Trust in higher guidance and suicidality in Afghan students under the Taliban regime

Background/Objective: After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation. Method: A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used. Results: Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated. Conclusion: PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance. (AU)

Temporal Trend in Suicide Mortality for Chinese Adolescents, 2008 to 2021.

This study aims to evaluate the temporal trend in suicide mortality for Chinese adolescents aged 10 to 19 years from 2008 to 2021.

Pediatric Mental Health Hospitalizations at Acute Care Hospitals in the US, 2009-2019.

Importance: Approximately 1 in 6 youth in the US have a mental health condition, and suicide is a leading cause of death among this population. Recent national statistics describing acute care hospitalizations for mental health conditions are lacking. Objectives: To describe national trends in pediatric mental health hospitalizations between 2009 and 2019, to compare utilization among mental health and non-mental health hospitalizations, and to characterize variation in utilization across hospitals. Design, Setting, and Participants: Retrospective analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative database of US acute care hospital discharges. Analysis included 4 767 840 weighted hospitalizations among children 3 to 17 years of age. Exposures: Hospitalizations with primary mental health diagnoses were identified using the Child and Adolescent Mental Health Disorders Classification System, which classified mental health diagnoses into 30 mutually exclusive disorder types. Main Outcomes and Measures: Measures included number and proportion of hospitalizations with a primary mental health diagnosis and with attempted suicide, suicidal ideation, or self-injury; number and proportion of hospital days and interfacility transfers attributable to mental health hospitalizations; mean lengths of stay (days) and transfer rates among mental health and non-mental health hospitalizations; and variation in these measures across hospitals. Results: Of 201 932 pediatric mental health hospitalizations in 2019, 123 342 (61.1% [95% CI, 60.3%-61.9%]) were in females, 100 038 (49.5% [95% CI, 48.3%-50.7%]) were in adolescents aged 15 to 17 years, and 103 456 (51.3% [95% CI, 48.6%-53.9%]) were covered by Medicaid. Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8%, and these hospitalizations accounted for a significantly higher proportion of pediatric hospitalizations (11.5% [95% CI, 10.2%-12.8%] vs 19.8% [95% CI, 17.7%-21.9%]), hospital days (22.2% [95% CI, 19.1%-25.3%] vs 28.7% [95% CI, 24.4%-33.0%]), and interfacility transfers (36.9% [95% CI, 33.2%-40.5%] vs 49.3% [95% CI, 45.9%-52.7%]). The percentage of mental health hospitalizations with attempted suicide, suicidal ideation, or self-injury diagnoses increased significantly from 30.7% (95% CI, 28.6%-32.8%) in 2009 to 64.2% (95% CI, 62.3%-66.2%) in 2019. Length of stay and interfacility transfer rates varied significantly across hospitals. Across all years, mental health hospitalizations had significantly longer mean lengths of stay and higher transfer rates compared with non-mental health hospitalizations. Conclusions and Relevance: Between 2009 and 2019, the number and proportion of pediatric acute care hospitalizations due to mental health diagnoses increased significantly. The majority of mental health hospitalizations in 2019 included a diagnosis of attempted suicide, suicidal ideation, or self-injury, underscoring the increasing importance of this concern.

Analysis of suicide statistics and trends between 2011 and 2021 among Korean women.

PURPOSE: This study aims to analyze the number of suicide deaths in women, trends in suicide mortality, characteristics of suicide by age, and outcomes of suicide means over the past decade (2011- 2021) in South Korea. METHODS: Using cause of death data from Statistics Korea, an in-depth analysis of Korean women's suicide trends was conducted for the period of 2011-2021. RESULTS: In 2021, women's suicide death in Korea was 4,159, a rate of 16.2 per 100,000 population. The rate increased by 1.4% from the previous year. Since 2011, women's suicide rate has been on a steady downward trend, but since 2018, it has been on the rise again. Suicide rates among women in their 20s and 30s have increased, especially since the coronavirus disease 2019 pandemic, and suicide rates among women over 70 years remain high. As compared to 2011, pesticide poisoning and hanging among the means of suicide have decreased significantly, while drug and carbon monoxide continue to increase. CONCLUSION: Suicide rates for Korean women in their 20s and 30s have increased significantly in recent years, and those for women over 70 years remain high. Therefore, it is necessary to investigate the causes and establish national policies for targeted management of these age groups, which contributes significantly to the rising suicide rate among Korean women.

