Non-receipt of psychiatric treatment among people in the USA reporting suicide thoughts or attempts is more common among men, younger people and non-white ethnic groups.

QUESTION Question: What are the characteristics of individuals in the USA who experience suicidal thoughts or attempt suicide but do not receive specialty psychiatric treatment? Population: 75 690 adults taking part in the National Survey on Drug Use and Health (NHSUH) in 2008 and 2009. The sample populations are representative of the US population. Setting: The USA; 2008 and 2009. Assessment: Participants completed an audio computerassisted self-interview. This included single-item yes–no response questions to assess suicidal thoughts and suicide attempts in the preceding 12 months. Further questions were also asked to identify: utilisations of specialty psychiatric treatment (including alcohol, drug abuse or mental health specialty treatment), drug use, psychological distress, depression and demographic information. Descriptive analyses were applied to generate the weighted percentage of suicidal thoughts or attempts by sociodemographic variables of interest and treatment participation. Logistic regressions were then applied to investigate odds of non-receipt of specialty psychiatric treatment among those who had suicidal thoughts or attempts. The OR fi gures reported are for non-receipt of specialty treatment, and are adjusted for age and gender. Outcomes: Non-receipt of specialty psychiatric treatment among those who had suicidal thoughts or suicidal attempts. METHODS Design: Cross-sectional study. MAIN RESULTS Overall, 3.7% of the total participants had experienced thoughts of suicide, 1.0% had made a suicide plan and 0.5% had attempted suicide in the 12 months prior to the survey. In the same period, 52% of those with suicide ideation, 64% of those with suicide plans and 66% of those who attempted suicide had sought specialty psychiatric services for substance abuse or mental health treatment. Non-receipt of specialty treatment services was more common among participants who had experienced thoughts of suicide if they had the following characteristics: male (OR 1.46, 95% CI 1.29 to 2.14), younger age (age ≥35 years vs 18–25 years OR 0.40, 95% CI 0.32 to 0.50; 26–34 years vs 18–25 years OR 0.45, 95% CI 0.34 to 0.60), non-white ethnicity (ORs and 95% CIs >1 for Black non-Hispanic, Hispanic, Asian or Pacifi c Islander, and ‘other’ ethnic groups vs white non-Hispanic), excellent overall health status (fair or poor vs excellent OR 0.32, 95% CI 0.23 to 0.56; good vs excellent OR 0.59, 95% CI 0.39 to 0.90), no psychological distress (yes vs no OR 0.33, 95% CI 0.23 to 0.39), no major depression (yes vs no OR 0.29, 95% CI 0.23 to 0.36), no drug use (use vs non-use OR 0.67, 95% CI 0.55 to 0.81) and no tobacco use (use vs non-use OR 0.74, 95% CI 0.58 to 0.96). There were similar fi ndings among participants who had attempted suicide, though in this group neither gender and overall health status were signifi cantly associated with nonreceipt of services nor was being of Asian or Pacifi c Islander or ‘other’ ethnic groups. In addition, in this group remaining ‘married’ was associated with non-receipt of specialty treatment (previously married vs married OR 0.29, 95% CI 0.10 to 0.87), as was not having health insurance (insured vs not OR 0.48, 95% CI 0.27 to 0.84). CONCLUSIONS A substantial proportion of people who consider or attempt suicide in the USA report not receiving any specialty psychiatric treatment. Non-receipt of specialty treatment is more common among males, younger individuals, those who are not of white non-Hispanic ethnicity and those without health insurance.