Spatial Accessibility
2023-7-20
Differential spatial-social accessibility to mental health care and suicide
This study finds that reduced accessibility to mental health care providers due to transportation barriers and provider shortages is associated with increased suicide rates across US counties.
Abstract:
In recent years, the United States has been experiencing historically high suicide rates. In the face of mental health care provider shortages that leave millions needing to travel longer to find providers with schedule openings, if any are available at all, the inaccessibility of mental health care has become increasingly central in explaining suicidality. To examine the relationship between access to care and suicide, we leverage a dataset mapping all licensed US psychiatrists and psychotherapists (N= 711,214), as of early 2020, and employ real-world transportation data to model patients’ mobility barriers. We find a strong association between reduced mental health care provider spatial-social accessibility and heightened suicide risk. Using a machine learning approach to condition on a host of 22 contextual factors known to be implicated in suicide (e.g., race, education, divorce, gun shop prevalence), we find that in locales where individuals seeking care can access fewer mental health care providers, already more likely to be saturated by demand, suicide risk is increased (3.2% for each reduced SD of psychiatrist accessibility; 2.3% for psychotherapists). Additionally, we observe that local spatial-social accessibility inequalities are associated with further heightened risk of suicide, underscoring the need for research to account for the highly localized barriers preventing many Americans from accessing needed mental health services.
Summary
- In recent years, suicide rates have been increasing in the US
- Access to mental health care is important for suicide prevention, but there are severe shortages of providers leading to barriers in access
- This study maps the locations of nearly all US psychiatrists and psychotherapists
- It uses computational methods to model spatial-social accessibility to mental health care based on provider locations, capacity, saturation, and real-world transportation data
- Findings show improved accessibility to psychiatrists and therapists is associated with lower county-level suicide rates, even after controlling for confounders
- Within-county inequalities in psychiatrist accessibility are linked to higher suicide rates
Study Questions and Answers
| Question | Answer |
|---|---|
| What has been happening with suicide rates in the US recently? | Suicide rates have been increasing in recent years. |
| Why is access to mental health care important? | Access is critical for suicide prevention, but there are severe shortages leaving barriers to care. |
| How did the study examine accessibility? | It mapped psychiatrist and therapist locations nationwide and used computational methods to model spatial-social accessibility incorporating capacity, saturation, transportation, etc. |
| What was the main finding? | Improved accessibility to providers was associated with lower county suicide rates, even accounting for confounders. |
| How did within-county inequality relate to risk? | More inequality in psychiatrist accessibility within counties was linked to higher suicide rates. |