This application is in response to RFA-MD-12-001: NIMHD Health Disparities Research. One of the priority areas of this RFA is the study of health conditions associated with significant mortality that have been understudied in health disparity populations. In older Americans, suicide rates are 30% higher than in the general population, and five times higher in non-Hispanic white men age 85 years or older-as the nation continues to grow and racially/ethnically diversify with age so will the rates of suicide. Yet, little is known about suicide-related behaviors (i.e., ideation, plans, and attempts) in older adults, which are strong risk factors for actual suicide and strong indicators of extreme emotional and mental distress. Even more so, differences in suicidal behavior by race/ethnicity have hardly been investigated at all, as most studies are from non-diverse clinic samples. Moreover, most of what we know about mental health services use related to suicide risk in older Americans comes from small non-diverse samples of suicide completers. However, understanding mental health services use and racial disparities in use is important, as all aging adults with emotional and mental distress related to suicidal thoughts and behaviors may benefit from service use and treatment. The proposed project will investigate the prevalence and predictors of suicidal ideation and related behaviors over the lifetime of older racially and ethnically diverse adults, that is, capturing transitions from ideation to plans and attempts and examining risk of late life and current suicidal behavior. It will also investigate mental health services use in those at increased risk of suicide.
The aims will be addressed by studying three nationally representative aggregated data sets: 1) the National Comorbidity Survey Replication (NCS-R), a probability sample of the general U.S.;2) the National Survey of American Life (NSAL), a probability sample of African- American, Afro-Caribbean, and non-Hispanic White Americans;and 3) the National Latino and Asian American Study (NLAAS), a probability sample of Latinos and Asian Americans. The project proposes to make innovative use of the combined data and examine a large, nationally-based cohort of over 3,600 respondents aged 55 and older. In a very cost-efficient approach, this project will be the first comprehensive examination of the prevalence and predictors of suicide-related behaviors and mental health services use in older Americans. Key predictors, including sociodemographic variables, psychiatric disorders, and chronic medical conditions associated with suicidal behavior will be determined (Aims 1 and 2)-assessing differences of associations overall and by race/ethnicity, that is, in older non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians. In addition, racial disparities will be assessed separately for men and women (Aim 3), and key predictors of mental health services use will be examined overall and by race/ethnicity (Aim 4). Information stemming from this project will be important for identifying those older adults most at risk of suicide and with great need of care-helping to define national priorities for suicide prevention in late life for all Americans.
Suicidal risk profoundly impacts individuals, families, and society. Knowledge gained from this proposal will be both novel and critical for understanding the occurrence and predictors of suicide-related behaviors (i.e., ideation, planning, and attempts) in older Black, Hispanic, Asian, and White Americans, including use of mental health services in those at increased risk of suicide. Thus, this proposed project will have unique public health importance, because it will provide evidence for future psychiatric research and policy planning that will help to define national priorities for suicide prevention in late life for all Americans.
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