Unemployment insurance program accessibility and suicide rates in the United States.

Unemployment is a risk factor for suicide. Unemployment insurance is the primary policy tool in the United States for alleviating the burden of unemployment on individuals. Our objective was to estimate the effect of state unemployment insurance accessibility on suicide rates, and effect modification by sociodemographic factors and unemployment rate. We used quarterly data from all 50 U.S. states and Washington, DC from 2000 to 2015, for a total of 3264 state-quarter units of analysis. The exposure was the quarterly unemployment insurance recipiency rate, i.e. the percentage of unemployed persons who received unemployment insurance. The outcome was the state-quarterly suicide rate per 100,000 population. Linear regression models included state, year, and calendar quarter fixed effects, state time trends, and state-level economic covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, educational attainment, age, gender, and race. Based on fully adjusted models, potential protective effects of higher unemployment insurance recipiency rates appear to be small and restricted to demographic groups at higher risk of suicide including men, non-Hispanic White Americans, and those 45-64 years of age. These groups also generally have higher UI recipiency rates, therefore differences in subgroup estimates may reflect variations in eligibility policies and accessibility of UI programs.