Socio-Spatial Patterns of Suicide Mortality in the United States

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Amin Rahimian, Kushagra Tiwari, Marie-Laure Charpignon, Philippe Giabbanelli, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9009432/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Suicides cause more than 49,000 deaths per year in the United States, including 55% associated with the use of a firearm. Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted averages of neighboring counties’ outcomes. First, using two-way fixed effects regression models with sociodemographic, economic, and spatial controls, we find that a one-standard-deviation increase in the SCI-weighted average suicide mortality rate of connected counties is associated with an increase of 2.78 suicide deaths per 100,000 people in the focal county (95% CI: 1.06-4.50). Second, we examine Extreme Risk Protection Orders (ERPOs), statelevel policies that allow temporary restriction of firearm access for individuals at risk of self-harm. Using a similar statistical approach, we show that counties with stronger social ties to counties located in ERPO-implementing states experience reductions in suicide mortality, even without local policy enactment. Specifically, we find that a one-standard-deviation increase in ERPO social exposure is associated with a decrease of 0.214 suicide deaths per 100,000 people in the focal county (95% CI: 0.0866-0.342). Such a protective association persists when adjusting for geographical proximity and including state-by-year fixed effects that capture timevarying state-level factors. In sum, our findings suggest that social networks can facilitate the diffusion of both harmful exposures and protective interventions. This socio-spatial structuring of suicide mortality underscores the need for prevention strategies that incorporate social network topology, alongside more traditional approaches based on geographical targeting. Health sciences/Health care/Public health/Epidemiology Health sciences/Health care/Public health Full Text Additional Declarations Yes there is potential Competing Interest. M.A.R. has served on the advisory committee of a vaccine confidence fund created by Meta and Merck; some of his research has also been funded by Meta. The other authors declare no competing interests. Supplementary Files sisuicidescinatcomm.pdf Supplementary Information for Socio-Spatial Patterns of Suicide Mortality in the United States Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9009432","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":601471533,"identity":"a182ac16-5395-4b57-96dc-1fe78d10ac91","order_by":0,"name":"M. 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Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted averages of neighboring counties’ outcomes. First, using two-way fixed effects regression models with sociodemographic, economic, and spatial controls, we find that a one-standard-deviation increase in the SCI-weighted average suicide mortality rate of connected counties is associated with an increase of 2.78 suicide deaths per 100,000 people in the focal county (95% CI: 1.06-4.50). Second, we examine Extreme Risk Protection Orders (ERPOs), statelevel policies that allow temporary restriction of firearm access for individuals at risk of self-harm. Using a similar statistical approach, we show that counties with stronger social ties to counties located in ERPO-implementing states experience reductions in suicide mortality, even without local policy enactment. Specifically, we find that a one-standard-deviation increase in ERPO social exposure is associated with a decrease of 0.214 suicide deaths per 100,000 people in the focal county (95% CI: 0.0866-0.342). Such a protective association persists when adjusting for geographical proximity and including state-by-year fixed effects that capture timevarying state-level factors. In sum, our findings suggest that social networks can facilitate the diffusion of both harmful exposures and protective interventions. 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