Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 348, Columbia, SC, 29201, USA.
Department of Health Policy and Management, Yale University, School of Public Health, 60 College Street, Suite 300B, New Haven, CT, 06510, USA.
BMC Psychiatry. 2020 Apr 25;20(1):188. doi: 10.1186/s12888-020-02607-y.
Despite the fact that the overwhelming majority of mental health services are delivered in outpatient settings, the effect of changes in non-hospital-based mental health care on increased suicide rates is largely unknown. This study examines the association between changes in community mental health center (CMHC) supply and suicide mortality in the United States.
Retrospective analysis was performed using data from National Mental Health Services Survey (N-MHSS) and the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) (2014-2017). Population-weighted multiple linear regressions were used to examine within-state associations between CMHCs per capita and suicide mortality. Models controlled for state-level characteristics (i.e., number of hospital psychiatric units per capita, number of mental health professionals per capita, age, race, and percent low-income), year and state.
From 2014 to 2017, the number of CMHCs decreased by 14% nationally (from 3406 to 2920). Suicide increased by 9.7% (from 15.4 to 16.9 per 100,000) in the same time period. We find a small but negative association between the number of CMHCs and suicide deaths (- 0.52, 95% CI - 1.08 to 0.03; p = 0.066). Declines in the number of CMHCs from 2014 to 2017 may be associated with approximately 6% of the national increase in suicide, representing 263 additional suicide deaths.
State governments should avoid the declining number of CMHCs and the services these facilities provide, which may be an important component of suicide prevention efforts.
尽管绝大多数精神卫生服务都是在门诊环境中提供的，但非住院精神卫生保健的变化对自杀率上升的影响在很大程度上仍是未知的。本研究考察了美国社区心理健康中心（CMHC）供应变化与自杀死亡率之间的关联。
使用国家心理健康服务调查（N-MHSS）和疾病控制与预防中心（CDC）广泛在线流行病学研究数据（WONDER）（2014-2017 年）进行回顾性分析。采用人群加权多元线性回归分析考察了人均 CMHC 与自杀死亡率之间的州内关联。模型控制了州级特征（即每 capita 的医院精神病单元数量、每 capita 的心理健康专业人员数量、年龄、种族和低收入百分比）、年份和州。
从 2014 年到 2017 年，全国 CMHC 的数量减少了 14%（从 3406 个减少到 2920 个）。同期自杀人数增加了 9.7%（从每 10 万人 15.4 人增加到 16.9 人）。我们发现 CMHC 数量与自杀死亡人数之间存在微小但负面的关联（-0.52，95%CI-1.08 至 0.03；p=0.066）。2014 年至 2017 年 CMHC 数量的下降可能与全国自杀人数增加的约 6%有关，这代表着 263 例额外的自杀死亡。
州政府应避免 CMHC 数量下降及其提供的服务，这可能是预防自杀工作的一个重要组成部分。
