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Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.
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Prisioneiros , Comportamento Autodestrutivo , Suicídio , Adulto , Humanos , Masculino , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/psicologia , Suicídio/psicologia , Violência/psicologia , Saúde MentalRESUMO
Suicide is a significant public health concern, particularly among primary care patients, given that many individuals who die by suicide visit their primary care provider in the months prior to their death. We examined constructs from two prominent theories of suicide, the interpersonal and psychache theories, including thwarted belongingness, perceived burdensomeness, and psychache. Among our sample (n = 224) of patients, perceived burdensomeness and psychache, individually and in serial, mediated the relation between thwarted belongingness and suicidal behavior. Thwarted belongingness was associated with greater perceived burdensomeness and, in turn, with more psychache and increased suicide risk. Our results elucidate the associations between the interpersonal and psychache theories of suicide. Clinical strategies that may reduce thwarted interpersonal needs and psychache, and which are appropriate for medical settings, are discussed.
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Relações Interpessoais , Suicídio , Humanos , Ideação Suicida , Atenção Primária à Saúde , Fatores de RiscoRESUMO
Assessing resilience among alternative sexuality (alt-sex; e.g., kink, polyamory) community members is imperative as alt-sex individuals often face discrimination and possess intersecting marginalized identities. The Brief Resilience Scale (BRS) has extensive psychometric support; however, prior research indicates both a one- and two-factor (i.e., succumbing and resilience) structure. Further, the psychometric properties of the BRS have not been examined among alt-sex community members. As such, the current study examined the BRS factor structure among alt-sex individuals and measurement invariance across demographic groups (i.e., sexual orientation, gender identity, and sexual assault history). Confirmatory factor analyses and multi-groups invariance analyses were conducted. The two-factor BRS model demonstrated better fit to the data. Model fit did not differ by sexual orientation or gender identity. Measurement invariance was observed by lifetime sexual assault history, with higher factor loadings on succumbing items among alt-sex community members with a lifetime history of sexual assault. Our findings support use of the BRS to measure resilience among alt-sex individuals. Succumbing, or weakened resilience, is a salient factor for alt-sex community members who are sexual assault survivors, warranting further attention.
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Identidade de Gênero , Minorias Sexuais e de Gênero , Humanos , Feminino , Masculino , Psicometria , Comportamento Sexual , Sexualidade , Análise FatorialRESUMO
Background: Sexual and gender minority (SGM) individuals are at increased risk for an array of chronic illness due to minority stress. Up to 70% of SGM individuals report healthcare discrimination, which may cause additional challenges for SGM people living with chronic illness including avoiding necessary healthcare. The extant literature highlights how healthcare discrimination is associated with depressive symptoms and treatment nonadherence. However, there is limited evidence on the underlying mechanisms between healthcare discrimination and treatment adherence among SGM people living with chronic illness.Methods: Among a sample of SGM individuals living with chronic illness (n = 149) recruited from social media, the current study examined the mediating roles of anticipated discrimination and depressive symptoms on the relation between healthcare discrimination and treatment adherence in a serial mediation model.Results: We found that healthcare discrimination was associated with greater anticipated discrimination, increased depressive symptoms, and, in turn, poorer treatment adherence. Conclusion: These findings highlight the association between minority stress and both depressive symptoms and treatment adherence among SGM individuals living with chronic illness. Addressing institutional discrimination and the consequences of minority stress may improve treatment adherence among SGM individuals living with chronic illness.
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Purpose: The current study explored how sexual orientation and gender identity interact with race/ethnicity to predict self-reported lifetime and current diagnosis of asthma. Methods: Using the 2020 Behavioral Risk Factor Surveillance System survey, we conducted logistic regression analyses, weighted for complex samples, stratified by sexual orientation and gender identity, and controlling for race/ethnicity, age, smoking, population density, and body mass index. Results: Analyses showed that there were significantly higher adjusted odds of lifetime asthma among gay men and bisexual men in comparison to heterosexual men, gay/lesbian women and bisexual women in comparison to heterosexual women, and transgender men in comparison to cisgender individuals. In addition, analyses showed that there were significantly higher odds of current asthma among women with other minority sexual orientations in comparison to heterosexual women. Finally, there was a significant interaction between race/ethnicity and sexual orientation among men. Conclusions: Sexual minority men of color might be particularly vulnerable to chronic asthma. Future research should examine asthma prevalence in sexual and gender minority (SGM) individuals of specific marginalized racial/ethnic groups. Future responses to SGM asthma inequities should include low-cost screening and treatment targeting SGM individuals, and policies improving air quality in urban areas.
