discordance, or disagreement, between sexual identity and the sex of sexual contacts, and refers specifically to reporting sexual contact that is inconsistent with a respondent’s sexual identity. Three suicide-related questions (whether they had considered attempting suicide, whether they had made a plan about how they would attempt suicide, and whether they had attempted suicide) were combined to create a nonfatal suicide risk variable. The students participating in the study identified as either heterosexual or gay/lesbian, had had sexual contact, and had no missing data for sex or suicide variables. Researchers used logistic regression to assess the association between sexual orientation discordance and nonfatal suicide risk. The prevalence of discordance in gay/lesbian students was 31.9%, whereas the prevalence was just 3.3% among heterosexual students. Risk for nonfatal suicidal behaviors was significantly higher in female students compared with male students; gay/lesbian students compared with heterosexual students; students who reported discordance compared with students who did not; students who were bullied on school property compared with students who were not bullied on school property; students who ever drank alcohol or used Older adults Risk factors that appear to be more strongly associated with suicide in older adults include depression, prior suicide attempts, comorbid general medical conditions, pain, role function decline, social dependency or isolation, family discord, losses, personality inflexibility, rigid coping, and access to lethal means (Van Orden et al., 2015). Longer life expectancies and a rapidly aging society show increasing numbers of older adults who have debilitating health conditions such as cancer, arthritis, and Alzheimer’s, which can cause chronic pain and functional decline (Rapaport, 2017). Chronic illness and loss of cognitive function can lead to hopelessness, depression, and other mental health illnesses that are factors in suicide. In 2017, researchers from the University of Texas at Austin conducted a number of studies on suicide among older adults (Choi and Di Nitto et al., 2017a; 2017b). They found physical health problems and untreated depression to be significant precipitating factors of suicide among older adults. “Many people may not know that suicide rates are higher among older than younger adults and this is especially true for older men, who are approximately 85 percent of all suicide victims aged 65 years or older,” Choi reports (Rapaport, 2017, p. 1405). Choi and colleague Di Nitto analyzed 10 years (2005 to 2014) of data on all older adults who died by suicide in 16 states. They used the National Violent Death Reporting System, which contains information from death certificates, coroner/ medical examiner and law enforcement reports, crime labs and toxicology reports and, when present, a summary of the suicide note contents. These multiple sources allowed them to identify key trends about older people who died by suicide (Rapaport, 2017). The study noted that physical health problems were a precipitant for half of the older adults who had died of suicide. Pain from cancer, arthritis, and other diseases was mentioned most often (Rapaport, 2017). According to their research, Choi, Di Nitto, et al. (2017b) found that from 2005 to 2014, firearms remained the most frequently- used method of late- life suicide. In the 50 to 64 years age group, each advancing year from 2005 to 2014 was associated with a 1% decrease in the odds of firearm use and a 6% increase in the odds of hanging/suffocation among men; a 9% increase in the odds of hanging/suffocation among women; and a 4% decrease in the odds of overdose among each gender. In the 65 and older age group, each advancing year was associated with a 4% increase in the odds of overdose among men. Physical health was a significant factor for firearm use among men only. Regardless of gender and age, mental health, substance abuse problems, and prior suicide attempts were associated with hanging/suffocation and overdose.
marijuana compared with students who did not use those substances; and students who had ever been physically forced to have sexual intercourse compared with students who had not been physically forced to have sexual intercourse. Approximately 4% of students experienced sexual orientation discordance. High suicide risk was significantly more common among discordant students compared with concordant students (46.3% vs. 22.4%, p<0.0001). In adjusted models, discordant students were 70% more likely to have had suicidal ideation or have attempted suicide compared with concordant students (adjusted prevalence ratio=1.7, 95% CI=1.4, 2.0). Sexual orientation discordance was associated with increased likelihood of nonfatal suicidal behaviors. This study highlights another potential risk factor for youth suicide in that discordant adolescents may experience unique stressors that should be considered when developing and implementing suicide prevention programs. In considering the health and well-being of youth, sexual identity, sexual behavior, and their intersection should be noted for their association with the mental health and well-being of adolescents. The study concluded that firearm use decreased among men ages 50 to 64 between 2005 and 2014, but its use did not change among women according to age group. With the population of older adults rapidly growing, routine suicide risk assessments, firearm safety monitoring, and interventions to improve quality of life are needed. The older the decedents, the more likely they are to have disclosed suicidal intent, and health problems largely explained their higher odds of disclosure. Health-care providers need better preparation to screen and aid those in need to prevent suicide. Members of social support systems for older adults should also be assisted in identifying warning signs and linking older adults to services. This research has shown that some older adults, especially men, tend to view suicide as acceptable and rational under conditions of physical illness. According to Di Nitto, “Rather than a reason for making suicide acceptable, this is a call to take measures to relieve the pain and suffering that precede suicide” (Rapaport, 2017). Based on the research from the studies above, several suggestions were given to address suicide among older adults: ● Families and caregivers must learn about suicide warning signs and how to provide support. This includes talking about wanting to die rather than suffering through chronic illness and pain; looking for a means of suicide, such as acquiring a gun; increasing alcohol or drug use; talking about being a burden to others; and stating that death is preferable to a nursing home. ● Encourage the older adult to seek help and assist him or her in locating it. If families and caregivers are not comfortable talking about suicide with an older adult, suggest they speak with a trusted mental health clinician. ● Take disclosures seriously. Do not let a disclosure go unheeded. Most people who plan suicide are ambivalent about whether to follow through. A disclosure is a call to provide support and connect the older adult to resources that can provide life-saving care. ● Take him or her to a hospital emergency department for a risk assessment. ● Help him or her identify reasons for living and develop a safety plan. ● Help him or her write a “coping card” that lists steps to take when suicidal thoughts occur. ● Help him or her construct a “hope box” containing materials with personal meaning to turn to in times of need. ● Restrict access to guns. The firearm-use rates, 80% among older men and 40% among older women, have not changed for a decade. “The lethality of firearms makes the chance of rescue slim and contributes to higher rates of completed
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Book Code: PYCA1423
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