National Trends of Mental Health Care Among US Adults Who Attempted Suicide in the Past 12 Months
Authors: Tanner J. Bommersbach, Robert A. Rosenheck, Taeho Greg Rhee
Journal: JAMA Psychiatry (2022)

Although suicide attempts remain the strongest risk factor for future suicide, little is known about recent trends in the prevalence of and risk factors for suicide attempts and past-year use of services among adults who attempted suicide.To estimate annual rates of suicide attempts and use of mental health services among US adults from 2008 to 2019.This US nationally representative cross-sectional study used the National Survey of Drug Use and Health (NSDUH) from 2008 through 2019. Participants included noninstitutionalized US civilians 18 years or older (n = 484 732). The overall annual rates of suicide attempts per 100 000 adults in the general population and national trends from 2008 to 2019 were estimated, with suicide attempts defined as self-reported efforts to kill one's self in the past 12 months. Subgroup analyses were also performed by demographic characteristics and clinical conditions. The trends in past-year use of mental health services among those who reported past-year suicide attempts were then examined. Data were analyzed from October to December 2021.Rate of suicide attempts from 2008 to 2019. Multivariate-adjusted logistic regression analyses were used to determine whether adjusting for sociodemographic and clinical factors associated with past-year suicide attempts could account for the change within the study period.Of 484 732 survey participants, most were 35 years or younger (69.8%), women (51.8%), and non-Hispanic White individuals (65.7%). From 2008 to 2019, the weighted unadjusted suicide attempt rate per 100 000 population increased from 481.2 to 563.9 (odds ratio [OR], 1.17 [95% CI, 1.01-1.36]; P = .04) and remained significant after controlling for sociodemographic characteristics (adjusted OR [aOR], 1.23 [95% CI, 1.05-1.44]; P = .01). Rates of suicide attempt increased particularly among young 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), those who were unemployed (aOR, 2.22 [95% CI, 1.58-3.12]; P < .001) or never married (aOR, 1.60 [95% CI, 1.31-1.96]; P < .001), and individuals who used substances (aOR, 1.44 [95% CI, 1.19-1.75]; P < .001). In multivariate analyses, the temporal trend of increasing suicide attempts remained significant even after controlling for other significant sociodemographic and clinical factors (aOR, 1.36 [95% CI, 1.16-1.60]; P < .001). Several sociodemographic and clinical subgroups remained independently associated with suicide attempts, especially those with 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), and alcohol use disorder (aOR, 1.81 [95%CI, 1.61-2.04]; P< .001) as well as individuals who reported being divorced or separated (aOR, 1.65 [95% CI, 1.35-2.02]; P < .001) or being unemployed (aOR, 1.47 [95% CI, 1.27-1.70]; P< .001) and those who identified as Black (aOR, 1.41 [95% CI, 1.24-1.60]; P < .001) or American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander (aOR, 1.56 [95% CI, 1.26-1.93]; P < .001). Among adults with a suicide attempt, there was no significant change in the likelihood of receiving past-year mental health or substance-related services. During the study period, 34.8% to 45.5% reported needing services but did not receive them, with no significant change from 2008 to 2019.Although suicide attempts appear to be increasing, use of services among those who attempted suicide has not increased, suggesting a need to expand service accessibility and/or acceptability, as well as population-wide prevention efforts.