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Asma , Minorias Sexuais e de Gênero , Feminino , Humanos , Masculino , Identidade de Gênero , Etnicidade , Prevalência , Comportamento Sexual , Asma/epidemiologiaRESUMO
The rate of college student mental health difficulties has been climbing, leading to overburdened college counseling centers. We propose the Holistic Prevention & Intervention Model (HPIM) as one solution in which campus and community resources work collaboratively to support students experiencing psychological distress and alleviate clinical demands. The HPIM moves from autonomous solutions to organizational-based strategies on a continuum of proactive to reactive interventions. We discuss how this model can be tailored and implemented for college campuses across the United States, including examining the resources available to the campus, the overall campus culture, and college demographics that affect risk and protective factors.
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OBJECTIVE: The 988 telephone number was established by the National Suicide Hotline Designation Act of 2020 and implemented in July 2022 as a more accessible way to reach the National Suicide Prevention Lifeline. Current financial and training resources, however, are insufficient to ensure effective implementation. METHODS: To better understand the state of the literature on crisis support lines in light of the 988 transition, the authors summarized research on suicidal and nonsuicidal outcomes of callers, research on other types of crisis support services, and the benefits of text- and chat-based crisis lines. RESULTS: Overall, existing evidence for the effectiveness of crisis lines has been weak and has primarily focused on short-term improvements in user distress and on user satisfaction. In addition, research on crisis lines specifically targeted to marginalized populations (e.g., sexual minority groups) and on text- or chat-based crisis lines is lacking. CONCLUSIONS: The policy-focused recommendations derived from this review include the need for additional research on crisis lines, design and evaluation of culturally tailored training for volunteers and staff, and ethical oversight of private data collected from crisis services. Scaling up state-level planning and comprehensive crisis systems is necessary to successfully implement 988 and to fill current training and research gaps.
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Intervenção em Crise , Suicídio , Humanos , Linhas Diretas , Prevenção do Suicídio , PolíticasRESUMO
Sexual minorities are at an increased risk for psychopathology, compared to heterosexual counterparts, in part due to stressors unique to their sexual minority identity. The greater socio-political climate may exacerbate sexual minority stress, and the context of the 2016 United States presidential election infringed upon the rights and well-being of LGBQ individuals. In our sample of sexual minorities (n = 253), we examined the association between anticipated stigma in response to the 2016 presidential election and symptoms of anxiety and depression, and the potential mediating role of self-compassion, hopelessness and social support. Greater anticipated stigma was associated with less self-compassion, less perceived social support, and greater hopelessness, and, in turn, greater symptoms of anxiety and depression. Anticipated stigma may erode feelings of environmental support and may be internalized as negative views of the self and future. From a public health perspective, policy-makers should be aware that the discussion and/or enactment of policies which discriminate against LGBQ persons may negatively impact mental health. Clinically, bolstering self-compassion and interpersonal functioning, and targeting hopelessness, through strategies such as Acceptance and Commitment Therapy and Compassion-Focused Therapy, may buffer the impact of minority stress among sexual minorities.
