A National Comparison of Suicide Among Medicaid and Non-Medicaid Youth

Publication date: Available online 17 January 2019

Source: American Journal of Preventive Medicine

Author(s): Cynthia A. Fontanella, Lynn A. Warner, Danielle L. Steelesmith, Jeffrey A. Bridge, Guy N. Brock, John V. Campo

Introduction

In the U.S., youth enrolled in Medicaid experience more risk factors for suicide, such as mental illness, than youth not enrolled in Medicaid. To inform a national suicide prevention strategy, this study presents suicide rates in a sample of youth enrolled in Medicaid and compares them with rates in the non-Medicaid population.

Methods

Data sources were death certificate data matched with Medicaid data from 16 states, and the Web-based Injury Statistics Query and Reporting System. Deaths by suicide that occurred between 2009 and 2013 by youth aged 10 to 18 years were identified for Medicaid and non-Medicaid groups. Age-, gender-, and cause-specific mortality rates were calculated separately for both groups. Standardized mortality ratios were calculated to compare rates, and standardized mortality ratio 95% CIs were estimated with Poisson regressions. The data were analyzed in 2018.

Results

A substantial proportion (39%) of the total number of deaths by suicide (N=4,045) in youth occurred among those enrolled in Medicaid. The overall suicide rate did not significantly differ between groups (standardized mortality ratio=0.96, 95% CI=0.90, 1.03). However, compared with the non-Medicaid group, the suicide rate in the Medicaid group was significantly higher among youth aged 10 to 14 years (standardized mortality ratio=1.28, 95% CI=1.11, 1.47), females (regardless of age; standardized mortality ratio=1.14, 95% CI=1.01, 1.29), and those who died by hanging (standardized mortality ratio=1.26, 95% CI=1.16, 1.38).

Conclusions

The population-based profile of suicide among youth enrolled in Medicaid differs from the profile of youth not enrolled in Medicaid, confirming the importance of Medicaid as a "boundaried" suicide prevention setting.

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