Social Exclusion and the Increased Risk of Suicide
By Michelle Robinson

Is there a link between how we handle rejection and an increased suicide risk?  A recent study has found that people who attempt suicide demonstrate an increase in negative consequences when experiencing social exclusion.  The study found that there were differences in their brain activity.  The differences were seen in the areas of the brain that react to both pain and social cognition.

Is there a link between how we handle social exclusion and an increased suicide risk?

The need to belong

Human beings have a built-in need to belong, and to feel included. When this does not happen, it can have consequences on mental wellbeing.

Lack of social inclusion has often been considered as a risk factor for suicide.  Also many people who committed suicide had experienced a negative life event that had caused them to feel excluded.  These included the loss of a job, or the breakdown of a relationship not long before their death.

Are some people just more at risk of suicide?

Negative and stressful life events are common.  It appears though, that some people are infinitely more vulnerable, and will not be able to cope with them.  It seems there’s a difference in the way that they process perceived or actual social exclusion.  Stressors such as the loss of a job or the end of a relationship can cause considerable psychological pain.  This pain is a recurring theme in the suicide notes of victims.  It plays a huge part in increasing suicidal ideation.

Studies have shown differences in brain activation

Previous studies have discovered that people who are vulnerable to suicidal behaviour exhibit deficits in several regions of the brain, and in their cognitive processes.

In one study, people who had previously attempted suicide had higher activity than the control group in the lateral orbitofrontal cortex of the brain following exposure to images of angry faces.  This suggests a tendency to over-evaluate negative emotional cues.  Recalling the psychological pain they experienced during a time when they felt suicidal increased the activity in their middle prefrontal cortex and anterior cingulate cortex, and reduced the activation of their ventral prefrontal cortex.  These brain activity differences both link to risky decision-making.

Another study of depressed patients suggested that psychological pain following social exclusion or rejection led to increased activity in the areas of the brain that are associated with seeking relief of pain despite risks.  This indicates that they are more at risk of carrying out suicidal acts or self-harming in some way.

Several further studies noted that the differences in the brains of people who attempted suicide went even further than first thought.  Other parts of the brain also showed higher activity, especially those that process social cognition.

The current study

The most recent study, led by a researcher from Montpellier University, used MRI scans to investigate how the brains of people who had attempted suicide reacted to social rejection.  36 women with a history of depression but no attempted suicide, 41 women with a history of depression and suicide attempts, and 28 healthy control subjects took part in a ‘Cyberball’ game.  Each participant was gradually excluded from the game.

Both groups of women with a history of depression reported that they felt higher levels of distress when facing social exclusion than the women with no history of depression.  The women who had previously attempted suicide showed decreased brain activation in the areas of the brain that control pain tolerance and social cognition.

The results appear to confirm that people who are more vulnerable to suicide are also more sensitive to social exclusion.  This raises the question of the role of the perception of social exclusion and feelings of pain in the decision to attempt suicide.

The limitations and strengths of the study

Most of the participants in the study were taking medications at the time.  This may have influenced some results to a degree.  Therefore researchers introduced controls for medication, type of mood disorder and the presence of any form of social phobia.  However, the results did not change.

The emotions people experience during a virtual game are, arguably, not necessarily the same as people’s everyday reactions.  However, participants who were the most sensitive to real-life rejection demonstrated this sensitivity during the game too.

It would be interesting to see what results a study on men would have.  Other reports show behavioural and biological differences between the genders in relation to social exclusion, and in their motivations for attempting suicide.

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