Acral Vitiligo: A Comprehensive Review of Clinical Features, Pathogenesis, and Novel Therapeutic Advances.

Suicide and suicidality continue to be a serious public health crisis with growing mortality rates throughout the United States (US) [–]. Over the past decade, suicide mortality rates increased by 16.3% in the US, from 12.3 to 14.3 per 100,000 between 2011 and 2021 []. However, suicide rates are not homogenous across population subgroups. Suicide among middle-aged adults, in particular, is a growing public health problem as adults aged 35–64 years account for 46.8% of all suicides in the US and it is the eighth leading cause of death for this age group [–]. Middle-aged adults, specifically those aged 45 to 54 years old, had the highest increase in mortality rate from 2011 to 2021, with a suicide mortality rate of 12.7 in 2011 and 18.2 per 100,000 in 2021. This equates to a 43.3% increase in mortality rate, more than double the rate of change across the general population []. Given the growing concern over this issue in the United States, millions of dollars in funding have been distributed to suicide prevention programs []. However, there is no one-size-fits-all intervention that works [–]. Despite numerous resources allocated to reduce suicide rates, other indicators of mental health distress, such as substance use and overdose, have been on the rise as well. As outlined by Case & Deaton, growing mortality from overdose and alcohol misuse has been referred to as deaths of despair []. These deaths of despair are indicators of a breakdown in the social fabric of our communities [, –]. While demographic and clinical characteristics are important factors that influence these mortality rates, efforts to address factors related to chronic stress, such as social disconnectedness and economic strain, are often difficult, expensive, and take time to show change. Moreover, research suggests that economic distress is not distributed equally over time; some generations experience higher levels of economic disadvantage []. The impact of economic changes, such as standard of living, is unclear and often underutilized in this research [–]. However, exploring associations of these chronic risk factors, such as economic stress and social disconnectedness, with suicide and suicidal ideation (SI) might help improve suicide prevention interventions. To date, research has identified a wide range of suicide risk factors across numerous domains, underscoring the complexity of addressing this public health problem []. Sociodemographic risk factors including being male or living in rural areas are associated with higher suicide rates -]. In addition, mental health risk factors include a diagnosis of depression, anxiety, schizophrenia, or substance use disorder (SUD) [–]. Substance use, in particular the use of opioids, is also a significant risk factor for suicide attempts, especially among those with a co-occurring mental health diagnosis [–]. Other clinical factors are associated with suicide, such as suffering from non-cancer pain, additional life events are also significant risk factors linked to suicide, including adverse life events such as economic distress, legal problems, family disruption, or other types of social disconnectedness [, , ]. Experiencing adversity and isolation coupled with lack of access to mental health can further exacerbate the risk of suicide ideation among adults. For youth, the factors associated with suicide ideation are known to be somewhat different [–] While psychiatric conditions such as depression and anxiety remain significant contributors, additional factors like academic pressure, bullying, and household dysfunction are particularly influential. Despite some age differences, access to supportive relationships and mental health resources are seen as protective factors that mitigate suicide risk [–]. Despite the myriad of suicide risk factors that have been previously established in the literature, little is known about the impact of generational changes in financial stability in combination with other demographic, clinical, and social stressors. Such findings could provide insights to inform tailored upstream prevention efforts needed to curtail growing suicide rates, especially among known high-risk groups. The primary aim of this study is to examine sociodemographic, substance use, economic and social stressors associated with past year suicide within a representative sample of middle-aged adults in the United States. With SI being one of the strongest predictors of suicide mortality, it is essential to have a comprehensive understanding of factors that are associated with SI in order to help identify individuals at the highest risk before they attempt suicide [, ]. A secondary aim is to identify which of these factors were associated with single or repeated SI compared to no SI in this sample, thereby expanding the literature and current evidence.