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Terapia de Aceitação e Compromisso , Minorias Sexuais e de Gênero , Humanos , Estados Unidos , Saúde Mental , Estigma Social , Identidade de Gênero , Estresse Psicológico/etiologia , Estresse Psicológico/psicologiaRESUMO
The coronavirus disease (COVID-19) pandemic has substantially impacted psychological health in the U.S and has disproportionately impacted underresourced individuals. Despite the higher need for mental health services during this time, service availability and access were disrupted due to increased demand, social distancing recommendations, and stay-at-home orders. Thus, it is crucial to understand factors that predict the desire for psychological services for underresourced individuals. The present study examined factors at multiple levels of Bronfenbrenner's socioecological model (Bronfenbrenner, 1994) to determine which factors best predicted the desire for mental health services including individual, group, in-person, and online services. The sample consisted of 155 underresourced adults in North Carolina. Participants completed an online survey of mental health symptoms, coping strategies, COVID-19 related stressors, and provided demographic information including ZIP code, which was used to classify urban-central and urban-outlying dwellers. Results from univariate general linear models demonstrated that depression symptoms, venting as a coping strategy, COVID-related stress, and living in more rural regions were all significant predictors of the desire for psychological services. Venting as a predictor of the desire for services may signify a general misunderstanding regarding the purpose of psychotherapy as well as the need for individuals to gain social support and connectedness during a pandemic. This study helps to clarify individual-level and contextual factors that impact the desire for psychological services during a global pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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COVID-19 , Transtornos Mentais , Serviços de Saúde Mental , Adulto , Humanos , Saúde Mental , Adaptação PsicológicaRESUMO
OBJECTIVE: This paper advances understanding of the kink community by examining mental health and coping-self efficacy (CSE) variation by gender and sexual orientation. DESIGN: Adult members of the National Coalition for Sexual Freedom (N = 332) completed an online cross-sectional health assessment. MAIN OUTCOME MEASURES: The assessment included the Coping Self-Efficacy (CSE) Scale; Depression and Anxiety Stress Scale-21; and Alcohol Use Disorders Identification Test. RESULTS: Transgender and non-binary persons reported consistently low coping beliefs and poor mental health. Queer sexual minority persons reported low CSE thought stopping and high anxiety. Several CSE thought stopping moderation effects on mental health were observed. CONCLUSIONS: Findings may inform clinical implications, as bolstering coping-related beliefs and skills via cognitive-behavioral therapy may offer mental health benefit to kink practitioners.
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Alcoolismo , Saúde Mental , Adulto , Humanos , Masculino , Feminino , Autoeficácia , Estudos Transversais , Comportamento Sexual/psicologia , Adaptação PsicológicaRESUMO
The Hate Crime Beliefs Scale (HCBS) is an assessment of attitudes about hate crime laws, offenders, and victims. The original HCBS includes four subscales (negative beliefs, offender punishment, deterrence, and victim harm), while a shortened and modified version from the United Kingdom (UK; HCBS-UK) consists of three subscales (denial, sentencing, and compassion). We conducted a psychometric test of the HCBS in order to identify a best fitting structure with possible item reduction. A total of 463 participants completed the original HCBS, measures of social dominance orientation (SDO) and right-wing authoritarianism (RWA), and demographic questions. Factor analyses revealed good fit of the data for a Hate Crime Beliefs Scale-Short Form (HCBS-SF), largely modeled after the HCBS-UK. The three subscales were: denial (i.e., downplaying hate crime severity and low support for hate crime laws), sentencing (i.e., support for more punitive offender punishment), and compassion (i.e., understanding and concern for victims). All subscales possessed acceptable internal consistency. The denial subscale was positively associated with RWA subscale and SDO scores. The sentencing and compassion subscales were significantly negatively correlated with SDO and RWA subscale scores. Republicans held the least supportive views of hate crime laws, concern for victims, and punishment of offenders. Data underscore the importance of evaluating hate crime beliefs in public opinion and other contexts. The HCBS-SF better captures hate crime related attitudes than the previously developed longer version of the HCBS.
