Researchers identify public policies that work to prevent suicide

An analysis led by New York University researchers determines which public policies effectively prevent suicide deaths in the United States. But it’s not just policies that limit firearms and expand access to health care—many economic and social policies that are not explicitly focused on mental health can also prevent suicide, according to their article published in the Annual Review of Public Health.

“Most of the policies that demonstrate evidence do not mention suicide and were not passed to prevent suicide. They are policies that are intended to address other issues—for instance, increasing minimum wage to promote economic security or reducing alcohol consumption—but they have spillover benefits in that they also prevent suicides,” said Jonathan Purtle, associate professor of public health policy and management at the NYU School of Global Public Health and the study’s lead author.

“This research highlights the importance of considering social determinants in suicide prevention,” said Michael A. Lindsey, Dean and Paulette Goddard Professor of Social Work at the NYU Silver School of Social Work and a study co-author. “An individual’s mental well-being is influenced not only by clinical factors, but also by their environment, circumstances, and experiences.”

Increasing policy activity to address a growing need

Suicide is a leading cause of death in the US, and rates have increased over the past two decades. Public policies, including laws passed by elected officials and regulations adopted by public agencies, play an important role in reducing suicide deaths. While suicide is addressed by some federal policies, most public health policy authority is at the state level. 

In their article in the Annual Review of Public Health, the researchers analyzed the number of state bills passed that mention suicide over the past two decades, as well as the volume of social media posts from state legislators on the topic—an indicator of policy priority. They found a dramatic increase in both, particularly beginning around 2017.

“Our analysis suggests that policymakers recognize that suicide is an issue of public health significance and are trying to address it, and there is bipartisan concern,” said Purtle. 

Policies that work

While many studies have looked at the impact of individual policies on suicide risk, until now, there was not an analysis that collectively examined the research to provide a deeper understanding of what policies are most effective.

To develop this analysis, Purtle, Lindsey, and their colleagues reviewed more than 100 studies and uncovered three categories of policies that research shows have the potential to prevent suicide:

• Policies that limit access to lethal means (e.g., policies for safe firearm storage and waiting periods to purchase firearms, installing barriers on bridges)
• Policies that increase access to mental health services (e.g., Medicaid expansion, laws requiring insurance to cover mental health care)
• Policies that address underlying risk factors for suicide, including those that increase economic security (e.g., minimum wage laws, paid sick leave, unemployment benefits, supplemental nutrition program), prohibit discrimination (e.g., protecting sexual and gender identity in hate crime laws), and limit access to alcohol and tobacco

While policies in all three categories have some potential to reduce suicide deaths, the researchers found that policies to improve economic security, limit access to alcohol, and restrict access to lethal means have the strongest evidence.

“Access to alcohol and lethal means of harm, as well as poverty, are all known risk factors for suicide,” said Lindsey. “Our research suggests that a great starting place for saving lives is to fund and enact public policies that target these three areas.”

In addition, while some of the most effective policies focus on improving well-being over the long term, others—including those related to firearms and restricting other lethal means—aim to make it more difficult to make quick decisions that can have fatal consequences. 

“Suicide is often an impulsive act,” said Purtle. “Anything you can do to delay that impulsivity on average will be beneficial and will prevent suicide from a public health perspective.”

Firearms are the most common and deadly method of suicide, although research on gun violence was long hampered by a federal law blocking funding for this work. However, evidence has begun to build over the past decade about firearm policy and suicide risk, enabling the researchers to include it in their analysis.

The review identified studies that determined that having a firearm in the home dramatically increases the risk of suicide and that policies to limit firearm access can reduce this risk. While not all firearm policies were found to be equally effective, laws requiring a waiting period for gun purchases were moderately effective at preventing suicides. Moreover, laws setting more restrictive age limits for gun purchases and those that require safe gun storage in the home—with consequences for adults who do not safely secure their guns—reduced suicide deaths among young people. 

More data needed

The researchers outlined several areas of research that need attention moving forward, including the new 988 suicide and crisis lifeline. Purtle is leading NIH-funded research on the implementation and impact of policies on the lifeline, with recent studies describing the increase in call volume to the lifeline during its first two years, the experience of users, and how federal and state investments in 988 have enhanced the capacity of these systems.

They also call for more research on technology and youth mental health, including the impact of social media age restrictions, school cell phone bans, and policies that prevent exposure to harmful suicide-related content online. Early efforts to reduce harm online have largely allowed technology companies to self-regulate, but in recent years, there have been growing efforts to implement policies to protect young people from the potential harms of technology.

“The policy landscape has changed so quickly, but it will take time to study these changes, so we don't yet have strong evidence as to what works,” said Purtle.

Amanda Mauri of the NYU School of Global Public Health and Katherine Keyes of the Columbia Mailman School of Public Health were additional authors of the study. The research is supported in part by the National Institute of Mental Health (R01MH131649).