Prevalence of Suicide Ideation and Attempts Among Black Americans in Later Life

Background and Purpose: Among all Americans, suicide is the eleventh leading cause of death and the rates vary by race and age, with older adults bearing the highest burden. Obtaining national estimates of nonfatal suicidal behavior among older black Americans is an important public health objective, given that the black population is projected to double by 2050 and that suicidal thoughts and behaviors are among the strongest predictors of suicide. This article seeks to provide for the first time national estimates of the prevalence and correlates of non-fatal suicidal behavior among older black Americans.

Methods: Data are from the National Survey of American Life (NSAL), a national U. S. adult household probability sample of black Americans. The WHO Composite International Diagnostic Interview (CIDI) was used to assess older blacks for non-fatal suicidal behavior and 14 DSM-IV disorders. Bivariate and multivariate logistic regression analyses were employed to delineate patterns and correlates of non-fatal suicidal behavior. Results: The estimated lifetime prevalence of suicidal ideation and attempts among older blacks in the United States was 6.1% and 2.1, respectively. On an average it took 2.5 and 5.7 years respectively to go from ideation to attempts or from planning to attempts. Surprisingly, among older black adults, male were 3.16 (÷21 = 2.82, p <. 09) and 1.93 (÷21 = 4.67, p <. 05) times more likely than females to report attempting suicide and to serious consider taking their own lives, respectively. Older blacks at higher risk for suicide attempts were middle aged, poorer health, anxious, and had multiple DSM IV disorders. The results also show that approximately one-in-four attempters and two-in-five ideators have never sought treatment for their emotional or psychological problems.

Conclusions and Implications: Preventative care, particularly screening in primary care settings, should consider these findings when treating older black Americans for psychiatric-related risk. We found no significant ethnic group differences in the prevalence of non-fatal suicidal behavior among Black Americans aged 55 and older, which contradict previous NSAL studies that found ethnic differences among blacks in early phases of life. The findings that among older blacks the risk for attempted suicide is highest among those middle aged, 55 to 64 years, is consistent with the mortality data that show among blacks Americans it is the younger generation that are at significantly higher suicide risk. Given our results that a majority of attempters went to a health professional for their emotional problems and about a third of them went to a general medical professional, physicians have an important role to play in the prevention of suicide among older black Americans. The results of the study should influence clinicians who screen for risk for suicide. For instance, clinicians should focus on modifiable risk factors (e.g., anxiety). Physicians and mental health professionals should be skilled in talking with black clients about the risk for suicide, providing interventions for those at imminent risk for suicidal behavior, and referring clients for expert assessment and treatment.