Explaining the income and suicidality relationship: Income rank is more strongly associated with suicidal thoughts and attempts than income

Purpose Low income is an established risk factor for suicidal thoughts and attempts. This study aims to explore income within a social rank perspective, proposing that the relationship between income and suicidality is accounted for by the rank of that income within comparison groups.  Methods Participants (N=5779) took part in the Adult Psychiatric Morbidity Survey across England. An income rank variable was created by ranking each individual’s income within four comparison groups (sex by education, education by region, sex by region, and sex by education by region). Along with absolute income and demographic covariates, these variables were tested for associations with suicidal thoughts and attempts, both across the lifetime and in the past year.  Results Absolute income was associated with suicidal thoughts and attempts, both across the lifetime and in the past year. However, when income rank within the four comparison groups was regressed on lifetime suicidal thoughts and attempts, only income rank remained significant and therefore accounted for this relationship. A similar result was found for suicidal thoughts within the past year although the pattern was less clear for suicide attempts in the past year.  Conclusions Social position, rather than absolute income, may be more important in understanding suicidal thoughts and attempts. This suggests that it may be psychosocial rather than material factors that explain the relationship between income and suicidal outcomes