National Trends and Disparities in Suicidal Ideation, Attempts, and Health Care Utilization Among U.S. Adults.

Samples H ，Cruz N ，Corr A ，Akkas F ... -  《-》

Identifying Intersecting Factors Associated With Suicidal Thoughts and Behaviors Among Transgender and Gender Diverse Adults: Preliminary Conditional Inference Tree Analysis.

Transgender and gender diverse (TGD) individuals are disproportionately impacted by suicidal thoughts and behaviors (STBs), and intersecting demographic and psychosocial factors may contribute to STB disparities. We aimed to identify intersecting factors associated with increased risk for suicidal ideation, intent, plan, and attempts in the US transgender population health survey (N=274), and determine age of onset for each outcome using conditional inference trees (CITs), which iteratively partitions subgroups of greater homogeneity with respect to a specific outcome. In separate analyses, we restricted variables to those typically available within electronic medical records (EMRs) and then included variables not typically within EMRs. We also compared the results of the CIT analyses with logistic regressions and Cox proportional hazards models. In restricted analyses, younger adults endorsed more frequent ideation and planning. Adults aged ≤26 years who identified as Black or with another race not listed had the highest risk for ideation, followed by White, Latine, or multiracial adults aged ≤39 years who identified as sexual minority individuals. Adults aged ≤39 years who identified as sexual minority individuals had the highest risk for suicide planning. Increased risk for suicidal intent was observed among those who identified as multiracial, whereas no variables were associated with previous suicide attempts. In EMR-specific analyses, age of onset for ideation and attempts were associated with gender identity, such that transgender women were older compared to transgender men and nonbinary adults when they first experienced ideation; for attempts, transgender women and nonbinary adults were older than transgender men. In expanded analyses, including additional psychosocial variables, psychiatric distress was associated with increased risk for ideation, intent, and planning. High distress combined with high health care stereotype threat was linked to increased risk for intent and for suicide planning. Only high everyday discrimination was associated with increased risk for lifetime attempts. Ages of onset were associated with gender identity for ideation, the intersection of psychiatric distress and drug use for suicide planning, and gender identity alone for suicide attempts. No factors were associated with age of onset for suicide intent in the expanded variable set. The results of the CIT analysis and the traditional regressions were comparable for ordinal outcomes, but CITs substantially outperformed the regressions for the age of onset outcomes. In this preliminary test of the CIT approach to identify subgroups of TGD adults with increased STB risk, the risk was primarily influenced by age, racial identity, and sexual minority identity, as well as psychiatric distress, health care stereotype threat, and discrimination. Identifying intersecting factors linked to STBs is vital for early risk detection among TGD individuals. This approach should be tested on a larger scale using EMR data to facilitate service provision to TGD individuals at increased risk for STBs.

Stanton AM ，Trichtinger LA ，Kirakosian N ，Li SM ，Kabel KE ，Irani K ，Bettis AH ，O'Cleirigh C ，Liu RT ，Liu Q ... -  《-》

Factors Associated With Suicide Risk Behavior Outcomes Among Black Middle School Adolescents.

Early adolescent self-identifying Black youth present with high rates of suicidality. This study assesses associations among 7 explanatory variables (sex, weapon carrying, weight perceptions, grades, grade level, bullying at school, and cyberbullying) and suicide ideation, planning, and attempts, and identifies associations with suicidality as a composite measure among a sample of Black middle school adolescents (BMSA) in the United States. Data were extracted from the 2019 Middle School Youth Risk Behavior Survey. Descriptive statistics were calculated, and associations between suicide ideation, planning, and attempts were explored. A network graphical representation of polychoric and tetrachoric correlations across suicidality outcomes and explanatory variables was performed. A multivariable, multinomial logistic regression model estimated associations among explanatory variables and suicide ideation (with and without planning) and planning (with and without ideation). Both suicide attempt and a composite suicidality metric were explored using independent logistic models with multiple imputation. The sample included 7,643 self-identifying BMSA. Our findings indicate that approximately 28% reported suicidality. Prevalence rates were found of about 1 in 4 BMSA for suicidal ideation, 1 in 6 for suicidal planning, and 1 in 10 for attempting suicide. Female BMSA, victims of cyberbullying, and BMSA carrying a weapon experienced significantly higher odds of all suicidality outcome measures. Practical implications for identifying and screening suicidality among BMSA to guide suicide prevention efforts are necessary. Findings validate the need for informed cultural approaches to suicide screening and prevention efforts to reduce suicide risk outcomes, especially when identifiable environmental factors are strongly associated with those outcomes. Suicide rates have alarmingly increased for early adolescent Black youth, and exploring factors that inform suicide risk behavior outcomes is necessary for this population. Using responses of 7,643 Black middle school adolescents who participated in the 2019 Youth Risk Behavior Survey, the authors found that approximately 28% of Black middle school adolescents reported some form of suicidality with higher odds experienced among female participants. Other factors associated with suicidality included carrying a weapon, being bullied, being cyberbullied, and reporting lower grades in school. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Richardson SC ，Gunn LH 《-》

National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States.

To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.

Rhee TG ，Bommersbach TJ ，Rosenheck RA ，Nierenberg AA ，McIntyre RS ... -  《-》

Prevalence and associated risk factors for suicidal ideation, non-suicidal self-injury and suicide attempt among male construction workers in Ireland.

Suicide among male construction workers are reported to be disproportionally high compared to the working age population. However, there is minimal understanding of the prevalence and associated factors for suicidal ideation, non-suicidal self-injury, and suicide attempt among this occupational group globally. A cross-sectional study was conducted on a large sample of male construction workers in Ireland (n = 1,585). We investigated the prevalence of suicidal ideation, non-suicidal self-injury and suicide attempts and sociodemographic, occupational, and mental health factors associated with these three outcomes. Multivariable Poisson regression was performed to estimate the prevalence rate ratio of suicidal ideation (model 1 primary outcome), while multivariable logistic regression was used to estimate the odds ratio of non-suicidal self-injury (model 2 primary outcome), and suicide attempt (model 3 primary outcome). The lifetime prevalence rate for suicidal ideation was 22%, 6% for non-suicidal self-injury, and 6% for suicide attempt. In univariate modelling, socio-demographic and occupation-specific factors associated with the three outcomes included younger age (suicidal ideation and non-suicidal self-injury), not being in a relationship (suicide attempt) and working 35-44 h per week (suicidal ideation and suicide attempt). The mental health factors generalized anxiety disorder, depression, and suicide bereavement were significantly associated with increased risk of the three outcomes. In fully adjusted multivariable models, increasing severity of generalized anxiety disorder and depression were associated with an increased prevalence rate ratio of suicidal ideation, and a higher odds ratio of non-suicidal self-injury and suicide attempt. Suicidal ideation, non-suicidal self-injury and suicide attempt are significant issues for male construction workers that require specific attention. Findings highlight a need to support younger male construction workers and those bereaved by suicide. They also highlight the need for the early detection and treatment of generalized anxiety disorder and depression in order to intervene in, and potentially prevent, suicidality among male construction workers.

O'Donnell S ，Egan T ，Clarke N ，Richardson N ... -  《-》