Suicidal Ideation Among Sexual and Gender Minority Midlife and Older Adults: Risk and Protective Factors

Background: Sexual and gender minority (SGM) individuals experience elevated risk for suicidal ideation (SI), yet much of the existing literature has focused on either the younger SGM population or on older adults without attention to sexual orientation and gender identity. This gap in the literature limits the evidence guiding inclusive, comprehensive aging and behavioral health services. The current study examines the risk and protective factors associated with lifetime suicidal ideation among SGM midlife and older adults. Guided by the Health Equity Promotion Model and Fluid Vulnerability Theory, the study investigates how social positions, historical/environmental adversities, psychological, and behavioral factors are associated with SI in this population.

Methods: This secondary analysis utilizes 2014 wave data from the National Health, Aging, and Sexual/Gender Study, the first national longitudinal study of SGM adults aged 50+. The analytic sample included 2,425 participants. Lifetime SI is measured with a single item assessing whether participants had ever seriously thought about committing suicide. Predictors such as demographic characteristics, lifetime discrimination, lifetime victimization, depression, anxiety, mastery, resilience, substance use disorder, alcohol use disorder, and physical activity. Descriptive and bivariate analyses are conducted, followed by multivariable logistic regression, controlling for demographic covariates, with survey weights applied.

Results: In the analysis, transgender identity is associated with significantly higher odds of lifetime SI (odds ratio [OR]=3.68, 95% CI [2.35, 5.78], p<.001). Lifetime discrimination (OR=1.061, 95% CI [1.01, 1.11], p=.011) and lifetime victimization (OR=1.08, 95% CI [1.05, 1.10], p<.001) are each significantly associated with higher odds of lifetime SI. Depression is the strongest psychological factor (OR=2.923, 95% CI [2.33, 3.66], p<.001), followed by substance use disorder (OR=2.233, 95% CI [1.12, 4.46], p=.023). Resilience (OR=0.78, 95% CI [0.70, 0.87], p<.001) and physical activity (OR=0.747, 95% CI [0.59, 0.94], p=.015) are protective factors. Several factors that are commonly considered to be SI predictors, such as age, sexual orientation, educational attainment, income level, and alcohol use disorder, does not predict lifetime SI in the current study.

Conclusion and Implications: This study highlights that SI among SGM midlife and older adults is a concerning issue in this population and can be understood with the context of both historical/structural inequities and modifiable behavioral health factors. Our findings support integrating culturally responsive suicide screening, depression assessment, substance use intervention, and resilience-enhanced strategies into aging and behavioral health services for this community. At the mezzo level, the study calls for trauma-informed care and competency-based trainings that address the consequences of discrimination and victimization among SGM midlife and older adults. At the structural level, our findings underscore the importance of affirming anti-discrimination protections and healthcare access for SGM midlife and older adults.