_____________________________________________________________ Suicide Assessment and Prevention
of suicide behavior risk than a specific type of problem (e.g., an addictive behavior or an emotional problem) [13; 33]. The presence of acne is associated with social and psychologic problems, and certain acne medications have been linked with an increased risk of suicidal ideation [36]. OLDER ADULTS (65 YEARS OF AGE AND OLDER) The elderly account for roughly 19.3% of suicides but only 16% of the population [13]. Suicide rates rise with age for men, especially after 65 years of age, and the suicide rate in elderly men is 5 times that of same-aged women; more than 85% of elderly suicides are among men [13; 35]. The overall rate of elderly suicide is nearly 20 per 100,000. However, the rate is 40 per 100,000 among elderly White men and 51.8 per 100,000 among White men older than 85 years of age, a rate that is almost 2 times the rate for men of all ages. In contrast, the suicide rate of women declines after 60 years of age [13; 35]. Although undiagnosed and/or untreated depression is the primary cause of suicide in the elderly, suicide completion is rarely preceded by only one factor. Risk factors for suicide in this population include a previous suicide attempt; mental ill- ness; physical illness or uncontrollable pain; fear of a prolonged illness; major changes in social roles, such as retirement; lone- liness and social isolation (especially in older men who have recently lost a loved one); and access to lethal means, such as firearms in the home [13]. LESBIAN, GAY, BISEXUAL, AND TRANSGENDER (LGBT+) INDIVIDUALS The true incidence of suicide among lesbian, gay, bisexual, transgender, and other gender and sexual minority (LGBT+) youth is unknown, but research indicates higher rates of sui- cidal behavior among LGBT+ youth (15 to 24 years of age) compared with heterosexual youth [33; 43]. Among adolescents and young adults, the lifetime prevalence of suicide attempts ranges from 20.5% to 52.4% among LGB individuals versus 4.2% to 24.8% among same-aged heterosexuals [39; 40; 42]. Among adolescents and young adults, past-year suicide attempts are more than 4.5 times higher among LGB youth than same-aged heterosexual youth [13; 37; 47]. LGBT+ youth generally have more risk factors, more severe risk factors, and fewer protective factors, such as family support and safe schools, than heterosexual youth. There are also risks unique to this population related to sexual orientation, such as disclosure to family or friends [13]. The impact of stigma and discrimination against LGBT+ individuals is enormous and is directly tied to risk factors for suicide such as isolation, alien- ation and rejection from family, and lack of access to culturally competent care [43]. Family connectedness, perceived caring from other adults, and feeling safe at school were reported as significant protective factors in a survey of 6th-, 9th-, and 12th-grade LGBT+ students [37; 38]. It has also been noted that LGBT+ adults have a two-fold excess risk of suicide than their heterosexual counterparts [37].
The American Academy of Child and Adolescent Psychiatry asserts that family connectedness, adult caring, and school
safety are highly significant protective factors against suicidal ideation and attempts in gay, lesbian, and gender-variant youth. (https://jaacap.org/article/S0890-8567(12)00500-X/ fulltext. Last accessed March 24, 2023.) Level of Evidence : Expert Opinion/Consensus Statement The effect of race/ethnicity and other demographic charac- teristics on suicidal behavior in the LGB population has also been studied little, but reports suggest high suicide attempt rates among African American gay/bisexual men, among gay/ bisexual men of lower socioeconomic status, and among LGB Latinx [35]. Depression and suicide are also common among transgender individuals. One survey assessed transgender individuals’ school experiences from kindergarten through grade 12. Of the individuals who were out as transgender during their school years, 77% reported at least one negative experience, including physical attacks, verbal abuse, and mistreatment by teachers and/or administrators. Among those with negative school experiences, 58% attempted suicide, compared with 37% of transgender individuals without negative school experiences. Among out transgender college students, 24% reported that they were physically, verbally, or sexually harassed. [38]. Across all age groups, 39% of transgender individuals reported experiencing serious psychologic distress in the past month, compared with 5% of the general U.S. population. Up to 82% of transgender persons have considered suicide in their lifetimes [124]. In addition, 40% of individuals reported attempting suicide, more than nine times the rate in the United States [38; 47; 124]. MILITARY SERVICE MEMBERS Although the true incidence of suicide among military service members and veterans is difficult to estimate due to the lack of national suicide surveillance data, the U.S. Department of Veterans Affairs (VA) estimates that 18% of all deaths from suicide in the United States are in military war veterans [79]. Despite preventive measures taken by the military, the number of suicides in this population continues to increase [52; 54; 56; 79]. Although the majority of military suicides occur among young men shortly after their discharge from military service, military women 18 to 35 years of age die by suicide nearly three times more frequently than civilian women of the same age group [57; 58]. Servicewomen, in particular, experience high rates of interpersonal violence, including childhood abuse, intimate partner violence, and sexual trauma during adulthood (e.g., military sexual assault) [123].
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