National trends in suicidal ideation, planning, and attempts among US adults aged 50 and older, 2021-2024.

Abstract

Background: Suicide rates among middle-aged and older adults in the US remain disproportionately high, yet recent national trends in suicidal ideation, suicide planning, and suicide attempts and their clinical correlates remain poorly characterized.

Methods: This serial cross-sectional study analyzed data from the 2021-2024 National Survey on Drug Use and Health, a nationally representative survey of 42,440 US adults aged ≥50 years. Logistic regression estimated temporal trends in suicidality; interaction terms tested differential trends by sociodemographic characteristics, past-year major depressive episode (MDE), serious psychological distress (SPD), substance use, prescription medication misuse, and chronic medical conditions for suicidal ideation and planning.

Results: From 2021 through 2024, suicidal ideation increased from 2.0% to 2.9% (p = 0.049), suicide planning from 0.3% to 1.1% (p < 0.001), and suicide attempts from 0.2% to 0.6% (p = 0.02). Significant increases in ideation and planning were concentrated among those without MDE, while increases in ideation were also observed among those without SPD, alcohol use, and prescription medication misuse. Suicide planning increased more steeply among those with cannabis use than those without (449.9% vs. 188.3% increase; interaction p = 0.04).

Conclusions: Suicidality increased significantly among US adults aged ≥50 years from 2021 through 2024. While individuals with MDE and other traditional risk factors had elevated absolute risk, increases in ideation were concentrated among those without these factors, and planning increased broadly across most subgroups. These findings highlight potential gaps in prevention frameworks that rely exclusively on traditional risk factor screening and underscore the need for broader risk assessment in this population.