摘要：Objectives. We examined the prevalence and correlates of past-year suicidal ideation among US community-dwelling adults. Methods. We examined data from 183 100 persons aged 18 years or older (including 9800 sampled adults with past-year suicidal ideation) who participated in the 2008–2011 National Survey on Drug Use and Health. We applied descriptive analyses and pooled and stratified (by age and major depression) multivariate logistic regression models. Results. The prevalence of past-year suicidal ideation among younger adults (6.6% among those aged 18–25 years and 4.0% among those aged 26–49 years) was higher than was that among adults aged 50 years or older (2.5%). The prevalence of suicidal ideation was high among adults with major depression (26.3%), adults with both major depression and substance use disorder (37.7%), and adults who received mental health treatment but perceived unmet treatment need (33.5%). Conclusions. Many risk and protective factors of suicidal ideation are dynamic and vary by age or major depression. These results have important implications for developing specific suicide prevention strategies that help screen, assess, and treat suicidal adults at the earliest possible time. Suicide is a major public health problem in the United States. More than 35 000 reported deaths are because of suicide each year. 1,2 Suicide is often misclassified and underreported. 3 Among Americans aged 15 to 54 years, about 60% of planned first suicide attempts occurred within the first year of having the onset of suicidal ideation (seriously considering trying to kill oneself). 4–7 About 13% of suicidal ideators in a year make a suicide attempt during that year. 8 The presence of suicidal ideation significantly increases the risk of suicide attempts 5–7 and eventual death by suicide. 9,10 In 2010, an estimated 8.7 million adults in the United States had suicidal ideation. 8 To improve the effectiveness of detecting and intervening with people at high risk of suicide, it is critical to fully understand specific risk and protective factors associated with suicidal ideation. Most previous studies used data from narrowly defined samples (e.g., restricted age ranges, 4,6,11–13 clinical samples, 11–15 or a local community sample 16 ) and could not extrapolate the results to the general US population. Moreover, most studies focused on a restricted set of predictors for suicidal ideations, such as sociodemographics, clinical symptoms, or psychiatric disorders. 5,6,12–14 Few studies have examined potential protective factors (e.g., social support, religious practice, and mental health treatment) on suicidal ideation, and the samples of those studies were limited to either older adults 11,15,16 or Latinos. 17 Furthermore, suicidal ideation is a complex, multidimensional problem. 2,18 Sociodemographics and other risk and protective factors of suicidal ideation tend to interact with each other. 2,18 However, no study has examined any interaction effects among these factors on suicidal ideation. Suicide rates differ by age, 2,18–21 as many risk and protective factors of suicide vary by age. 19 Psychosocial stressors and family or developmental issues are often age related and may affect suicide risks. 21 Some psychiatric disorders with typical onset ages are also associated with suicide. 21 For example, the median age at onset tends to be earlier for substance use disorder (SUD, aged 20 years) than for mood disorders (aged 30 years). 22 Both SUD and mood disorder are associated with suicide. 2,6,7,21 An earlier age of onset of major depression is associated with increased suicidality. 23 It is not surprising that the prevalence of suicidal ideation is higher among young adults than among older adults. 5,24 However, none of the previous studies examined whether and how sociodemographics and other risk and protective factors that are associated with suicidal ideation differ by age. Co-occurrence of major depression and SUD greatly raises the risk of suicide. 18 Major depression is the most common individual disorder among people with suicidal behaviors. 2,6 SUD may complicate depression, increase susceptibility to psychological impairment, and contribute to an elevated risk for suicide. 7,21,25 However, it is unknown whether and how major depression and SUD influence each other and affect the risk of suicidal ideation among different age groups. Effective treatments of suicidal ideation and behaviors have emerged over the past decade. 21 Effective interventions can reduce suicidal ideation. 12 However, more than half of adults with past-year suicidal ideation did not receive mental health services in the past year. 26 Many adults who perceived an unmet need did not receive mental health services, indicating problems in access to treatment. Others received mental health services but perceived an unmet need, suggesting disparities in treatment quality. Little is known about the relationships between the receipt of mental health treatment, perception of unmet need, and suicidal ideation among different age groups with or without major depression or SUD. Gaining a better understanding of these questions will help enhance prevention efforts and assist in developing specific interventions to reduce suicidal ideation and suicide risk. Using recent nationally representative data, we estimated the prevalence rates of past-year suicidal ideation by sociodemographic characteristics and other risk and protective factors and investigated the relationships between these factors and suicidal ideation among community-dwelling (i.e., civilian, noninstitutionalized) adults.
