Suicide is a leading cause of death in the US, and there is a critical need for evidence-based interventions to reduce risks. In recent years, predictive algorithms have identified some common risk factors for suicidal ideation (SI) and suicide attempts (SA), including but not limited to mental health and substance use diagnoses, previous SI/SA, and medical burden.
In a 2023 study, Dr. Wenna Xi, instructor in population health sciences, Dr. Jyotishman Pathak, chief of the Division of Health Informatics and the Frances and John L. Loeb Professor of Medical Informatics, and colleagues found that risk factors for SI vary by US geographic census divisions among commercially insured children and youth with an outpatient psychiatric diagnosis.
A new study in the Journal of Psychiatric Research expands on these findings. Researchers used insurance claims to examine the geographic variations of the prevalence and the risk factors for SI and SA among commercially insured US adults with at least one MH/SUD-related outpatient visit. The study was conducted using data from the Health Care Cost Institute in compliance with the Health Insurance Portability and Accountability Act.
Results indicate that the frequency and risk factors for SI and SA of adults vary across US geographic divisions. The Mountain Division, defined by the US Census Bureau, had the highest frequency of SI and SA. The Northeast region and West Coast had the lowest rates. Contrary to the growing literature that found no effect of urbanicity among US adults, this study indicates that its association with SI and SA varies geographically.
Given their findings, suicide prevention efforts should include a concerted focus on urban adults in the West North Central and Pacific Divisions, and rural adults in the Mountain Division. The fact that the Mountain Division had consistent high risk of SI and SA and was the only division with a positive association between rurality and SA requires further investigation into the cultural influence on SI and SA and ease of healthcare access in the Mountain Division.
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