Suicidal behaviors and sedentary behavior in adolescents: systematic review and meta-analysis / Comportamientos suicidas y sedentarismo en adolescentes: revisión sistemática y metaanálisis / Comportamentos suicidas e sedentarismo em adolescentes: revisão sistemática e meta-análise

Objective:To determine the association between suicidal behaviors (ideation, planning and attempt) and sedentary behavior in adolescents.Method:Systematic searches were performed in eight databases (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO; PsycINFO;CINAHL). The effect measures used for meta-analysis were odds ratios and 95% confidence intervals, directly collected from included studies.Results:Eleven studies were included in the systematic review and six articles were included in the meta-analysis. The meta-analysis showed thatadolescents who used video games/computers for ≥3 hours/day were more likely of having suicidal ideation. Adolescents who used television or videogame/computer for ≥3 hours/day were more likely of having suicide attempt. Boys who spent ≥3 hours/day in combined sedentary behavior were lesslikely of having suicidal attempt.Conclusions:There is an increased likelihood of suicidal behaviors, in special suicide ideation and attempt in adolescents who used videogames/computers and watched television for ≥3 hours/day.(AU)

Objetivo: Determinar la asociación entre comportamientos suicidas (ideación, planificación e intento) y sedentarismo en adolescentes.Método: Se realizaron búsquedas sistemáticas en ocho bases de datos (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO;PsycINFO; CINAHL). Las medidas de efecto fueron los odds ratios y intervalos de confianza del 95%, recopilados directamente de los estudios.Resultados: Se incluyeron once estudios en la revisión sistemática y seis estudios en el metanálisis. El metanálisis mostró que los adolescentes que usabanvideojuegos/computadoras durante ≥3 horas/día tenían más probabilidades de tener ideación suicida. Los adolescentes que usaban televisión yvideojuego/computadora durante ≥3 horas/día tenían más probabilidades de tener un intento de suicidio. Los niños que pasaron ≥3 horas/día incomportamientos sedentarios combinados tenían más probabilidades de tener intento de suicidio.Conclusiones: Existe una mayor probabilidad de conductas suicidas, en ideación e intento de suicidio en adolescentes que usaronvideojuegos/computadoras y vieron televisión durante ≥3 horas/día.(AU)

Objetivo: Determinar a associação entre comportamentos suicidas (ideação, planejamento e tentativa) e comportamento sedentário em adolescentes.Método: Pesquisas sistemáticas foram realizadas em oito bancos de dados (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO;PsycINFO; CINAHL). As medidas de efeito utilizadas para a metanálise foram odds ratio e intervalos de confiança de 95%, coletados diretamente dosestudos.Resultados: Onze estudos foram incluídos na revisão sistemática e cinco artigos foram incluídos na meta-análise. A meta-análise mostrou que osadolescentes que usavam videogame/computador por ≥3 horas/dia tinham maiores chances de ter ideação suicida. Os adolescentes que usavamtelevisão ou videogame/computador por ≥3 horas/dia apresentaram maiores chances de tentativa de suicídio. Os meninos com ≥3 horas/dia emcomportamentos sedentários combinados apresentaram menores chances de reportar tentativas de suicídio.Conclusões: Existe maiores chances de comportamentos suicidas, em especial ideação e tentativa de suicídio em adolescentes que usavamvideogame/computador e assistiam televisão por ≥3 horas/dia.(AU)

Discussion of the features of suicide trends in 1994-1995 and 2019-2020: The need for different contents in suicide prevention measures for both periods in Japan from the viewpoint of the present.