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Sexual and gender minority (SGM) military veterans have endured a history of discriminatory policies and hetero- and cis-sexist-related military culture that can negatively impact identity and mental health. The present pilot evaluation examined measure characteristics of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS) and lesbian, gay, and bisexual positive identity measure (LGB-PIM) in a clinical sample of SGM military veterans in order to assess the potential use of these instruments in understanding identity and mental health in the context of program implementation. A cross-sectional pilot survey of 83 SGM veterans was conducted in 10 veterans affairs sites. Self-report data were collected as part of a quality improvement project across 2018 and 2019. Results showed that the sample was characterized by low internalized prejudice and identity uncertainty, as well as generally high positive aspects of identity (e.g., identity affirmation, authenticity, social justice beliefs). LGB-PIM subscale internal consistency values were acceptable (α range = .89-.92), whereas LGBIS subscale values varied (α range = .51-.87). Acceptance concerns, identity uncertainty, and social justice beliefs distinguished mental health symptom severity levels. Higher identity uncertainty and social justice beliefs were associated with worse symptoms of depression, anxiety, and suicide risk. Preliminary results support further application and study of the LGB-PIM and some LGBIS subscales as possible tools in program development and improvement within military veteran samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Homossexualidade Feminina , Minorias Sexuais e de Gênero , Veteranos , Bissexualidade/psicologia , Estudos Transversais , Feminino , Identidade de Gênero , Homossexualidade Feminina/psicologia , Humanos , Projetos PilotoRESUMO
Self-directed violence (SDV), comprising both suicide and self-injury, presents a continued public health challenge for correctional institutions. In fact, correctional settings are one of four primary targets for the reduction of SDV by leading professional organizations. This article presents a public health solution to SDV in correctional settings, namely the Core Competency Model for Corrections (CCM for Corrections), an educational program for correctional mental health providers. Grounded in the general CCM of Suicide Prevention, we proffer an evidence-based sample curriculum covering 10 SDV prevention competencies in correctional settings. These competencies address both clinical care (e.g., enacting evidence-based treatment plans, using best practice documentation standards) and provider-focused (e.g., managing personal attitudes about SDV and incarcerated persons, engaging in self-care and debriefing) skills. We further espouse the underlying social-cognitive theory of CCM for Corrections toward the goal of identifying mechanisms of action for improved SDV prevention skills. Finally, we highlight considerations in the initial design and testing of CCM for Corrections. These recommendations address (a) utilization of a community-academic partnership approach and corrections SDV advisory panel, (b) selection of an in-person or online training modality, and (c) measurement of sample educational program outcomes. The CCM for Corrections represents a promising approach to SDV reduction and management in correctional settings ripe for collaborative pilot testing. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Comportamento Autodestrutivo , Prevenção do Suicídio , Humanos , Violência , Currículo , Estabelecimentos CorrecionaisRESUMO
OBJECTIVES: Black same-gender loving men (BSGLM) represent a population with understudied lived experiences as both racial and sexual minority individuals. Most existing research among BSGLM focuses on sexual health outcomes in the context of minority stress, without consideration of the full experiences of BSGLM or strengths-based approaches. The present study aimed to address this gap in the literature by examining self-love among BSGLM using a phenomenological qualitative approach. METHOD: Adult BSGLM in the U.S. (n = 19; Mage = 31.79 years [SD = 8.88]) were recruited online and completed interviews via phone and video conferencing. Data were coded independently by two trained coders via an iterative approach that included in vivo coding and line-by-line comparative coding. Codes were grouped thematically, guided by sexual minority identity and positive psychology literature. RESULTS: Three major themes related to self-love among BSGLM emerged: (a) Freedom of identity, meaning participants' ability to construct an identity outside of societal expectations; (b) Community connection and pride, or participants' connection to and pride derived from the BSGLM community; and (c) Adversarial growth and resilience, or ways that adversity related to BSGLM identity generated personal growth. CONCLUSIONS: Current findings may have clinical implications. Using narrative therapy approach, facilitating connectedness to the BSGLM community, and implementing gratitude interventions in therapeutic settings may enhance self-love and positive self-regard among BSGLM. Future research should continue to give voice to the full lived experience of BSGLM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Negro ou Afro-Americano , Homossexualidade Masculina , Amor , Homens , Pesquisa Qualitativa , Minorias Sexuais e de Gênero , Adulto , Negro ou Afro-Americano/psicologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Homens/psicologia , Terapia Narrativa , Minorias Sexuais e de Gênero/psicologiaRESUMO
The purpose of this longitudinal study was to examine associations between per capita income, unemployment rates, and COVID-19 vaccination rates at the county-level across the United States (U.S.), as well as to identify the interaction effects between county-level per capita income, unemployment rates, and racial/ethnic composition on COVID-19 vaccination rates. All counties in the U.S. that reported COVID-19 vaccination rates from January 2021 to July 2021 were included in this longitudinal study (n = 2857). Pooled ordinary least squares (OLS) with fixed-effects were employed to longitudinally examine economic impacts on racial/ethnic disparities on county-level COVID-19 vaccination rates. County-level per capita income and county-level unemployment rates were both positively associated with county-level COVID-19 vaccination rates across the U.S. However, the associations were divergent in the context of race/ethnicity. Public health efforts to bolster COVID-19 vaccination rates are encouraged to consider economic factors that are associated with decreases in COVID-19 vaccination rates.
