Mental Health Treatment Use and Perceived Treatment Need Among Suicide Planners and Attempters in the United States: Between and within Group Differences

Background/Purpose:  Suicide is a serious public health problem globally and in the United States (US).  According to the Centers for Disease Control and Prevention, suicide resulted in more than 38,000 deaths in the US in 2010 and was a top four cause of death among age groups between 15 and 54 years. Despite many previous studies of suicidal ideation and/or attempts, little research has been done to examine mental health treatment use among those with suicidal ideation and/or suicide attempt. In this study, using Andersen’s behavioral model of health service use, we examined mental health treatment use and perceived treatment need among US adults who had serious suicidal thoughts in the preceding 12 months.

Methods: Data came from the public use files of the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) for individuals aged 21+ (n=154,923). Serious suicidal thoughts were assessed with a question: “Did you seriously think about trying to kill yourself?”  Suicide plans and attempts were assessed with two questions, respectively; “Did you make any plans to kill yourself?”; “Did you try to kill yourself?” Responses to these questions (yes=1 or no=0) were used to classify four groups with different levels of suicide risk: (1) no plan/no attempt; (2) planned/no attempt; (3) no plan/attempted; and (4) planned/attempted. Mental health treatment use referred to any inpatient/outpatient treatment for “any problem with emotions, nerves, or mental health (not including treatment for alcohol or drug use).” Perceived mental health treatment need referred to not getting treatment when needed. All analyses, including multivariate logistic regression models, were conducted with Stata/MP 13’s svy function to account for NSDUH’s multi-stage, stratified sampling design.

Results: Of the sample, 3.5% reported past-year serious suicidal thoughts. Of those with suicidal thoughts, 69.8% neither made plans nor attempted suicide (no plan/no attempt group); 18.3% made plans but did not attempt suicide (planned/no attempt group); 2.4% had no plan but attempted suicide (no plan/attempted group); and 9.5% made plans and attempted suicide (planned/attempted group). The 12% attempt rate is especially striking, given that a nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide. More than 30% of planners and/or attempters received no treatment before or after planning or attempting. Only one-third of the planned/attempted group received inpatient treatment. The planned/no attempt group included the largest proportion of people who perceived treatment need. Racial/ethnic minorities had lower odds of treatment use in all four groups, but major depression significantly increased the odds in all but the no plan/attempted group. Treatment use and substance use disorder increased the odds of perceived need in all four groups.

Conclusions and Implications: The four groups that present different levels of suicide risk have different rates of treatment access and perceived treatment need that are not commensurate to their risk level. The findings underscore the importance of treatment access for those at-risk, especially racial/ethnic minorities and those of lower SES. Along with mental health screening and treatment, screening and treatment for substance use disorders is necessary.