The Role of Social Connections on Suicide Attempts After Heroin Detoxification Treatment in South Africa: A Prospective Study

Background: Seventy-seven percent of suicides occur in Low- and Middle-Income Countries (LMIC), and this risk increases threefold for those with substance use disorder. Theoretically, the interplay of sociodemographic and cultural resources embedded in an individual’s setting can raise or lower risk for suicide. We therefore aim to observe the associations between available social connection resources: social network size and quality, social support, and conflicts, on future 3- and 9-month suicide attempts following heroin detoxification treatment. Methods: Prospective observational study from two state-funded drug and alcohol rehabilitation centers in South Africa. Three hundred seventeen participants were screened, with 304 participants enrolled ( n = 4 were withdrawn during baseline interview due to active suicidal behaviors), with a final sample of 300 participants. Consented participants were assessed during rehabilitation (baseline), and at 3 and 9 months after leaving treatment. Results: In a sample of 300 South African participants, we observed significant associations between sociodemographics, lack of support, conflicts, and subsequent substance use on suicide attempts. Fully adjusted models showed that socially disconnected experiences, homelessness, and interpersonal conflicts were associated with a fivefold and threefold risk of future 3 and 9 months suicide attempts, respectively. Conclusions: Our findings highlight the importance of targeting social (dis)connection factors when treating and supporting individuals after substance use detoxification, particularly in settings reliant on interwoven social resources in the absence of available mental health services and infrastructure. Implications for a more inclusive research literature that better understands the role of social connectedness and suicide risk is discussed.