Japan is a country that is prone to natural disasters. This study compared the characteristics of suicide trends before and after the Great Hanshin-Awaji Earthquake, and during the current COVID-19 pandemic 25 years later. In the present study, we examined the annual number of suicides, the number of suicides by age group, and the reason for suicide during the period associated with the earthquake (1994-1995) and the period associated with the pandemic (2019-2020). This study used statistical analyses to compare the two periods. Our findings suggest that research needs to be conducted from the perspective of legal medicine and social medicine to devise current and future measures to prevent suicides. During the first period, suicides increased in 1995 compared to 1994. Suicide due to economic and life problems increased significantly. During the second period, suicides increased in 2020 compared to 2019. Suicides by males decreased significantly and those by females increased significantly; suicides by individuals aged 19 or under and by those aged 20-29 increased significantly, while suicides by individuals aged 60-69 decreased significantly; and suicides due to "other problems" increased significantly, while suicides due to economic and life problems decreased significantly. Ongoing studies of detailed trends in suicides due to the effects of COVID-19 need to be conducted in the future, and it is important to determine suicide risk due to the effects of COVID-19. Legal medicine and social medicine are fields that conduct such studies and that can offer science-based responses to these trends.

¿Son concluyentes los estudios epidemiológicos de suicidio en España? / Are the epidemiological studies of suicide in Spain conclusive?

No disponible

Introduction to the PLOS ONE collection on 'Understanding and preventing suicide: Towards novel and inclusive approaches'.

More than 700,000 people lose their lives to suicide each year and evidence suggests that the current COVID-19 pandemic is leading to increases in risk factors for suicide and suicide-related behaviour, in particular among young people. It is widely documented that some sectors of the population are over-represented in the suicide statistics. It is also well established that the pathways that lead someone to a suicidal crisis are complex and differ across regions and sectors of the population; as such a multi-faceted approach to prevention is required. Many of us would also argue that novel approaches, that combine broad population-based strategies with individual interventions, and approaches that capitalise on new technologies and methodologies are also required. For these reasons, when bringing together this collection, we deliberately sought studies that focused upon those groups who are over-represented in the suicide statistics yet under-represented in research. We also called for studies that reported on novel approaches to suicide prevention and for studies that reflected the voices of people with lived experience of suicide, also often unheard in research efforts.

Changes in Suicide Rates - United States, 2019 and 2020.

Suicide was among the 10 leading causes of death in the United States in 2020 among persons aged 10-64 years, and the second leading cause of death among children and adolescents aged 10-14 and adults aged 25-34 years (1). During 1999-2020, nearly 840,000 lives were lost to suicide in the United States. During that period, the overall suicide rate peaked in 2018 and declined in 2019 and 2020 (1). Despite the recent decline in the suicide rate, factors such as social isolation, economic decline, family stressors, new or worsening mental health symptoms, and disruptions to work and school associated with the COVID-19 pandemic have raised concerns about suicide risk in the United States. During 2020, a total of 12.2 million U.S. adults reported serious thoughts of suicide and 1.2 million attempted suicide (2). To understand how changes in suicide death rates might have varied among subpopulations, CDC analyzed counts and age-adjusted suicide rates during 2019 and 2020 by demographic characteristics, mechanism of injury, county urbanization level, and state. From 2019 to 2020, the suicide rate declined by 3% overall, including 8% among females and 2% among males. Significant declines occurred in seven states but remained stable in the other states and the District of Columbia. Despite two consecutive years of declines, the overall suicide rate remains 30% higher compared with that in 2000 (1). A comprehensive approach to suicide prevention that uses data driven decision-making and implements prevention strategies with the best available evidence, especially among disproportionately affected populations (3), is critical to realizing further declines in suicide and reaching the national goal of reducing the suicide rate by 20% by 2025 (4).

Firearm Homicides and Suicides in Major Metropolitan Areas - United States, 2015-2016 and 2018-2019.

