Suicides tied to lack of health insurance, income, internet
4 min read
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People with health insurance, higher income and internet access may be less likely to die by suicide, a new study has found.
Counties with lower levels of health insurance coverage, broadband internet access and household income had higher suicide rates, according to a Centers for Disease Control and Prevention report published Tuesday.
“We want to help people in need before a crisis occurs,” Dr. Debra Houry, the CDC’s chief medical officer, told reporters in a briefing. “Suicide is preventable, and we know what works to stop it and to spare families and friends from losing loved ones.”
The national suicide rate has steadily risen over the past two decades to about one every 11 minutes. In 2022, more than 49,000 people died by suicide. Deaths in 2023 appear to be at the same level. Native American people had the highest suicide rate, followed by white people. Men were more likely than women to die by suicide, as were people in rural areas versus urban residents.
The CDC report helps shift the narrative about suicide risk, which is often framed as a concern exclusive to people with mental illness rather than factors leading to crisis, one expert said.
“Everybody has a risk of suicide,” Michiko Ueda-Ballmer, associate professor of public health administration and international affairs at Syracuse University, told USA TODAY. “That also means that everybody basically should think about suicide prevention as their … business.”
Ueda-Ballmer, who was not involved in the CDC study, contributed to a recent Lancet Public Health series examining social factors around suicide risk. The CDC findings, she said, offer insight into “contextual factors” that form a person’s life, not just individual risks with mental health.
The CDC study drew from federal data on people who had died by suicide. Researchers cross-referenced that information with census data at the county level, narrowing in on household incomes and the percentages of people with health insurance and internet subscriptions.
Suicide rates among Native and white people, men and people ages 25 to 44 were significantly lower if they lived in counties with the highest levels of health insurance, internet access and income, the study found. In counties where people had the most health insurance coverage, people had 26% lower suicide rates compared with counties that had the least coverage, CDC researchers found. Households in counties with the most internet access had 44% lower suicide rates than counties with the least. And suicide rates were 13% lower in counties with the highest household income versus counties with the lowest.
Health insurance, internet access and household income have been shown to reduce the risk of suicide, said Alison Cammack, the study’s lead author and a health scientist on CDC’s Suicide Prevention Team.
The findings were not consistent across the board. For example, women in counties with the lowest levels of insurance, internet access and income had similar suicide rates to women in the highest-income counties. Black people had similar suicide rates regardless of their health insurance coverage.
But researchers said their findings indicate the need to improve people’s access to basic needs that could prevent suicides. Greater access to health insurance may allow people to access mental health services, primary care and crisis intervention. People in higher-income communities tend to have their basic needs met.
About 19 million people in the U.S. lack access to reliable internet service, according to the Federal Communications Commission. Federal officials have called internet access “a super determinant of health” that plays a role in health outcomes and influences key factors in a person’s life. A person with internet access also may have a chance at a better education or job or access to telehealth appointments and also may have better social connections or support.
Researchers said other factors at the local level may contribute to suicide risk. The study didn’t focus on groups at higher risk of suicide, such as veterans, people with disabilities, or sexual or gender minorities. The researchers also acknowledged that there may be limited data on deaths, particularly in Native and Hispanic communities, which could mean the number of suicide deaths in each group is undercounted.
The researchers suggest taking a comprehensive approach to suicide prevention and considering the upstream strategies laid out in the National Strategy for Suicide Prevention. These include strengthening economic support and access to suicide care and helping communities develop healthy connections and coping skills. Researchers also highlighted the need to limit vulnerable people’s access to lethal means, such as firearms.
Assisting with in-home safety can be difficult in rural communities accustomed to keeping firearms in their homes, according to Ethan Dahl, co-director of ND HOPES, a CDC-funded suicide prevention program. The organization is based in western North Dakota, a rural area in a sparsely populated state, where there are 29.2 suicide deaths per 100,000 people, more than twice the national average. Key interventions, such as teaching safe firearm storage, can help, but only if communities are engaged and they teach strategies to residents.
In rural North Dakota, Dahl told USA TODAY, many people have been affected by suicide through the death of someone they know.
“It’s a tragic thing, especially for these small communities,” Dahl said. “But they are strong. They are resilient.”
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