Use of mental health services stagnant despite rise in suicide attempts among US adults

Despite an increase in the rate of suicide attempts, use of mental health services by those who attempted suicide within a year of doing so has not increased, per a nationwide cross-sectional study published in JAMA Psychiatry.

“Suicide attempts are the single most important risk factor for suicide and the risk factor most likely to precipitate contact with the health care system. The rate of suicide in the year after a suicide attempt has been estimated to be 0.8% to 3% for men and 0.3% to 1.9% for women,” Tanner Bommersbach, MD, MPH, of the department of psychiatry at Yale University School of Medicine, and colleagues wrote. “Because the most effective suicide prevention approaches rely on identifying and treating individuals at high risk for suicide, suicide attempts offer a valuable opportunity to intervene at a critical time to prevent future suicide.”

Bommersbach and colleagues sought to estimate annual rates of suicide attempts and use of mental health services among U.S. adults, as there is little information regarding recent trends in prevalence and risk factors, as well as suicide attempts and acute care among adults who attempted suicide in the past year, they wrote.

The researchers culled information from the National Survey of Drug Use and Health between 2008 and 2019. They included noninstitutionalized U.S. civilians aged 18 years or older. In all, 484,732 adults participated, with 69.8% aged35 years or younger, 51.8% women and 65.7% non-Hispanic white individuals.

Researchers determined the overall rate of suicide per 100,000 adults in the general population and estimated national trends within the study period. Additional subgroup analyses were performed by breaking down trends regarding demographic characteristics and clinical conditions. From that information, trends in use of mental health services among those who reported past-year attempts were examined.

Results showed 4,342 past-year suicide attempts within the study timeframe. Bommersbach and colleagues reported an increase in the weighted unadjusted suicide attempt rate per 100,000 population from 481.2 to 563.9 (OR = 1.17; 95% CI, 1.01-1.36), which remained significant following adjustment for sociodemographic characteristics (adjusted OR = 1.23; 95% CI, 1.05-1.44), between 2008 and 2019. Suicide attempt rates rose among those aged 18 to 25 years (aOR = 1.81; 95% CI, 1.52-2.16), women (aOR = 1.33; 95% CI, 1.09-1.62), those who were unemployed (aOR = 2.22; 95% CI, 1.58-3.12), those who never married (aOR = 1.6; 95% CI, 1.31-1.96) and those who used substances (aOR = 1.44; 95% CI, 1.19-1.75). Multivariate analyses revealed the temporal trend of increasing suicide attempts was still significant after controlling for other significant sociodemographic and clinical factors (aOR = 1.36; 95% CI, 1.16-1.6).

Several subgroups exhibited independent associations with a rise in suicide attempts, especially those with serious psychological distress, major depressive episodes and alcohol use disorder, as well as individuals who reported being divorced or separated during the study period. In addition, individuals who identified as Black, American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander had an increase in suicide attempts.

Among adults who attempted suicide, 34.8% (2010 to 2011) to 45.5% (2018 to 2019) reported needing mental health services but did not receive them, with no significant change between 2008 and 2019. Data additionally revealed a sharp rise in the number of participants who stated they did not know where to receive treatment, that lack of transportation provided an obstacle or services were too far away.

“Our finding that less than half of suicide attempters had clinical contact around the time of their attempt suggest that it is not only important to expand initiatives for high-risk individuals with clinical contact, but also to implement public health–oriented strategies outside the formal treatment system,” Bommersbach and colleagues wrote.