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Table 2 Associations between State-level Mental Health Services Capacity and Suicide Mortality Rates 2014–2017

From: Changes in community mental health services availability and suicide mortality in the US: a retrospective study

 

Coefficients [95% Confidence Interval]

Model 1

Model 2

Model 3

Model 4

Between-state Model

Add State & Time

Add Age and Race

Add Low-income

State Indicators Included

No

Yes

Yes

Yes

Number of Community Mental Health Centers Per 100,000 Persons

2.78 (2.36, 3.20) ***

−0.52 (−1.03, −0.02)*

−0.60 (− 1.09, −0.11)*

−0.52 (− 1.08, 0.03)§

Number of Hospital Psychiatric Care Settings per 100,000 Persons

−1.70 (−2.54, − 0.85) ***

0.75 (− 0.72, 2.21)

1.32 (− 0.03, 2.67)§

1.39 (0.02, 2.75)*

Number of 100 Mental Health Professionals per 100,000 Persons†

−0.71 (− 1.26, − 0.16)*

0.10 (− 0.21, 0.41)

−0.10 (− 0.51, 0.30)

−0.10 (− 0.46, 0.26)

Year (Reference: 2014)

 2015

 

0.27 (0.20, 0.34)***

0.52 (0.32, 0.73)***

0.45 (0.27, 0.63)***

 2016

 

0.39 (0.31, 0.48)***

0.91 (0.50, 1.31)***

0.52 (0.17, 0.87)**

 2017

 

0.80 (0.67, 0.93)***

1.67 (1.14, 2.20)***

1.17 (0.69, 1.65)***

% Persons Below 200% Federal Poverty Level

   

−0.09 (−0.14, −0.04)**

% Population by Age Group

 Less than 15 Years Old

  

Ref

Ref

 15–24 Years Old

  

1.02 (0.63, 1.42)***

0.63 (0.21, 1.06)**

 25–44 Years Old

  

−0.15 (− 0.55, 0.25)

−0.94 (−1.34, − 0.53)***

 45–64 Years Old

  

−1.27 (− 1.57, − 0.97)***

−1.82 (−2.41, − 1.23)***

 65–74 Years Old

  

−0.14, − 0.92, 0.64)

−0.41 (− 1.15, 0.32)

 75 Years Old or More

  

−1.50 (− 2.56, − 0.45)**

−1.81 (− 2.53, − 1.10)***

% Population by Race/Ethnicity

 Non-Hispanic White

  

Ref

Ref

 Non-Hispanic Black

  

0.84 (0.73, 0.94)***

0.93 (0.67, 1.18)***

 American Indian and Alaska Native

  

1.45 (−0.74, 10.33)

−0.98 (−10.24, 8.28)

 Asian

  

−1.70 (− 2.28, − 1.12)***

−1.67 (− 2.15, − 1.18)***

 Native Hawaiian and Pacific Islander

  

21.47 (16.58, 26.37)***

22.49 (18.01, 26.96)***

 Hispanic

  

−1.43 (− 1.61, − 1.25)***

−1.41 (− 1.58, − 1.24)***

 Two or More Races

  

− 1.48 (− 1.86, − 1.10)***

−1.42 (− 1.79, − 1.05)***

  1. NOTES Data were from 2014 to 2017 National Mental Health Services Survey (N-MHSS) to identify state-level mental health facility availabilities during 2014–2017 and from Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) data for suicide rates, identified as intentional self-harm by ICD-10-CM diagnosis codes U03, X60-X71, X72-X74, X75-X84, Y87.0. Significance at p-values of § p < .1, * p < .05, **p < .01, ***p < .001 were noted for the average marginal effects of suicide mortality rates per a unit increase for continuous variables, switching from the reference group, accounting for intra-state correlation across years. Estimates were derived from multivariate linear regression models, weighted by state population size. †Data on mental health professionals, including psychiatrists, psychiatric technicians, psychiatric aides, clinical, counseling, and school psychologists, all other psychologists, mental health counselors, mental health and substance abuse social workers, were derived from U.S. Bureau of Labor Statistics [22]
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BMC Psychiatry

ISSN: 1471-244X

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