As Suicide Attempts Rise in America, Mental Health Care Remains Stagnant

Despite the substantial increase in suicide attempts among U.S. adults over the last decade, use of mental health services by these individuals didn’t match that growth, data from the National Surveys on Drug Use and Health (NSDUH) revealed.

From 2008 to 2019, suicide attempts among adults increased from 481.2 to 563.9 per 100,000 (adjusted odds ratio [aOR] 1.23, 95% CI 1.05-1.44, P=0.01), reported Greg Rhee, PhD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And according to their study in JAMA Psychiatry, there was a significant uptick in the number of individuals that attempted suicide within the past year who said they felt they needed mental health services but failed to receive it (34.8% in 2010-2011 vs 45.5% in 2018-2019).

Overall, the researchers found no significant changes in the likelihood of receiving past-year outpatient, inpatient, or medication services for mental health reasons, nor any change in substance use treatment services. An increase in the number of visits to mental health centers was detected, but even this change was no longer significant after correcting for different sources of mental health care.

“One would hope that as suicide attempts increase, the percentage of individuals who receive treatment in proximity to their attempt would also increase,” Rhee and colleagues wrote. “Current suicide prevention interventions largely focus on individuals connected to treatment and high-risk individuals 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[s] 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 suggested.

When looking more closely at some of the reasons participants gave for not being able to access care, there was an increase in the number of people who said they didn’t have the time, that they didn’t know where to go for treatment, and that they lacked transportation to get to services.

Across the study period, there were 4,342 suicide attempts among the 484,732 survey participants. After adjusting for sociodemographic factors, the significant uptick in suicide attempts was particularly apparent for:

• Adults ages 18 to 25: aOR 1.81 (95% CI 1.52-2.16)
• Women: aOR 1.33 (95% CI 1.09-1.62)
• The unemployed: aOR 2.22 (95% CI 1.58-3.12)
• Individuals who never married: aOR 1.60 (95% CI 1.31-1.96)
• People with substance abuse issues: aOR 1.44 (95% CI 1.19-1.75)

Those with serious psychological distress, major depressive episodes, alcohol use disorder, and people who identified as either Black, American Indian/Alaska Native, Asian, or Native Hawaiian/other Pacific Islander also had disproportionately higher rates of suicide attempts over the last decade.

The research team suggested that in addition to the valuable annual surveillance data collected annually by the National Center for Health Statistics, more effort should be placed on surveilling other types of suicidal behaviors, like attempts, nonsuicidal self-injury, and even the prevalence of suicidal thoughts.

Among the NSDUH sample used in this study, most (70%) were 35 years or younger and about half identified as women. A majority of respondents — 66% — identified as non-Hispanic white, 12% were Black, 15% were Hispanic, and 8% were of other races and ethnicities.

Study limitations, the authors noted, included the retrospective, self-reported nature of the NSDUH data. Also, suicide attempts were assessed through a single question, which asked respondents if they had tried to kill themselves in the past 12 months. While this question may seem straightforward, researchers explained it’s possible that respondents may have identified other behaviors — like non-suicidal self-injury — as suicide attempts.

The NSDUH also does not account for individuals that are homeless, incarcerated, or institutionalized, thus possibly leading to an underestimation of the number of suicide attempts per year.