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COVID-19 , Desemprego , Vacinas contra COVID-19 , Disparidades nos Níveis de Saúde , Humanos , Renda , Estudos Longitudinais , SARS-CoV-2 , Estados Unidos , VacinaçãoRESUMO
Purpose: The current study examined the relationship between sexual orientation and human papillomavirus (HPV) vaccination status (no vaccination vs. vaccination initiation [one to two doses] or completion [three or more doses]) among a nationally representative sample of U.S. adults. Methods: Pooled Integrated Public Use Microdata Series-National Health Interview Survey data from 2013 to 2017 were used. The analysis sample (N = 35,266) reported on HPV vaccination status, sexual orientation, and demographic covariates. Multinomial logistic regression, stratified by sex, was conducted to assess the relationship between sexual orientation and HPV vaccination status. Results: Most of the sample (80.37%) had not received any HPV vaccination dose, and only â¼10% reported vaccine completion (three or more doses). After adjusting for demographic covariates, gay and bisexual males were more likely than heterosexual males to initiate (gay: adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.67-3.62; bisexual: AOR = 2.30, 95% CI = 1.28-4.12) and complete (gay: AOR = 2.59, 95% CI = 1.45-4.65; bisexual: AOR = 3.20, 95% CI = 1.56-6.55) HPV vaccination. Bisexual females were more likely than heterosexual females to initiate (AOR = 1.99, 95% CI = 1.55-2.54) and complete (AOR = 1.45, 95% CI = 1.23-1.86) HPV vaccination. Females of another sexual orientation were less likely than heterosexual females to complete HPV vaccination (AOR = 0.49, 95% CI = 0.26-0.92). Conclusions: HPV vaccination remains low across sexual orientation groups. Sexual minority status may be a promotive factor in HPV vaccination for specific subgroups.
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Alphapapillomavirus , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Minorias Sexuais e de Gênero , Adulto , Feminino , Heterossexualidade , Humanos , Masculino , Infecções por Papillomavirus/prevenção & controle , Comportamento Sexual , VacinaçãoRESUMO
OBJECTIVE: We developed the Self-Injury Risk Assessment Protocol for Corrections (SIRAP-C) to meet legal mandates for self-directed violence (SDV) risk assessment standards in correctional settings. We focused on two empirical aims: (1) factor structure and internal consistency and (2) subscale associations with SDV and intervention recommendation outcomes. HYPOTHESES: We expected a multifactorial SIRAP-C structure with acceptable internal consistency. We further expected SIRAP-C subscales would distinguish history of SDV events while incarcerated, current SDV event category, and treatment recommendation. METHOD: We drew electronic health record data for adult incarcerated persons (N = 3,929) from state Division of Prisons records from 2016 to 2020. Clinical records included demographic and correctional institutional information, as well as SIRAP-C records. Factor analyses assessed Aim 1. Regression models tested Aim 2. RESULTS: Factor analyses supported a seven-factor SIRAP-C structure (27 items) comprising Depressive Symptoms, Reasons for Living, History of Self-Directed Violence, Current Suicidal Thinking, Family History of Self-Directed Violence, Coping Skills, and Social Connectedness. Subscales displayed acceptable internal consistency, with the exception of social connectedness in the confirmatory factor analysis subsample. Lower depressive symptoms and coping skills, as well as higher history of SDV, were associated with increased risk for a prior SDV assessment event while incarcerated. Lower depressive symptoms, current suicidal thinking, and coping skills and higher history of SDV marked worse risk for self-injurious behavior. Higher depressive symptoms and current suicidal thinking, as well as lower reasons for living, demarcated suicidal acts from self-injury. Higher history of SDV and lower coping skills indicated outpatient/residential treatment. Elevated depressive symptoms and history of SDV, as well as lower reasons for living and coping skills, were associated with inpatient hospitalization. CONCLUSIONS: The SIRAP-C represents a promising clinical approach advancing correctional SDV risk assessment. We offer future research, policy, and implementation recommendations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Comportamento Autodestrutivo , Adulto , Análise Fatorial , Humanos , Medição de Risco , Comportamento Autodestrutivo/diagnóstico , Ideação Suicida , ViolênciaRESUMO
