Mental health diagnoses are linked to less than half of U.S. suicidal deaths. Focusing on social drivers of health (SDOH) can contextualize suicidality for prevention but also expand our understanding of suicidal risk in our screening and assessment efforts. This study draws from EHR data from an urban, safety-net hospital in the Midwest of the United States. Patients were asked to complete a SDOH survey from 2019-2023 (n=126,665). Our study seeks to determine links between SDOH and suicidality among a racially and ethnically diverse sample.
Participants were mostly female (65%), non-Hispanic white (58%), Black (32%), and Hispanic (9%). The most common SDOH’s reported were social isolation (73%), stress (55%), and financial barriers (23%).
Suicidal ideation and attempt were assessed using ICD10 codes. Patients disclosing suicidal ideation were mostly female (67%) with a greater proportion of Black (34%) and Hispanic (14%) patients than the general population. Those reporting suicide ideation had higher rates of every SDOH risk category besides social isolation compared to those without ideation. Younger patients with social isolation were more likely to have suicide ideation when compared to older socially isolated patients (OR: 1.01 for every decrease in age; p < 0.0001). Those who reported ideation were 1.56 times more also report food insecurity, 1.87 times more likely to self-report stress, 1.16 times more likely to share transportation issues, 1.60 times more likely to disclose IPV, and 1.45 times more likely to disclose social isolation.
Those with reported suicide attempt were generally younger (M age=32.5) and female (56%). Patients with financial strain, housing stability, food insecurity, transportation, and IPV had higher prevalence of suicide attempts. Patients who reported an attempt had a larger prevalence of food insecurity then those who did not, increasing from 18% to 36%.
As most people who die by suicide do not have a mental health diagnosis, we need to broaden our scope to incorporate SDOH in suicide prevention, assessment, and intervention. Recognition of each patient in context and that SDOH are often related to roughly 80% of patient outcomes, more than provider and medical center services, we can find patients who might not present as depressed or anxious. And SDOH are often the pre-cursor to mental health diagnoses and often can be the motivating factor to ideate or attempt we can broaden our understanding on upstream interventions in this area.