Intersectional Prevalence of Suicide Ideation, Plan, and Attempt Based on Gender, Sexual Orientation, Race and Ethnicity, and Rurality

Abstract

ImportanceSuicidal thoughts and behaviors (STBs) are major public health problems, and some social groups experience disproportionate STB burden. Studies assessing STB inequities for single identities (eg, gender or sexual orientation) cannot evaluate intersectional differences and do not reflect that the causes of inequities are due to structural-level (vs individual-level) processes.ObjectiveTo examine differences in STB prevalence at the intersection of gender, sexual orientation, race and ethnicity, and rurality.Design, Setting, and ParticipantsThis cross-sectional study used adult data from the 2015-2019 National Survey on Drug Use and Health (NSDUH), a population-based sample of noninstitutionalized US civilians. Data were analyzed from July 2022 to March 2023.Main Outcomes and MeasuresOutcomes included past-year suicide ideation, plan, and attempt, each assessed with a single question developed for the NSDUH. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) models were estimated, in which participants were nested within social strata defined by all combinations of gender, sexual orientation, race and ethnicity, and rurality; outcome prevalence estimates were obtained for each social stratum. Social strata were conceptualized as proxies for exposure to structural forms of discrimination that contribute to health advantages or disadvantages (eg, sexism, racism).ResultsThe analytic sample included 189 800 adults, of whom 46.5% were men; 53.5%, women; 4.8%, bisexual; 93.0%, heterosexual; 2.2%, lesbian or gay; 18.8%, Hispanic; 13.9%, non-Hispanic Black; and 67.2%, non-Hispanic White. A total of 44.6% were from large metropolitan counties; 35.5%, small metropolitan counties; and 19.9%, nonmetropolitan counties. There was a complex social patterning of STB prevalence that varied across social strata and was indicative of a disproportionate STB burden among multiply marginalized participants. Specifically, the highest estimated STB prevalence was observed among Hispanic (suicide ideation: 18.1%; 95% credible interval [CrI], 13.5%-24.3%) and non-Hispanic Black (suicide plan: 7.9% [95% CrI, 4.5%-12.1%]; suicide attempt: 3.3% [95% CrI, 1.4%-6.2%]) bisexual women in nonmetropolitan counties.Conclusions and RelevanceIn this cross-sectional study, intersectional exploratory analyses revealed that STB prevalence was highest among social strata including multiply marginalized individuals (eg, Hispanic and non-Hispanic Black bisexual women) residing in more rural counties. The findings suggest that considering and intervening in both individual-level (eg, psychiatric disorders) and structural-level (eg, structural discrimination) processes may enhance suicide prevention and equity efforts.

Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities

“…We determined the prevalence of foster care involvement for each diagnosis group by race, ethnicity, age group, and sex across groups. We also established the prevalence of foster care involvement by intersectional categorizations across sex and race and ethnicity . Logistic regressions examined associations between the likelihood of foster care involvement and race, ethnicity, age, and sex adjusting for age separate from sex and race and ethnicity.…”

“…We also established the prevalence of foster care involvement by intersectional categorizations across sex and race and ethnicity. 26 Logistic regressions examined associations between the likelihood of foster care involvement and race, ethnicity, age, and sex adjusting for age separate from sex and race and ethnicity. Data analysis was conducted with R version 4.3 from July 2022 to September 2023.…”

Accounting for diversity in the treatment of suicide and self‐injury: A systematic review of the past 50 years of randomized controlled trials

“…Similarly, there are major differences across the experiences of people with diverse sexual orientations and genders, and for the current analyses, any assessment of diverse sexual orientation and genders were combined into one category, likely erasing important differences in the frequency of assessment of different identity groups. Thus, the present study is unable to speak to gaps in representation of other sociodemographic characteristics, or of intersecting identities which are implicated in the prevalence of suicide and self-injury in the United States and abroad (e.g., veteran status, black bisexual women; Forrest et al, 2023;Kang et al, 2015;Kaplan et al, 2007;Standley & Foster-Fishman, 2021). We encourage future work to explore key nuances within sociodemographic groups that can more precisely identify SITB risk and treatment needs.…”

“…A promising direction for future SITB RCTs involves oversampling groups who have been identified as having higher SITB rates (e.g., those who identify as LGBTQ+, or veterans; Kang et al., 2015; Kaplan et al., 2007; Ramchand et al., 2022). This research may be uniquely poised to provide insight into the complex interplay of intersecting identities and how they relate to treatment needs and SITB intervention outcomes (Forrest et al., 2023; Standley & Foster‐Fishman, 2021). Finally, with the appropriate funding available multisite clinical trials are an important next step to extend SITB RCTs to middle‐ and low‐income countries.…”