Trends in Crisis Hotline Call Rates and Suicide Mortality in the United States.

Objective: Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services.
Methods: Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year.
Results: Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time.
Conclusions: Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource.
Competing Interests: Dr. Gould has received research support from Vibrant Emotional Health and the National Suicide Prevention Lifeline. Dr. Gould has also received funding to conduct research evaluations of the National Suicide Prevention Lifeline. Dr. Keyes has been financially compensated as an expert witness in litigation. Dr. Shaman has received research funding from Pfizer, Salesforce, and Regeneron and has also been a consultant for BNI. Dr. Shaman and Columbia University declare partial ownership of SK Analytics. The other authors report no financial relationships with commercial interests.