Simpler is better when it comes to saving lives

Suicide deaths among young adults and youth declined after a federal agency simplified the phone number for a national crisis hotline and increased resources, a new study says.

The 988 Suicide and Crisis Lifeline, run by the federal Substance Abuse and Mental Health Services Administration, replaced 1-800-273-Talk in 2022, accompanied by a $1.5 billion campaign to expand crisis center capacity and workforce nationwide.

The change came amid a national conversation about declining mental health — particularly among American teens — that worsened during the COVID-19 pandemic. Since then, suicide deaths among young adults and youth have declined 11 percent — representing 4,372 lives — from the level anticipated by a long upward trend before 2022, researchers say.

“This is one of those rare good-news stories in public health,” said Vishal Patel, first author of a paper on the study, published in the Journal of the American Medical Association in April. “Most population health research diagnoses issues like rising mortality and widening differences, so it was refreshing to see this intervention having an effect, though it’s not going to solve the issue on its own.”

Patel, a clinical fellow in surgery at Harvard Medical School and surgical resident at Brigham and Women’s Hospital, said that when researchers first examined figures for all age groups, the lifeline’s potential impact appeared to be slight.

But when they broke down the data, they saw a significant decline among those age 15 to 34 — encompassing the high-risk teenage years — that had been masked by results in other groups.

The researchers noted a decline from both observed suicide deaths in 2022 and from predictions based on a long-term upward trend. In 2010, about 11 suicides per 100,000 were reported in that age group. By 2022, that had risen to nearly 18 per 100,000. Three years after the 988 number went online, however, that had fallen to approximately 15 per 100,000, according to the study.

Another high-risk group also saw suicide mortality decline after the hotline started. Adults age 65 and older saw suicide mortality fall 4.5 percent.

In recent decades, the overall U.S. suicide rate has become a major public health concern.

Suicide mortality had declined from the mid-1980s until 1999. After 1999, however, it began climbing, peaking in 2018 then resuming its climb in 2020, during the pandemic and post-pandemic years, according to information from the National Center for Health Statistics.

Patel said he and co-authors became interested in the hotline in July, when its federal funding was partially cut. The cuts targeted specialized services for lesbian, gay, bisexual, transgender, and queer adults, a high-risk group who represented about 10 percent of lifeline callers.

Patel said he wanted to know whether the funding change was due to the hotline’s poor performance, so he and colleagues gathered statistics from the National Vital Statistics System to conduct their analysis.

In addition to the nationwide figures, state-by-state data also shows an association with the establishment of the 988 number.

The 10 states with the largest increases in calls after its establishment — 146.2 percent more — also saw a larger decline in suicide deaths, about 18.2 percent. The 10 states with the lowest call volume increase — about 23.6 percent — saw a lower, 10.6 percent decline.

As a control, researchers compared suicide mortality in the U.S. to that in the United Kingdom over the same three-year period, during which the U.K. did not change its intervention policies and saw no comparable reductions in mortality.

“This is an intervention that seems to be working,” Patel said, “so it’s one of those things that should continue to receive funding, not one we should start to scale back.”