Article

Suicide Rates in Relation to Health Care Access in the United States

Harvard University, Cambridge, Massachusetts, United States
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 04/2006; 67(4):517-23. DOI: 10.4088/JCP.v67n0402
Source: PubMed

ABSTRACT

We tested the hypothesis that suicide rates in the United States are associated with indicators of access to health care services.
With an ecological study design, we compared age-adjusted suicide rates for men and women with demographic, socioeconomic, and other indices of access to health care, by state (N = 51, including the District of Columbia). The most recently available information from the National Statistics Reports at the U.S. Census Bureau, the U.S. Centers for Disease Control and Prevention National Center for Health Statistics, and the American Board of Medical Specialties was used. Data on suicide are from 2001; other measures were matched for the closest available year, except that state-based data on psychiatrists and physicians are from 2004.
Positive bivariate associations with state suicide rates (all p < or = .005) are ranked as follows: male sex, Native American ethnicity, and higher proportion of uninsured residents. Negative bivariate associations (all p < or = .002) are ranked as follows: higher population density, higher annual per capita income, higher population density of psychiatrists, higher population density of physicians, higher federal aid for mental health, and higher proportion of African Americans. All factors were associated with state suicide rates in expected directions. In multivariate models of associations between suicide rates and indices of access to health care, the state rate of federal aid for mental health was the strongest indicator, followed by the rate of uninsured persons and population density of psychiatrists and physicians and by population density.
Such aggregate analyses cannot specify risk indices for individual persons. Nevertheless, the methods employed detected several factors with well-established associations with suicide. They also yielded strong correlations of state-based suicide rates with proposed indicators of access to health care. The findings support the view that clinical intervention is a crucial element in the prevention of suicide.

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    • "This result shows the importance of having psychiatrists in each municipality. It is inconsistent with a previous study in Austria, but agrees with a study in the United States [12, 14]. The Austrian study showed that the density of psychiatrists in the United States (0.14 per 1,000) was higher than in Austria (0.02 per 1,000 ) and that the effect of psychiatrists on suicide rates had been shown in the United States [14]. "
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    Full-text · Article · Feb 2016 · PLoS ONE
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    • "However, studies of the relationship between suicide rates and availability of mental health services are rare (5). Nevertheless, some studies confirm the relationship between the suicide rates and the number of working physicians (18), psychiatrists (19), or outpatient mental health services (20) available. "
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    • "The increase in antidepressant utilization, as reflected in antidepressant prescriptions, is only a proxy marker of greater access of patients to appropriate care, and higher population density of doctors in general [82,83] and psychiatrists and psychotherapists in particular [21,22,83] are negatively associated with national and regional suicide rates. It is likely that many patients receiving antidepressants also receive a prescription of lithium and other mood stabilizers as well as they receive more frequently supportive or specific psychotherapy for depression. "
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