Suicide Risk Increasing and Many High-Risk People Don’t Receive Mental Health Care

A new study shows that from 2015 to 2019, the United States saw increases in the overall rate of suicide attempts and the rate of people experiencing suicidal thoughts, with sharper increases among certain sociodemographic groups.

Although people with suicidal thoughts have an elevated risk of suicide attempts and death, less than half receive mental health care. Use of general health care is much higher: Almost as many people with suicide risk reported visiting an emergency room as receiving mental health care. Interactions with the health care system are critical points of intervention during which people with suicide risk can be identified and connected to care; in fact, research shows that more than half of people who die by suicide interact with the overall health care system within a month before their death. 

This research underscores the need for universal suicide screening, as more than 49,000 people in the United States died by suicide in 2022. For every death, there were 32 people reporting suicide attempts, and more than 250 people reporting seriously thinking about suicide.

Universal screening is a practice in which every patient is asked if they are experiencing suicidal thoughts, also known as suicidal ideation, or planning a suicide attempt regardless of what kind of medical facility they are visiting or why. The study, which examined sociodemographic data in the National Survey on Drug Use and Health, also further demonstrates the need for tailored protocols and strategies that reflect different populations’ unique cultural and linguistic needs and risk factors. The study was conducted by The Pew Charitable Trusts and Dr. Hillary Samples.

Growing disparities in suicide risk

This research highlights the growing disparities in risk across sociodemographic groups. Researchers found that, from 2015 to 2019, suicide attempts increased by 48% for Black adults and by 82% for adults identifying as more than one race/ethnicity or “other” (that is, not Black, White, Hispanic, Asian/Pacific Islander, or American Indian/Alaska Native). This finding contrasted sharply with White adults among whom suicide attempts fell 33% and the overall population, for which suicide attempts decreased by about 20%. The study also found a 22% rise in suicidal ideation overall, with pronounced increases for young adults ages 18-25 (45%).

It’s important to note that the survey asked about suicide attempts only if the respondent first reported ideation. However, many attempts are impulsive and not necessarily preceded by suicidal thoughts or planning. As a result, some people who attempted suicide may not be represented in the data. Additionally, given smaller sample sizes, significant trends in disparities were not observed for certain demographic subgroups, including American Indian and Alaska Natives and Asian and Pacific Islanders. Further, gender identity is not measured in the survey, and certain high-risk group—such as unhoused and institutionalized (for example, incarcerated) people—are not included in the dataset, therefore results are not generalizable to these groups.

High need for health care, but low utilization

This analysis also looked at trends in health care utilization among people with suicidal ideation, given the potential to address suicidality in health care settings. Researchers found that less than 50% of people with suicidal ideation received mental health care from 2015 to 2019, and the groups at highest risk for ideation and attempts were even less likely to receive care. Specifically, an estimated 41% of young adults ages 18-25 received mental health services. Further, Black (36%), Hispanic (37%), multiracial/other (44%), and Asian and Pacific Islander (28.5%) adults were significantly less likely to receive health care than White adults (53%). Comparatively, use of general health care services—including inpatient, emergency, and outpatient services—was high overall (87%) and across all groups.

The role of hospitals and health systems

Health systems have an important role to play in suicide prevention, but these systems are missing opportunities to identify suicide risk among patients who are not seeking, or can’t access, behavioral health services. Current hospital accreditation standards require suicide risk screening only for patients in mental health facilities and for individuals primarily seeking care for behavioral health conditions in general health facilities. Expanding universal suicide screening across both mental health and general health settings has been shown to effectively identify more patients experiencing suicide risk.

Further, research found that emergency departments that implemented universal screening followed with specific prevention interventions reduced suicide attempts in the following year by 30%.

What’s next

Health care systems should expand screening practices to identify more patients who may be at risk for suicide and connect them to care. The marked disparities in ideation and attempts also underscore the importance of embedding health equity into prevention strategies to improve suicide outcomes for all. For hospitals, this includes building an equitable and diverse workforce trained to address the needs of the communities they serve, using culturally and linguistically effective screening tools and protocols to better identify risk, and tailoring screening and intervention strategies to address the particular risk factors of different populations.

Screening more people by consistently using protocols and practices that are effective in recognizing and assessing risk in diverse populations can better identify a greater number of people at heightened risk, connect them to care, and save lives.

Allison Corr is an officer and Farzana Akkas is a senior associate on The Pew Charitable Trusts’ suicide risk reduction project.