The relationship between gender identity, economic stressors, social support, concurrent substance use and suicidal...

To examine a comprehensive list of demographic, substance use, economic, and social factors associated with suicidal ideation (SI) among middle-aged adults.

Cross-sectional data were obtained from a national sample of middle-aged adults between February and November 2022. The study's final sample include 1,337 respondents who represented the adult population of persons aged 40-60 years in the United States. Bivariate and multivariate statistics were employed to identify significant factors associated with past year SI, including the examination of factors associated with single SI and multiple instances of SI in the past year.

Of the sample, 140 (10.4%) reported SI in the past year. Among those, more than half (60.0%, n = 84) reported SI multiple times in the past year. Multivariable logistic regression indicated that those who reported a lower standard of living compared to their parents/caregivers (adjusted odds ratio [aOR] 2.62), were a gender minority (aOR 7.06), engaged in concurrent substance use (aOR 3.29), or were unemployed (aOR 1.80) had significantly higher odds of past year SI, whereas higher social support was protective against SI (aOR 0.69). Multinomial regression found that concurrent substance use, unemployment, and having a lower standard of living than their parents/caregivers predicted repeated past year SI whereas higher social support was protective against multiple SI experiences (aOR 0.65).

Middle-aged adults reporting concurrent substance use, lower social support, unemployment and were gender minority had higher odds of past year SI. These findings underscore the need to develop public health and clinical interventions tailored to these highest-risk middle-aged adults in order to prevent suicide.