Understanding the associations between unemployment, Medicaid, social welfare programs, and suicides, 1999-2009

Background: During economic contractions, unemployed individuals experience a heightened risk for worsening mental health disorders and increased risk of suicide. This study sought to examine the relationship between unemployment, suicide, social welfare programs, and Medicaid provisions.

Data and Methods: Data were collected for 50 states and the District of Columbia from 1999-2009. Unemployment data obtained from the Bureau of Labor Statistics. Suicide and mental distress data derived from the Center for Disease Control. Health insurance data collected from the Centers for Medicare and Medicaid Services and the Census Bureau. Temporary Assistance for Needy Families (TANF) and State Unemployment Insurance (SUI) data obtained from the Departments of Health and Human Services, and Labor. State fixed effects regression models were used to examine the associations between unemployment, mental distress, suicide, and social welfare and Medicaid provisions. Statistical tests were based on a two-sided α significance level of p<.05. Analyses were performed with STATA.

Results: White non-Hispanic unemployment was associated with increased mental distress (p<.05), suicide (p<.001), uninsured (p<.001), Medicaid recipients (p<.001), and SUI beneficiaries (p<.001), and decreased TANF recipients (p<.01). Improved TANF (p<.001) and SUI (p<.05) coverage was associated with lower White non-Hispanic suicide, whereas increasing numbers of uninsured and Medicaid beneficiaries had the opposite association. Medicaid mental health spending did not have a statistically significant relationship with White non-Hispanic suicide.

Conclusion: As unemployment increases so does mental distress and suicides. Budget cuts on social welfare programs and Medicaid mental health services could lead to increases in suicides during economic downturns.