Exploring Suicide Risk Among Homeless Adults in Texas: Investigating Factors Influencing Suicide Ideation and the Need for Safety Planning

Background and Purpose: Suicide is a serious public health issue among homeless populations globally. The Centers for Disease Control and Prevention (CDC) reported that in 2020, approximately 12.2 million individuals reported suicide ideation, 1.2 million individuals attempted suicide, and 45,979 individuals died by suicide. Previous research has shown that homeless individuals are at a much greater risk, with suicide rates ten times higher than the general population. However, suicide ideation rates are severely underreported among the homeless population in the United States. Nonetheless, little is known about how these factors correlate with suicide ideation among the homeless population in the South and the importance of having a safety plan to help cope with suicide ideation. Thus, this study explores the risk factors influencing suicide ideation and the need for safety planning among Texas homeless adults.

Method: A total of 1,664 (aged 18-74) homeless adults were selected from a state-funded Healthy Community Collaborative Program (HCC) that completed their adult needs and strengths assessment (ANSA) in the fiscal year of September 2021 to December 2022. The outcome variable was suicide ideation (no evidence/evidence of ideation). The predictors were all binary and included suicide risk, self-injurious behaviors, other self-harm, suicide history, anxiety, depression, substance use, family/friend suicide history, criminal history, impulse problems, and interpersonal problems. Other covariates included age, sex, race, and ethnicity. Multivariate logistic regression examined the association between suicide ideation and the risk factors mentioned above.

Results: Overall, 62% of the sample were males, 59% were White, and 81% were not Hispanic or Latino, with a mean age of 40. Homeless adults with a history of suicide risk and needing a safety plan had 3.8 times greater odds of suicide ideation (p < 0.01). Homeless adults with previous suicide history (OR=1.59; p < 0.05), having depression (OR=6.67; p < 0.01), family/friend history with suicide (OR=3.01; p < 0.01), and interpersonal problems (OR=1.81; p < 0.05) reported higher odds of experiencing suicide ideation compared to individuals who did report these risk factors.

Conclusions and Implications: This study showed that homeless adults who reported suicide risk and the need for a suicide safety plan along with several significant risk factors had increased odds of suicide ideation. Homeless service providers across Texas should implement an effective suicide care system that includes personal safety plans for individuals. These safety plans should identify warning signs, coping strategies, crisis management, and mental health services, promote healthy distractions, and remove means of suicide to decrease the risks of suicide ideation, planning, and attempts among homeless adults. Such comprehensive suicide care plans can be critical in mitigating the risks of suicide among homeless populations.