Mental Health Care Utilization of a National Sample of U.S. Adults with Suicidality

Abstract

Background: Suicide remains a significant public health issue in the United States, with a 32% increase in suicide rates over the past two decades. Mental health disorders, such as depression and anxiety, along with substance use disorders, are major risk factors. Sociodemographic determinants further complicate the issue. This study examines the risk factors associated with the utilization of inpatient and outpatient mental health care among individuals experiencing suicidal ideation or attempts in the past year.Methods: This analysis utilized data from the Mental Health and Substance Use Disorders Prevalence Study (MDPS), a cross-sectional project that collected qualitative and quantitative data from 5679 adults across the United States between October 2020 and October 2022. Participants were assessed for behavioral health diagnoses and other standardized questions. The study focused on adults reporting suicidal ideation (SI) and suicide attempts (SA) in the past year compared to those who had experienced neither SI or SA. Health care utilization, particularly inpatient or residential treatment and outpatient treatment, was examined. All analyses were weighted inversely to the selection probability, adjusted for nonresponse to the screener, adjusted for the clinical interview, and then poststratified to 2019 1-year ACS for the frame items and demographics. Results: Of the 4751 participants analyzed, 3529 reported no suicidal ideation or attempt in the past year (74%), 1168 reported suicidal ideation alone (25%), and 54 reported a suicide attempt (1%). The SI and SA groups were younger, received less education, were more likely to be unmarried, and had lower income compared to those without SI or SA. The SI and SA groups had significantly greater inpatient and outpatient mental health service utilization compared to the no SI/SA group. Participants with suicidal ideation or attempt in the past year were less likely to receive inpatient mental health care if they were Asian but more likely if they had a stimulant, opioid, or alcohol use disorder. For outpatient care, those with higher education levels, females, public health insurance, or diagnoses of PTSD, anxiety, depression, or schizophrenia were more likely to receive services, while racial minorities had lower odds compared to white participants. Discussion: The study identified substantial disparities in mental health care utilization, influenced by sociodemographic factors, mental health diagnoses, and substance use disorders. Of the participants who had experienced SI or SA in the past year, racial and ethnic minorities, lower-income individuals, and those without adequate health insurance faced significant barriers in accessing care. Integrated treatment approaches and culturally sensitive outreach are essential to address these gaps. The increased utilization among individuals with concurrent substance use disorders and specific mental health diagnoses highlights the need for integrated treatment approaches. Conclusions: Addressing disparities in mental health care access and improving the delivery of culturally competent care are critical steps in reducing the incidence of suicide and enhancing mental health outcomes for at-risk individuals. Future research should focus on prospective studies to understand the temporal relationships between suicidal behavior and mental health care engagement and explore the impact of stigma on care utilization.