Study Examines Suicide Attempts and Use of Mental Health Services

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According to a new analysis, the annual rate of suicide attempts among US adults increased 17% from 2008 to 2019.¹ Furthermore, the study showed that the rate of patients who were suicidal and did not know how to seek treatment more than doubled in the same time period. The findings highlighted the sociodemographic factors associated with increased risk of suicide attempts, and the pressing need to improve accessibility and social acceptability of care, as well as suicide prevention efforts.

Tanner J. Bommersbach, MD, MPH, and colleagues conducted a cross-sectional analysis of nationally representative data taken from the National Survey of Drug and Health (NSDUH) from 2008 to 2019 to estimate annual rates of suicide attempts and use of mental health services by US adults.

For years, suicide has been one of the most common causes of death in the US, and it has increased by more than 60% since 1999. However, Bommersbach noted a “small but growing” number of decedents from suicide had contact with health services in the 12 months prior to their deaths. A recent systematic review and meta-analysis using data from 2000 to 2017 showed inpatient mental health stay (18.3%), outpatient mental health services (26.1%), and contact with both services (25.7%) were becoming more common among people who eventually suicided.

Bommersbach colleagues sought to understand the use of care among those who have only attempted suicide to inform prevention efforts.

“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,” they 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.”

The data of adult participants in NSDUH from the observed time period provided 484,732 persons who attempted suicide. Bommersbach et al estimated the overall annual rates of suicide attempts per 100,000 adults in the general population and from national trends for each year. They conducted subgroup analyses based on participant demographic characteristics and their clinical conditions, determining whether adjusting for such factors could account for any observed change in annual suicide attempt rates. They also examined trends in past-year mental health service use relative to past-year suicide attempts.

Approximately two-thirds of the observed survey participants were more than 35 years old (69.7%), as were those who were non-Hispanic white (65.7%). Another 51.8% were women. More than 38% were married; 31.2% had received some college education, 50.2% were employed full-time, and 44.5% lived in large metropolitan areas.

The weighted unadjusted suicide attempt rate per 100,000 persons increased from 481.2 in 2008 to 563.9 in 2019 (odds ratio [OR], 1.17; 95% CI, 1.01 – 1.36; P = .04). After controlling for sociodemographic characteristics, the increase rose to 23% (adjusted OR [aOR], 1.23; 95% CI, 1.05 – 1.44; P = .01). Multivariate analyses showed an even greater increase in suicide attempts after controlling for other significant sociodemographic and clinical factors (aOR, 1.36; 95% CI, 1.16 – 1.60; P <.001).

Suicide attempt rates particularly increased among adults aged 18 to 25 years (aOR, 1.81; 95% CI, 1.52 – 2.16; P <.001); women (aOR, 1.33; 95% CI, 1.09 – 1.62; P = .005); unemployed adults (aOR, 2.22; 95% CI, 1.58 – 3.12; P <.001); adults who never married (aOR, 1.60; 95% CI, 1.31 – 1.96; P <.001); and adults who used substances (aOR, 1.44; 95% CI, 1.19 – 1.75; P <.001).

In addition, adults with the following clinical and social characteristics and cultural groups remained independently associated with suicide attempts: serious psychological distress (aOR, 7.51; 95% CI, 6.49 – 8.68; P <.001); major depressive episodes (aOR, 2.90; 95% CI, 2.57 – 3.27; P <.001); alcohol use disorder (aOR, 1.81; 95% CI, 1.61 – 2.04; P <.001); divorced or separated (aOR, 1.65; 95% CI, 1.35 – 2.02; P <.001); Black adults (aOR, 1.41; 95% CI, 1.24 – 1.60; P <.001); American Indian, Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander (aOR, 1.56; 95% CI, 1.26 – 1.93; P <.001)

Through the observed study period, 34.8% to 45.5% of adults who attempted suicide reported needing mental health care services but did not receive any. Bommersbach et al observed no significant change in the likelihood of an adult who attempted suicide receiving past-year mental health or substance-related care from 2008 to 2019.

From 2008 to 2019, the use of reasons for not seeking mental health care among adults who attempted suicide increased by 32%, per NSDUH survey responses. The reasons increased the most included: lack of transportation or services were too far away (aOR, 5.15; 95% CI, 2.35 – 11.30; P <.001); did not know where to go for treatment (aOR, 1.96; 95% CI, 1.16 – 3.32; P = .01); did not have time (aOR, 1.89; 95% CI, 0.95 – 3.75; P = .07); and did not think treatment would help (aOR, 1.61; 95% CI, 0.62 – 2.74; P = .48).

Bommersbach and colleagues noted that current US suicide prevention interventions predominately focus on individuals connected to treatment as well as those who have contact with the health care system.

“However, 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,” they wrote.

“The findings of this study suggest that suicide attempts have increased in the US in recent decades without a corresponding increase in service use among those who made such attempts,” Bommersbach et al concluded. “These data further suggest a need to expand service accessibility and/or acceptability of services as well as population-wide suicide prevention efforts.”

An earlier version of this story appeared with our sister publication HCPLive.

Reference

1. Bommersbach TJ, Rosenheck RA, Rhee TG. National Trends of Mental Health Care Among US Adults Who Attempted Suicide in the Past 12 Months [published online ahead of print, 2022 Jan 19]. JAMA Psychiatry. 2022;10.1001/jamapsychiatry.2021.3958.