as comparison points for
evaluating the substantive importance of the estimated public-health
effects of the exposure variables. Here we perform the same type
of thought experiments for three negative life events that are often
considered in suicide research: becoming a widower, going through a
divorce, and experiencing the unnatural death of a family member. For men,
family exposure appears to be of approximately the same public-health
importance as these three types of life events, while workplace exposure
is more important. For women, the public-health effect of family exposure
is comparable to that of an unnatural death of a family member, but it is
not of the same magnitude as that of the other two types of events.

Conclusion

The analyses reported here suggest that network effects are important
for explaining suicides. Suicides of family members as well as of co-
workers influence the suicide risks of those exposed. In addition, the
results suggest that the degree of the deceased individual’s ego-
centered network is important because it influences the number of
exposed individuals and thereby the suicide rate. When examining the
dyad-based social-interaction effects, exposure in the family domain
seemed to be about twice as important as exposure in the work domain,
but when we also took into account the degree-based exposure effects
and examined the collective public-health effect, we found workplace
exposure for men to be at least twice as important as family exposure.
This result is particularly striking because the estimated family-exposure
effect is likely to be upwardly biased since we were not able to control
for factors such as the genetic component of suicide and inheritable
psychiatric disorders known to increase the suicide risk.
Individual-level studies of exposures to suicide have largely concentrated
on adolescents, and it is generally believed that exposure effects are
important only within this age group. As far as we know, this is the first
study to demonstrate that workplace exposure is also associated with a
734 • Social Forces 87(2)

higher suicide risk among adults. National suicide prevention strategies

usually pay no attention to suicide exposure in the workplace. The results
reported here suggest that prevention strategies focusing on the workplace
may be at least as important as those focusing on the family.
We believe that some of the empirical results and analytical distinctions
introduced in this article are important also for explaining other outcomes.
Whenever the interaction among individuals is deemed important for the
collective outcome to be explained, as in differential-association theory’s
(Sutherland 1947) explanation of crime rates for example, the distinction
between dyad-based and degree-based network effects appears essential.

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Focusing exclusively on one of these two types of effects can lead to a faulty
understanding of the importance of social interactions and networks.
In addition, we believe that this article illustrates the importance of
tightly linking theory and data.12 If our theory suggests that networks and/
or localized social interactions are important, it is essential to use datasets
which actually contain such information because the wider the gap is
between theory and data the less theoretical bearing and relevance will
the empirical research have. It is always tempting to cut corners by using
aggregate data or indirect proxy variables from existing surveys, but since
social action and interaction is at the heart of so much of sociological theory,
there will often be no good alternative to collecting the type of data used
in this article, i.e., longitudinal data on the actions and attributes of large
numbers of individuals and the patterns of interaction among them.13

Notes
1. See Sainsbury, Jenkins and Levey (1980) and Breault (1986) for examples.
Mäkinen’s (1997) replication study of Sainsbury et al.’s study, however, has
cast serious doubts on the reliability and robustness of such aggregate
associations. Also see Pescosolido (1994) for a critique of the approach.

2. Let us emphasize that analyzing suicides as intentional actions does not mean
that the intention behind all suicides is to take one’s life. The intention may
have been to send a signal to others about a desperate life situation, but the
unintended outcome of the act was death. Nor does an action approach imply
that individual intentions are necessarily unclouded by strong emotions or
cognitive biases.

3. It also is exemplified by the title of the Swedish singer Magnus Uggla’s 1989
hit album “What’s the Point of Killing Yourself if You Can’t be Around to Hear
the Yap.”

4. We ignore pure opportunity-related interaction mechanisms because a

person’s suicide rarely affects others’ opportunities to commit suicide. One
possible exception is when an individual invents a new suicide method, e.g.,
 Interaction Domains and Suicide • 735

the use of car exhaust gas as a means of committing suicide in Britain in the
1970s. See Clarke and Lester (1987).

5. pea can be thought of as measuring how the probability of an alter’s committing

suicide is affected by e’s suicide, holding everything else constant.

6. It should be observed that only individuals residing in the Stockholm

metropolitan area are included in the database.

7. Given the fact that previous research suggests that religion plays an
important role in this context, we regret the fact that the database includes

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no information on the individuals’ religious orientations.

8. It would have been useful to estimate fixed-effect logit models, but

unfortunately such models would be highly inefficient because they disregard
so much of the data. Suicides are extremely rare events, and fixed-effect
logit models only make use of data on units with variation on the dependent
variable. Since suicides occur so rarely, we also estimated the so-called
rare-event logit model (King and Zeng, 1999). Qualitatively the results were
identical to those reported here.

9. These ORs of family exposure are higher than those found in another
Swedish register-based study (Runeson and Åsberg, 2003). There are some
differences in the study designs that may explain these discrepancies, most
notably that they used people who had died from other causes than suicide
as their control group.

10. If we examine the relationship between the two educational variables and
the suicide risks without any other control variables, the expected negative
pattern is found.

11. In larger workplaces, the number of potentially exposed individuals was of

course much higher, but because we do not have information on the way in
which these workplaces were internally organized, we cannot estimate the
likely number of truly exposed individuals in large workplaces. Our cut-off value
of 100 to distinguish between “large” and “small” workplaces is arbitrarily
chosen, but the results seem robust at least to small changes in this value.

12. See Hedström and Bearman (forthcoming) for more detailed discussions
of this analytically oriented middle-range approach that seeks to tightly link
sociological theory and empirical research.

13. Needless to say, data of the size and scale used in this article will be
prohibitively expensive to collect, but such data only is needed when the
outcomes to be explained are extremely rare, and even in such circumstances
smaller case-control designs often can be used.
736 • Social Forces 87(2)

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