Individuals with fibromyalgia report lower levels of health-related quality of life (HRQL) compared to other chronically ill populations and interpersonal factors (i.e., social support) may influence risk. What is less understood is how intrapersonal factors (i.e., self-compassion) may impact the social support-HRQL linkage. We examined the association between social support and HRQL in a sample of persons with fibromyalgia and tested the potential mediating role of self-compassion. Self-identified adults in the United States with fibromyalgia (N = 508) were recruited from state, regional, and national organizations and support groups and completed an online battery of self-report questionnaires including: Multidimensional Health Profile-Psychosocial Functioning Index, Short-Form 36 Health Survey, and Self-Compassion Scale-Short Form. Individuals with greater subjective social support reported higher levels of self-compassion and, in turn, higher mental HRQL. These findings provide greater information about psychosocial constructs and HRQL and extend our understanding of self-compassion among individuals living with fibromyalgia.
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Fibromialgia , Adulto , Autoavaliação Diagnóstica , Fibromialgia/psicologia , Humanos , Qualidade de Vida , Autocompaixão , Apoio SocialRESUMO
Human immunodeficiency virus (HIV) continues to disproportionately affect gay, bisexual, and other men who have sex with men (GBM) and transgender and nonbinary (trans/NB) individuals. This study investigated attitudes toward participation in HIV survey research, guided by Emanuel's framework for ethical clinical research (e.g., risk-benefit ratio, fair participant selection, respect for participants, social value, and collaborative partnership). GBM (n = 294) and trans/NB (n = 86) persons recruited at a Pride event in Milwaukee completed a survey assessing risks and benefits of participation in, and comfort responding to, sexual health surveys. Participants reported few ethical concerns (e.g., privacy and confidentiality), with notable differences by race, sexual orientation and gender identity, and prior research experiences. Implications for HIV research with GBM and trans/NB individuals are discussed.
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Infecções por HIV , Minorias Sexuais e de Gênero , Pessoas Transgênero , Adulto , Feminino , Identidade de Gênero , Homossexualidade Masculina , Humanos , Masculino , Comportamento SexualRESUMO
INTRODUCTION: Suicide and substance use are prevalent problems among persons discharged from facilities. This study (1) articulated rates of substance-related suicide deaths among those discharged correctional, behavioral health, and healthcare facilities, and (2) identified factors associated with substance-related suicide deaths unique to, or generalizing across, facility discharge. METHODS: We used data from the National Violent Death Reporting System. Suicide deaths (N = 105,968) were aggregated from 2003 to 2017. Chi-square and independent samples t-tests were used to examine associations between drug/alcohol-related deaths and each correlate. Logistic regression was employed to identify the most robust substance-related suicide death-related factors. RESULTS: Suicide deaths were commonly marked as being substance-related: 69% from correctional institutions, 54% from behavioral health facilities, 45% from those not released from a facility, and 39% from healthcare facilities. Regression models indicated housing interruptions and interpersonal stressors increased odds of the suicide death being marked as substance-related across discharge categories. Each discharge category also had unique predictors, underscoring the need for tailored prevention. CONCLUSIONS: Substance-related suicide deaths are particularly common among adults discharged from correctional and behavioral health facilities. Findings are discussed with respect to community-focused, discharge planning, and clinical care suicide prevention strategies.