Firearm homicides and suicides represent an ongoing public health concern in the United States. During 2018-2019, a total of 28,372 firearm homicides (including 3,612 [13%] among youths and young adults aged 10-19 years [youths]) and 48,372 firearm suicides (including 2,463 [5%] among youths) occurred among U.S. residents (1). This report is the fourth in a series* that provides statistics on firearm homicides and suicides in major metropolitan areas. As with earlier reports, this report provides a special focus on youth violence, including suicide, recognizing the magnitude of the problem and the importance of early prevention efforts. Firearm homicide and suicide rates were calculated for the 50 most populous U.S. metropolitan statistical areas (MSAs)† for the periods 2015-2016 and 2018-2019, separated by a transition year (2017), using mortality data from the National Vital Statistics System (NVSS) and population data from the U.S. Census Bureau. Following a period of decreased firearm homicide rates among persons of all ages after 2006-2007 in large metropolitan areas collectively and nationally, by 2015-2016 rates had returned to levels comparable to those observed a decade earlier and remained nearly unchanged as of 2018-2019. Firearm suicide rates among persons aged ≥10 years have continued to increase in large MSAs collectively as well as nationally. Although the youth firearm suicide rate remained much lower than the overall rate, the youth rate nationally also continued to increase, most notably outside of large MSAs. The findings in this report underscore a continued and urgent need for a comprehensive approach to prevention. This includes efforts to prevent firearm homicide and suicide in the first place and support individual persons and communities at increased risk, as well as lessening harms after firearm homicide and suicide have occurred.

Reasons for Suicide During the COVID-19 Pandemic in Japan.

Importance: Although the suicide rate in Japan increased during the COVID-19 pandemic, the reasons for suicide have yet to be comprehensively investigated. Objective: To assess which reasons for suicide had rates that exceeded the expected number of suicide deaths for that reason during the COVID-19 pandemic. Design, Setting, and Participants: This national, population-based cross-sectional study of data on suicides gathered by the Ministry of Health, Labor, and Welfare from January 2020 to May 2021 used a times-series analysis on the numbers of reason-identified suicides. Data of decedents were recorded by the National Police Agency and compiled by the Ministry of Health, Labor, and Welfare. Exposure: For category analysis, we compared data from January 2020 to May 2021 with data from December 2014 to June 2020. For subcategory analysis, data from January 2020 to May 2021 were compared with data from January 2019 to June 2020. Main Outcomes and Measures: The main outcome was the monthly excess suicide rate, ie, the difference between the observed number of monthly suicide deaths and the upper bound of the 1-sided 95% CI for the expected number of suicide deaths in that month. Reasons for suicide were categorized into family, health, economy, work, relationships, school, and others, which were further divided into 52 subcategories. A quasi-Poisson regression model was used to estimate the expected number of monthly suicides. Individual regression models were used for each of the 7 categories, 52 subcategories, men, women, and both genders. Results: From the 29 938 suicides (9984 [33.3%] women; 1093 [3.7%] aged <20 years; 3147 [10.5%] aged >80 years), there were 21 027 reason-identified suicides (7415 [35.3%] women). For both genders, all categories indicated monthly excess suicide rates, except for school in men. October 2020 had the highest excess suicide rates for all cases (observed, 1577; upper bound of 95% CI for expected number of suicides, 1254; 25.8% greater). In men, the highest monthly excess suicide rate was 24.3% for the other category in August 2020 (observed, 87; upper bound of 95% CI for expected number, 70); in women, it was 85.7% for school in August 2020 (observed, 26; upper bound of 95% CI for expected number, 14). Conclusions and Relevance: In this study, observed suicides corresponding to all 7 categories of reasons exceeded the monthly estimates (based on data from before or during the COVID-19 pandemic), except for school-related reasons in men. This study can be used as a basis for developing intervention programs for suicide prevention.

Perceptions towards charcoal-burning suicide and the surge of this lethal method in Taiwan.

