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Rising suicide mortality among veterans and active military in the U.S. has been a serious national concern. Being male, white, single, unemployed, and depressed predict increased risk for suicide, based on multivariate logistic regression models. However, such single-indicator models do not fully account for the correlation and the overlap among these individual suicide risk factors. We therefore used latent class analyses to identify multiple-indicator socioeconomic status and mental health status classes as potential correlates of suicidal thoughts.
METHODS: This analysis identified two latent class domains of socioeconomic status and mental health status among 6,884 adult respondents in the 2011 Behavioral Risk Factor Surveillance System who had served in the U.S. military. Adults who were unemployed or unable to work, with household incomes<$25,000/year, and who did not own their own homes represented the lower social class (14%) and the remaining adults, the higher social class (86%). Those who had ever been told they had depressive disorders or depression/anxiety/post-traumatic stress disorder or had received mental health treatment/counseling in the last 12 months represented the mentally unhealthy class (12%) and the remaining adults, the mentally healthy class (88%). We examined the associations of social class and mental health status with reporting suicidal thoughts.
RESULTS:
Overall, 4.8% of adults who served in the U.S. military reported suicidal thoughts. Adults in the lower social class reported suicidal thoughts four times as often as those in the higher social class (13.9%[95% CI: 9.8−19.4%] vs. 3.3%[95% CI: 2.6−4.2%], p<0.001, crude prevalence ratio [PR]: 4.21[95% CI: 2.76−6.40]). Adults in the mentally unhealthy class reported suicidal thoughts nine times as often as those of the mentally healthy class (21.1% [95% CI: 17.0−28.1%] vs. 2.4% [95% CI: 1.8−3.2%], p<0.001, PR: 9.21[95% CI: 6.23−13.62]). After adjustment for age, sex, marital status, health insurance coverage, self-rated health, disability, smoking, physical activity, and traumatic brain injury, being in the lower socioeconomic class (adjusted PR=2.05[95%CI: 1.15−3.66]) or in the mentally unhealthy class (adjusted PR=5.73[95% CI: 3.59−9.15]) still strongly predicted reporting of suicidal thoughts.
CONCLUSIONS:
A latent class modeling approach identified socioeconomic and mentally unhealthy status among adults as strongly associated with suicidal thoughts. Suicide prevention programs should focus on adults in this group.