The Patient Protection and Affordable Care Act (ACA) Medicaid Expansion was found to decrease suicide rates among younger adults, according to results of a cross-sectional study published in JAMA Network Open.
Investigators from Washington University School of Medicine in St Louis sourced data for this study from the National Center for Health Statistics. Trends in suicides between 2000 and 2018 among adults aged 20-64 years were evaluated on the basis of whether the suicide occurred in a state in the United States with ACA Medicaid Expansion.
During the study period, 553,912 deaths by suicide occurred among a population comprised of 77.6% men and 89.6% White individuals.
States that had ACA Medicaid Expansion had smaller proportions of Black individuals, lower rates of poverty, and more laws about opioid prescribing and firearm control.
Prior to the expansion period in 2011-2013, suicides occurred at a rate of 13.94 per 100,000 individuals in expansion states compared with 16.67 per 100,000 individuals in nonexpansion states. Prior to ACA Medicaid Expansion, the expansion and nonexpansion states had parallel trends of increases in suicide rates.
After ACA Medicaid Expansion in 2014, the increase in suicide rate was partially attenuated in expansion states (mean, 2.56 vs 3.10 per 100,000 increase). ACA Medicaid Expansion was associated with a decrease of -0.40 (95% Credible Interval [CrI], -0.66 to -0.14; P <.001) per 100,000 individuals, averting 1818 suicides.
The largest suicide aversion occurred among adults aged 20-29 years (adjusted difference-in differences [aDID], -0.52; 95% CrI, -1.00 to -0.05; P =.02), men (aDID, -0.41; 95% CrI, -0.86 to 0.03; P =.04), and White individuals (aDID, -0.39; 95% CI, -0.71 to -0.09; P =.005).
The major limitation of this study was the ecological design which did not allow for individual-level data to be evaluated.
The study authors concluded, “Data from this cross-sectional study suggest that Medicaid expansion is associated with attenuating the increase in suicide in the US and affirm previous data that increased access to mental health care and reductions in financial barriers are vital to appropriately and adequately address the national emergency of suicides in the country. Vigorous efforts advocating to expand and improve access to mental health care should be continued.”
Patel H, Barnes J, Osazuwa-Peters N, Bierut LJ. Association of state Medicaid expansion status with rates of suicide among US adults. JAMA Netw Open. 2022;5(6):e2217228. doi:10.1001/jamanetworkopen.2022.17228