This month’s topic focuses on suicide and social determinants of health (SDoH)
Welcome to the Healthy Intersections podcast for October, 2023. Today’s podcast focuses on the links between suicide and social determinants of health in the United States. Suicide is one of the causes of deaths of despair, along with deaths from drugs and alcohol. We will be discussing some key statistics and findings related to this topic as well as discussing a new study on the topic.
Link to audio here (also available on your favorite podcast streaming service).
Transcript below!
Let’s start by looking at some suicide statistics:
- The total age-adjusted suicide rate increased from 10.7 deaths per 100,000 people in 2001 to a recent peak of 14.2 in 2018, went down to 13.5 in 2020, then back up in 2021 to 14.0 per 100,000 people.
- Approximately 5% of adults in the United States report having had serious thoughts of suicide — that represents over 12.1 million people.
What does the literature say about links between SDoH and suicide?
- Social-ecological composite measures (specifically the SVI and a newer, similar metric) have been shown to be associated with suicide rates in a recent paper from a group at the University of Chicago.
- That paper found a 56% increase in the suicide rate from the lowest to the highest social risk group
- Individual social determinants of health closely associated with higher suicide rates include environmental factors, exposure to violence, access to quality healthcare, and employment status.
To better understand the relationship between social determinants of health and suicide risk, let’s discuss a new study just released in the November, 2023 issue of Medical Care.
- (Citation: Llamocca, Elyse N.; Yeh, Hsueh-Han; Miller-Matero, Lisa R.; Westphal, Joslyn; Frank, Cathrine B.; Simon, Gregory E.; Owen-Smith, Ashli A.; Rossom, Rebecca C.; Lynch, Frances L.; Beck, Arne L.; Waring, Stephen C.; Lu, Christine Y.; Daida, Yihe G.; Fontanella, Cynthia A.; Ahmedani, Brian K. Association Between Adverse Social Determinants of Health and Suicide Death. Medical Care 61(11):p 744-749, November 2023. DOI: 10.1097/MLR.0000000000001918)
A link to the paper is available in the description for this episode and, of course, on The Medical Care Blog, along with the transcript.
Now I’d like to give you a quick summary of the paper:
- The objective of the study was to identify adverse social determinants of health (SDoH) codes in the records for people who died by suicide and to examine associations between documented adverse SDoH and suicide.
- The study design was a case-control study using linked medical record, insurance claim, and mortality data from 2000 to 2015 obtained from 9 Mental Health Research Network-affiliated health systems.
- The study included 3330 individuals who died by suicide and 333,000 randomly selected controls matched on index year and health system location.
- All cases and controls were enrolled in their respective health care plans for at least 10 months in the year before the index date.
- The primary outcome of interest was suicide death during the study period.
- The primary exposures of interest were adverse SDoH documented using ICD-9-CM codes captured during clinical visits in the year before the index date.
- Adverse SDoH were classified into 9 categories.
- The associations between reported SDoH categories and suicide were estimated using logistic regression models conditional on index year and site, controlling for age group, sex, and history of mental health diagnosis.
- The study found that adverse SDoH documentation was low, with only 6.6% of cases having ≥1 documented adverse SDoH in the year before suicide.
- It was observed that any documented SDoH and several specific adverse SDoH categories were more frequent among cases than controls.
- Any documented adverse SDoH was associated with higher suicide odds.
- Although documented SDoH prevalence was low, the study found that several adverse SDoH were associated with increased suicide odds, supporting calls to increase SDoH documentation in medical records.
- By improving the understanding of SDoH prevalence and assisting in identification and intervention among individuals at high suicide risk, increased documentation can help prevent suicide.
So my big takeaway from this study is this: Understanding the relationship between suicide risk and SDoH is crucial for developing effective strategies to prevent suicide. By addressing and mitigating the adverse SDoH, we can work towards reducing suicide rates and improving the overall well-being of individuals in the United States.
Well, that’s all the time we have for today. Thanks for listening to this podcast, sponsored by the American Public Health Association’s Medical Care Section and hosted on The Medical Care Blog. Don’t forget to subscribe, and tell your friends! See you next time!
Lisa M. Lines