Among deaths of despair, the individual and community correlates of US suicides have been consistently identified and are well known. However, the suicide rate has been stubbornly unyielding to reduction efforts, promoting calls for novel research directions. Linking levels of influence has been proposed in theory but blocked by data limitations in the United States. Guided by theories on the importance of connectedness and responding to unique data challenges of low base rates, geographical dispersion, and appropriate comparison groups, we attempt a harmonization of the National Violent Death Reporting System (NVDRS) and the American Community Survey (ACS) to match individual and county–level risks. We theorize cross-level sociodemographic homogeneity between individuals and communities, which we refer to as “social similarity” or “sameness,” focusing on whether having like-others in the community moderates individual suicide risks. While analyses from this new Multilevel Suicide Data for the United States (MSD-US) replicate several individual and contextual findings, considering sameness changes usual understandings of risk in two critical ways. First, high individual risk for suicide among those who are younger, not US born, widowed or married, unemployed, or have physical disabilities is cut substantially with greater sameness. Second, this moderating pattern flips for Native Americans, Alaska Natives, Asians, and Hispanics, as well as among native-born and unmarried individuals, where low individual suicide risk increases significantly with greater social similarity. Results mark the joint influence of social structure and culture, deliver unique insights on the complexity of connectedness in suicide, and offer considerations for policy and practice.

在绝望的死亡中，美国自杀的个人和社区关联得到了一致的确认并广为人知。然而，自杀率一直顽固地不屈服于减少努力，促进了对新颖研究方向的呼吁。理论上已经提出了影响力的关联级别，但是在美国，由于数据限制而受到限制。在有关连通性重要性的理论指导下，并针对低基数，地理分散和适当的比较群体的独特数据挑战做出响应，我们尝试将国家暴力死亡报告系统（NVDRS）和美国社区调查（ACS）协调为匹配个人和县级风险。我们将个人和社区之间的跨级别社会人口统计同质化理论化，我们将其称为“社会相似性”或“相同性”，着重于在社区中与其他人共处是否减轻个人自杀风险。虽然从美国新的多层次自杀数据（MSD-US）中获得的分析重复了一些个人和背景调查结果，但考虑到相同性却以两种重要方式改变了人们对风险的通常理解。首先，在更大的范围内，年轻人，而非美国出生，丧偶或已婚，失业或有身体残疾的人的自杀风险较高。其次，这种节制的模式在美国原住民，阿拉斯加原住民，亚洲人和西班牙裔美国人以及在当地出生和未婚的个人中发生了翻转，在这些地方，较低的个人自杀风险随着社会相似度的增加而显着增加。结果标志着社会结构和文化的共同影响，