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Cited by 132Suicide and Self-Harm StudiesMental Health Treatment and AccessGlobal Health Workforce Issues

Association of youth suicides and county-level mental health professional shortage areas in the US

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Hoffmann, Jennifer A., Attridge, Megan M., Carroll, Michael S., Simon, Norma-Jean E., Beck, Andrew F., Alpern, Elizabeth R.·2023·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2022.4419PMC PMC9679958
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Abstract

Importance: Suicide is the second leading cause of death among US adolescents. Workforce shortages of mental health professionals in the US are widespread, but the association between mental health workforce shortages and youth suicides is not well understood. Objective: To assess the association between youth suicide rates and mental health professional workforce shortages at the county level, adjusting for county demographic and socioeconomic characteristics. Design, Setting, and Participants: This retrospective cross-sectional study included all US counties and used data of all US youlth suicides from January 2015, through December 31, 2016. Data were analyzed from July 1, 2021, through December 20, 2021. Exposures: County health-professional shortage area designation for mental health, assigned by the US Health Resources and Services Administration based on mental health professionals relative to the population, level of need for mental health services, and service availability in contiguous areas. Designated shortage areas receive a score from 0 to 25, with higher scores indicating greater workforce shortages. Main Outcomes and Measures: Suicides by youth aged 5 to 19 years from 2015 to 2016 were identified from the US Centers for Disease Control and Prevention’s Compressed Mortality File. A multivariable negative binomial regression model was used to analyze the association between youth suicide rates and mental health workforce shortage designation, adjusting for the presence of a children’s mental health hospital and county-level markers of health insurance coverage, education, unemployment, income, poverty, urbanicity, racial and ethnic composition, and year. Similar models were performed for the subgroups of (1) firearm suicides and (2) counties assigned a numeric shortage score. Results: During the study period, there were 5034 youth suicides (72.8% male and 68.2% non-Hispanic White) with an annual suicide rate of 3.99 per 100 000 youths. Of 3133 US counties, 2117 (67.6%) were designated as mental health workforce shortage areas. After adjusting for county characteristics, mental health workforce shortage designation was associated with an increased youth suicide rate (adjusted incidence rate ratio [aIRR], 1.16; 95% CI, 1.07-1.26) and an increased youth firearm suicide rate (aIRR, 1.27; 95% CI, 1.13-1.42). For counties with an assigned numeric workforce shortage score, the adjusted youth suicide rate increased 4% for every 1-point increase in the score (aIRR, 1.04; 95% CI, 1.02-1.06). Conclusions and Relevance: In this cross-sectional study, US county mental health professional workforce shortages were associated with increased youth suicide rates. These findings may inform suicide prevention efforts.

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  • The demand for youth mental health care has increased, and workforce and skills shortages are a major challenge globally, particularly in low-resource settings.

    “The demand for youth mental health care has increased, 230,380-382 and workforce and skills shortages are a major challenge globally, particularly in low-resource settings.”

    From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [385]

    The Conclusions (page not provided) say that declining youth mental health is likely to exacerbate US workforce shortages, and the Discussion describes substantial unmet need for care. These passages support growing pressure on youth mental health services, but they do not establish that demand for care has increased or address workforce and skills shortages globally, particularly in low-resource settings. (LLM, conf=0.83)

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Authors
Hoffmann, J. A., Attridge, M. M., Carroll, M. S., Simon, N.-J. E., Beck, A. F., & Alpern, E. R.
Affiliations
  • Northwestern University (US)
  • Cincinnati Children's Hospital Medical Center (US)
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2023-01-01
Volume
177
Issue
1
Pages
71
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2022.4419
PMC
PMC9679958
OpenAlex
W4309513135
Cited by
132
References
45
Citations by year
2026: 27 · 2025: 30 · 2024: 43 · 2023: 30 · 2022: 2
FWCI
23.98
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
Keywords
youth suicide, mental health workforce shortage, county-level disparities, firearm suicide, adolescent suicide, health insurance coverage, socioeconomic factors, urban-rural differences, racial and ethnic disparities, suicide prevention policy, United States counties
MeSH terms
Adolescent, Child, Cross-Sectional Studies, Female, Humans, Male, Mental Health, Retrospective Studies, Socioeconomic Factors, Suicide

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