Medicaid Expansion and County-Level Suicide: Disparities Based on Rurality and Mental Health Provider Shortages

Area of Science:

• Public Health
• Health Services Research
• Epidemiology

Background:

• Previous state-level studies indicated Medicaid expansion correlates with reduced suicide rates.
• Understanding the county-level impact and disparities is crucial for targeted interventions.

Purpose of the Study:

• To examine the association between Medicaid expansion and county-level suicide rates.
• To investigate disparities in this association based on rurality and mental health professional availability.

Main Methods:

• Cross-sectional study utilizing difference-in-differences analysis.
• Regression-adjusted ordinary least squares with county and year fixed effects.
• Analysis of county-level suicide mortality rates among nonelderly adults before and after Medicaid expansion.

Main Results:

• Medicaid expansion showed no significant association with overall county-level suicide rates.
• A significant decrease in suicide rates was observed in metropolitan counties lacking mental health professional shortages (adjusted coefficient=-1.32, p=0.014).

Conclusions:

• Medicaid expansion's impact on suicide rates may be contingent on existing mental health care resources and infrastructure.
• Further research is needed to elucidate the mechanisms driving these observed disparities.