Individuals involved with the criminal justice system or recently released from incarceration are among those at greatest risk of suicide mortality, according to an “umbrella analysis” published in in JAMA Psychiatry.
This analysis of how social determinants of health (SDOH) affect suicidality also found that exposure to parental suicide, experiencing divorce or unemployment in mid-life, and accessibility to firearms were strongly associated with suicide mortality.
“Routine assessment of social constructs that are strongly associated with suicide mortality, suicide attempt, and suicidal ideation should be built in daily clinical practice,” wrote Peter Jongho Na, M.D., M.P.H., of the West Haven VA Medical Center, and colleagues. “Efforts to develop and validate brief and practical standardized assessment measures will be critical in screening and monitoring subpopulations at heightened risk.”
The researchers combined data from 46 separate meta-analyses looking at the effect of various SDOH domains on suicide mortality, suicide attempts and suicidal ideation. The domains included: social networks, childhood maltreatment, racism and discrimination, incarceration, nativity status, geographic location, education, employment, homelessness, poverty, environmental factors, exposure to violence, and gender or sexual minority status.
Different SDOH were prominent for each of the three outcomes. For instance, experiencing repetitive childhood abuse and identifying as lesbian, gay, or bisexual were the strongest risk factors for suicide attempts; identifying as bisexual and experiencing intimate partner violence as a woman were the strongest risk factors for suicidal ideation.
However, there were also some protective SDOH. Religious affiliation and being married were protective against the risk of suicide mortality, and school connectedness showed protective associations against suicide attempt and suicidal ideation.
The researchers recommended the following overarching priorities:
- Focusing supportive policies and interventions on individuals with a history of justice system involvement or foster care in childhood.
- Prioritizing resources and interventions for suicide loss survivors.
- Promoting firearm counseling, safe storage practices and gun licensing requirements.
- Developing policies to relieve the financial and social burden of unemployed individuals in midlife.
- Addressing discrimination against LGBTQ+ youth, ascertaining gender identity and sexual orientation in clinical settings and expanding trauma-informed, and LGBTQ+-informed mental health care services.
Past APA President Dilip Jeste, M.D., a senior author of the report, told Psychiatric News that suicide is one of the most urgent public health priorities and that the findings in the report need to be incorporated into daily clinical practice and social policy. “We have a moral and social obligation to address these factors,” he said.
For related information see the Psychiatric News article, “New Group Seeks to Make Management of Social Determinants a Reality in Health Care.”
(Image: Getty Images/iStock/syahrir maulana)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.