OBJECTIVE: Whether sociocultural perceptions of charcoal-burning suicide have influenced its rapid increase in prevalence is unclear. We aimed to explore perceptions of Taiwan's general population regarding charcoal-burning suicide, their personal belief in life after death, and related feelings of thoughts associated with those who attempt charcoal-burning suicide. METHODS: An online web-based survey, focussing on sociocultural attitudes towards death, as well as perceptions towards charcoal-burning suicide, and those who attempt charcoal-burning suicide, was conducted from 14 January to 14 June 2016. RESULTS: In total, 1343 adults completed the online survey (mean age of 33.46; 66.6% women). Notably, 90.3% of participants considered charcoal burning to be an easily accessible suicide method. Multivariable analyses revealed that among the examined factors, the perceived 'painlessness' of charcoal-burning suicide was associated with an over seven-fold increased risk of choosing charcoal-burning suicide (OR = 7.394; p < 0.001; 95% CI: 2.614-20.912). CONCLUSION: As reflected in this study, charcoal-burning suicide is perceived as easily accessible and painless. The perceived 'painlessness' may be the factor that distinguishes the choice of charcoal-burning suicide from that of other suicide methods. Future efforts to target these perceptions regarding charcoal-burning suicide may be warranted in both media reporting and suicide prevention programmes.

Mental Health Services Under Strain in Rural America.

Improvements are needed to address high rates of suicide.

Suicide among Scottish military veterans: follow-up and trends.

OBJECTIVES: The risk of suicide among UK military veterans remains unclear. Few recent studies have been undertaken, and most studies found no clear evidence of increased risk. We used data from the Trends in Scottish Veterans Health cohort to investigate suicides up to 2017 in order to examine whether there have been any changes in the long-term pattern of veteran suicides since our earlier study to 2012, and to compare trends in the risk of suicide among veterans with matched non-veterans. METHOD: Retrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence, using survival analysis to examine the risk of suicide in veterans in comparison with non-veterans overall and by subgroup, and to investigate associations with specific mental health conditions. RESULTS: Up to 37 years of follow-up, 388 (0.5%) veterans and 1531 (0.6%) non-veterans died from suicide. The risk of suicide among veterans did not differ from non-veterans overall. Increased risk among early service leavers was explained by differences in deprivation, and the previously reported increased risk in female veterans is now confined to older women. Suicide was most common in the fifth decade of life, and around 20 years postservice. A history of mood disorder or post-traumatic stress disorder was non-significantly more common in veterans. CONCLUSIONS: Veterans are not at increased risk of suicide overall. The highest risk for both men and women is in middle age, many years after leaving service.

Suicide preceded by health services contact - A whole-of-population study in New Zealand 2013-2015.

New Zealand's rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Maori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19-2.88], 4.45 times [95% CI 3.69-4.66] and 6.57 times [95% CI 5.84-7.38], respectively, compared to those who had no health services contact.

Análisis descriptivo del suicidio en el bienio 2018-2019 en Valladolid (España) / Descriptive analysis of suicide in the 2018-2019 biennium in Valladolid (Spain)

Introducción: El suicidio y su prevención suponen un reto esencial en salud pública. Como primera causa externa de muerte en nuestro país, parece escapar a nuestra comprensión y control en vista de los numerosos estudios e intervenciones realizadas. Llevamos a cabo un estudio de los suicidios mortales estudiados por el Instituto de Medicina Legal y Ciencias Forenses de Valladolid durante el bienio 2018-2019. Material y métodos: Se recogieron todas las muertes por suicidio durante 2018-2019 y se cruzaron con los datos anonimizados del Servicio de Psiquiatría del Hospital Clínico Universitario de Valladolid en 2019. Resultados: La tasa de suicidios fue de 8,5/100.000 habitantes, 49 casos en 2018 y 44 en 2019, con una distribución de 3:1 para varones frente a mujeres, principalmente en el medio rural. La franja de edad con mayor incidencia fue la de 31-70 años. La ahorcadura en el medio rural y la precipitación en el urbano fueron los principales métodos. La comorbilidad psiquiátrica identificada más frecuente fueron los trastornos del estado de ánimo-afectivos (F30-39 CIE-10). Conclusiones: Las tasas de suicidio presentan un ligero descenso, mientras que el perfil de riesgo y las características del suicidio mortal se mantienen constantes en nuestro medio más de 20 años después, lo que indica una escasa eficacia de los esfuerzos preventivos realizados hasta ahora. La prevención efectiva del suicidio debe partir de la mejor identificación, prevención y tratamiento de los trastornos psiquiátricos, pudiendo resultar esencial la participación de los Institutos de Medicina Legal y Ciencias Forenses en programas poblacionales multinivel. (AU)

