JMIR Publications

ABSTRACT

Background:

Suicide remains a leading cause of death in the US and is on the rise. Limited evidence describes the current burden of suicidal ideation (SI) among commercially insured outpatients, a population that represents a large and rapidly expanding segment of those seeking care.

Objective:

The objective of this study was to characterize the prevalence of SI among a national cohort of commercially insured individuals presenting for outpatient mental health services and to examine differences across key demographic and social factors.

Methods:

This was a retrospective evaluation of patients, aged 6-64 years, presenting for their first visit with an outpatient mental health provider between 1/1/2024-10/31/2025. The prevalence of SI (defined as a non-zero response on question nine of the Patient Health Questionnaire-9) was compared by age, gender, and geography using regression analysis.

Results:

Among 189,225 commercially insured individuals included in the analysis, mean age was 33.60 years (SD 11.33); 34,168 (68%) identified as female, 14,491 (29%) as male, and 1719 (3%) as non-binary. Most had a diagnosis of generalized anxiety disorder (56,176; 29.7%) or major depressive disorder (50,075; 26.4%). 35,215 individuals (18.6%) indicated some level of SI. Across age groups, SI was highest among adolescents (age 13-17) with 2107 (32.8%) reporting any suicidality and 306 (4.8%) reporting SI nearly every day (P<.0001). The population with the greatest SI were individuals identifying as non-binary (644 [37.5%], P<.0001). SI increased as a function of patients’ social vulnerability (P<.0001) and varied by geography.

Conclusions:

Nearly 1 in 5 individuals endorsed some degree of SI with one third of adolescents reporting SI, proportions that are notably higher than estimates from the general US population. These findings underscore the need for comprehensive screening for SI and expansion of clinical support for suicidal populations.