Human flourishing and suicide: A national-level analysis with 22 countries

Purpose Suicide rates continue to increase in many nations despite awareness and prevention campaigns. While economic factors, substance abuse and availability of means have been associated with suicide rates, much of the population-level variability remains unexplained. To assess the association between national-level flourishing index scores, flourishing subdomains and age-standardised suicide mortality rates. Methods This study used national-level, cross-sectional data from Global Flourishing Study (GFS) and the Global Burden of Disease (GBD) Study (2021). Generalised linear models were used to assess the relationships between the exposures and outcomes. The exposures included the flourishing index and flourishing domain scores (happiness/life satisfaction, mental/physical health, meaning/purpose, character/virtue, close social relationships, and financial/material stability). The primary outcome was suicide mortality (GBD 2021). Results There were 202,838 participants included in the GFS from 22 countries nations that differed widely by socioeconomic status, cultural background, and religious tradition. In the main age-adjusted analysis, national flourishing index scores were inversely associated with the GBD estimates of suicide mortality (B=-5.2; 95%CI[-8.9, -1.4]). The two flourishing domains associated with suicide mortality were meaning/purpose (B=-4.6; 95%CI[-7.3, -1.8]) and close social relationships (B=-4.8; 95%CI[-8, -1.6]), with little evidence of associations found with the other four domains. Conclusion Measures of flourishing may be more closely associated with suicide mortality than previously used measures of wellbeing. Flourishing, particularly in domains of meaning/purpose and close social relationships, should be considered in further research of causal factors and in national frameworks for suicide prevention.