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Primary Submission Category: Health care/services
Association between state-level utilization of 988 Lifeline and suicide-related outcomes in the US.
Authors: Parvati Singh,
Presenting Author: Parvati Singh*
In July 2022, the US launched the 988 Suicide and Crisis Lifeline, a nationwide three-digit number for individuals in crisis, which preceded a sharp rise in the use of these services nationally. We examined the ecological association between 988 Lifeline utilization and suicide-related outcomes at the state-quarter level from July 2021 to December 2023 across all US states.
We retrieved state-level quarterly data on (1) suicide mortality from CDC WONDER, (2) suicide-related emergency department (ED) visits from the State Emergency Department Database, and (3) suicide-related hospitalizations from the State Inpatient Database. We defined our three outcomes as state-quarterly rates per 100,000 population. We obtained state-quarter-level data on 988 utilization from the Lifeline’s public reports, from July (quarter 3) 2021 (earliest 988 data availability) to December (quarter 4) 2023.
We used the timing of the national 988 launch (binary: 1 for quarter 2 2022 onward; 0 otherwise) as an instrumental variable (IV) to examine the association between our outcomes and three 988 utilization-related exposures using two-stage least squares (2SLS) linear regression analyses: (1) volume of calls to 988 per 100 population, (2) volume of 988 calls answered in-state per 100 population, and (3) answer rate (percentage of in-state calls answered to calls made). Analyses controlled for state, quarter fixed effects, non-suicide-related mortality/ED visits/hospitalizations (per outcome), and co-terminus abortion bans.
Results from IV analyses show no change in suicide mortality and suicide-related hospitalizations in relation to 988 utilization. However, suicide-related ED visits declined with increase in volume of calls to 988 (coeff= -123.8, 95% CI -196,-51.6), volume of 988 calls answered in-state (coeff= -110.5, 95% CI -174,-47), and answer rate (coeff = -72.88, 95% CI: -116.2,-29.5).
Higher utilization of 988 Lifeline may correspond with reductions in suicide-related ED visits.