Association Between Changes in Community Mental Health Services Availability and Suicide Mortality in the US
Association Between Changes in Community Mental Health Services Availability and Suicide Mortality in the US
Tuesday, June 25, 2019: 2:00 PM
Jefferson - Mezzanine Level (Marriott Wardman Park Hotel)
Discussant: Julia Raifman
Importance: Despite an overwhelming majority of mental health services being delivered in outpatient settings, how changes in non-hospital-based mental health care is associated with increased suicide has been left unanswered.
Objective: To examine the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.
Study Design: Retrospective analysis was performed using data from National Mental Health Services Survey and the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (2014-2016). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state fixed effects.
Setting: All 50 U.S. states and DC.
Exposure: State-level number of CMHCs per 100,000 persons.
Main Outcome: State-level number of suicide deaths per100,000 persons.
Results: From 2014 to 2016 the number of CMHCs nationally decreased by 11% (from 3,406 to 3,024). Suicide increased by 4% (from 15.4 to 16.0 per 100,000). We find a small but statistically significant negative association between number of CMHCs and suicide deaths (-0.81, 95% CI -1.44 to -0.71; P=0.013). Results suggest that declines in the number of CMHCs from 2014 to 2016 were associated with approximately 16.7% of the national increase in suicide, representing 358 additional suicide deaths. In sensitivity analyses, an increase in the number of outpatient suicide prevention services (-0.42, 95% CI -0.80 to -0.04; P=0.031), but not inpatient (0.45, 95% CI -0.25 to 1.14; P=0.21), were significantly associated with decreases in suicide mortality rates in a state.
Conclusions and Relevance: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.
Objective: To examine the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.
Study Design: Retrospective analysis was performed using data from National Mental Health Services Survey and the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (2014-2016). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state fixed effects.
Setting: All 50 U.S. states and DC.
Exposure: State-level number of CMHCs per 100,000 persons.
Main Outcome: State-level number of suicide deaths per100,000 persons.
Results: From 2014 to 2016 the number of CMHCs nationally decreased by 11% (from 3,406 to 3,024). Suicide increased by 4% (from 15.4 to 16.0 per 100,000). We find a small but statistically significant negative association between number of CMHCs and suicide deaths (-0.81, 95% CI -1.44 to -0.71; P=0.013). Results suggest that declines in the number of CMHCs from 2014 to 2016 were associated with approximately 16.7% of the national increase in suicide, representing 358 additional suicide deaths. In sensitivity analyses, an increase in the number of outpatient suicide prevention services (-0.42, 95% CI -0.80 to -0.04; P=0.031), but not inpatient (0.45, 95% CI -0.25 to 1.14; P=0.21), were significantly associated with decreases in suicide mortality rates in a state.
Conclusions and Relevance: State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.