Introduction: Suicide and its prevention are a serious public health challenge. As the primary external cause of death in our country, it seems to be beyond our understanding and control in view of the numerous studies and interventions carried out. We conducted a study of suicide at the Valladolid Institute of Legal Medicine from 2018-2019. Material and methods: All deaths by suicide from 2018-2019 were collected and crossed with anonymized data of the Psychiatry Service of the University Clinical Hospital of Valladolid in 2019. Results: The suicide rate was 8.5/100,000 inhabitants, 49 cases in 2018 and 44 in 2019, with a 3:1 male to female ratio, mainly in rural areas. The age group with the highest incidence was 31-70 years. Hanging in rural areas and precipitation in urban areas were the main methods. Affective disorders (F30-39 ICD-10) were the most common identified psychiatric disorders. Conclusions: Suicide rates are slightly lower, while the risk profile and features of suicide remain constant in our environment more than 20 years later, indicating that preventive efforts carried out have not been completely successful. The effective prevention of suicide must start with better identification, prevention, and treatment of psychiatric disorders, but the contribution of the Institutes of Legal Medicine in the implementation of multilevel population programmes is also essential. (AU)

Suicide among Asian young people aged under 25 years in Aotearoa New Zealand: different methods warrant different preventive initiatives.

BACKGROUND: The Asian population is growing rapidly in New Zealand and is expected to overtake Maori and Pacific population groups by 2038. Although there has been research on suicide in elderly Asian people in New Zealand, there is relatively little knowledge regarding suicide within Asian young people. AIMS: To describe the characteristics and prevalence of suicide among Asian young people aged 10-24 years between 2002 and 2017. METHODS: A retrospective review of all child and adolescent suicide deaths in New Zealand was conducted using a national database. RESULTS: Results include a pattern of increasing deaths with increasing age, with 87.5% over the age of 16 years, and two-thirds of deaths occurring in the Auckland region. The majority of Asian young people who died by suicide were born outside of New Zealand (80.7%), consistent with the fact that the majority (77%) of the Asian population in New Zealand were born overseas. However, deaths tended to decrease with longer duration of residence in New Zealand. That certain methods of suicide were more prominent among Asian young people has important implications for suicide prevention. CONCLUSIONS: Overall, there has been no significant change in the rates of suicide between 2002 and 2017. Young Asian people who die by suicide come from heterogeneous cultural and linguistic traditions, so prevention strategies need to be culturally responsive and delivered across multiple settings, including education, primary care and mental health services. However, certain methods are more common in many Asian countries, such as jumping from a height. We found this method was more commonly used by Asian young people compared with NZ Europeans, which should be a consideration in town planning, particularly in areas where there is a significant Asian population as part of a multilevel approach to suicide prevention.

Association Between Medicaid Expansion and Suicide Mortality Among Nonelderly US Adults.

In 2014, the Affordable Care Act gave states the option to expand Medicaid coverage to nonelderly adults (persons aged 18-64 years) with incomes up to 138% of the federal poverty level. To our knowledge, the association of Medicaid expansion with suicide, a leading cause of death in the United States, has not been examined. We used 2005-2017 data from the National Violent Death Reporting System to analyze suicide mortality in 8 Medicaid expansion states and 7 nonexpansion states. Using a difference-in-differences approach, we examined the association between Medicaid expansion and the rate of suicide death (number of deaths per 100,000 population) among nonelderly adults. After adjustment for state-level confounders, Medicaid expansion states had 1.2 fewer suicide deaths (ß = -1.2, 95% confidence interval: -2.5, 0.1) per 100,000 population per year during the postexpansion period than would have been expected if they had followed the same trend in suicide rates as nonexpansion states. Medicaid expansion was associated with reductions in suicide rates among women, men, persons aged 30-44 years, non-Hispanic White individuals, and persons without a college degree. Medicaid expansion was not associated with a change in suicide rates among persons aged 18-29 or 45-64 years or among non-White or Hispanic individuals. Overall, Medicaid expansion was associated with reductions in rates of suicide death among nonelderly adults. Further research on inequities in Medicaid expansion benefits is needed.