Suicide rates, incidence in U.S. adults decreased following Medicaid expansion

Rates of suicide among adults in the United States decreased following the 2014 expansion of Medicaid, with the sharpest subsistence occurring for young adults, according to a study published in JAMA Network Open.

“Suicidality is a symptom of mental illnesses and increasing treatment of mental illnesses and improving mental health care access is a target for suicide prevention,” Hetal Patel, MD, of the department of psychiatry, Washington University School of Medicine, and colleagues wrote.

Under the Patient Protection and Affordable Care Act, states had the opportunity to broaden health care access to low-income adults. By 2021, a total of 39 states had adopted Medicaid expansion.

Researchers sought to compare changes in the rate of suicides in those states enacted Medicaid expansion compared with states did not.

The obtained information from the National Center for Health Statistics included all individuals from the United States aged 20 to 64 between January 2000 and December 2018. Among that initial group, a total of 553,912 deaths by suicide were recorded, with 89.6% occurrence in white and 77.6% in male individuals.

Changes in suicide mortality rates among nonelderly adults before and after Medicaid expansion in both expansion and nonexpansion states were compared using adjusted difference-in-differences analyses via hierarchical Bayesian linear regression.

Results showed that, among the total population at risk for suicide, 50.4% were female, 13.3% were Black, 79.5% were white, and 7.2% were of other races. Medicaid expansion states had a lower incidence of suicide (13.94 per 100,000 individuals) compared with the nonexpansion states (16.67 per 100,000 individuals) in the preexpansion period (2011-2013), while suicide rates increased similarly in both expansion and nonexpansion states from 2000 to 2013.

However, smaller increases occurred in the suicide rate after 2014 in Medicaid expansion (2.56 per 100,000 increase) states compared with nonexpansion states (3.10 per 100,000 increase). In adjusted difference-in-differences analysis, a significant decrease of 0.40 (95% CI, 0.66 to 0.14) suicides per 100,000 individuals was found, translating to 1,818 suicides that were averted 2015 to 2018.

Data additionally revealed a large qualitative expansion-associated risk mitigation among the 20-to-29-year-old population (-0.52 suicides per 100,000; 95% CI, -1 to -0.05).

“Vigorous efforts advocating to expand and improve access to mental health care should be continued,” Patel and colleagues wrote.