Associations between mental health shortage areas and county-level suicide rates among adults aged 25 and older in the USA, 2010 to 2018

Objective
Suicide is a serious public health concern, but little is known about the relationship between access to mental health care and suicide deaths, and whether suicide rates differ by mental health provider Health Professional Shortage Areas (HPSAs). This study investigated the associations between mental health HPSAs and suicide rates.
Method
We used generalized linear mixed models to test the associations between HPSAs and suicide rates from 2010 to 2018. For each county during a 3-year period, the total number of suicides was obtained from Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER).
Results
Mental health HPSAs had higher suicide rates (adjusted incidence rate ratio (IRR), 1.06 [95% CI, 1.03–1.09]). The interaction terms of mental health HPSAs and time (adjusted IRR, 1.01 [95% CI, 1.00–1.01]) showed that the association between mental health shortage areas and suicide rates has increased over time.
Conclusions
Suicide rates are more common in mental health provider shortage areas, and this association has been growing over time. The study’s findings suggest that many communities in the US are likely facing simultaneous challenges of limited access to mental health care, social and economic disadvantage, and high burden of suicide.