Comparing suicide prevention policies across states: a systems science perspective
Poster #: 147
Session/Time: B
Author:
Caitlyn Grace Martindale, BS
Mentor:
Philippe Giabbanelli, MS, PhD
Research Type: Public Health
Abstract
INTRODUCTION:
Suicide is a leading cause of death in the United States (U.S.), ranking among the top ten causes across most age groups and contributing to significant public health and societal burden. Despite national efforts, suicide rates have remained persistently high over the past two decades. Prevention policies are largely developed and implemented at the state level, yet each state publishes policies in lengthy narrative formats that are challenging to systematically compare. This creates barriers to understanding how states align with evidence-based recommendations, such as the Centers for Disease Control and Prevention's (CDC) suicide prevention package, and to assessing whether policies reflect suicide's complexity as a system of interrelated determinants. The objective of this study is to develop and apply a framework for systematically analyzing state-level suicide prevention policies, with a focus on whether and how systems thinking is represented, and to identify similarities and differences in policy approaches across states.
METHODS:
We selected 15 U.S. states using purposive sampling to ensure diversity of geography, demographics, and policy context, and continued sampling until thematic saturation was reached. Guided by a systems map of suicide, we manually extracted policy initiatives from state policy documents. Each initiative was coded as a concept (e.g., "increase access to mental health treatment") and, when specified, causal relationships (e.g., "financial stability and access to care enable mental health treatment") were also identified. This approach enabled consistent extraction of both discrete policy levers and the connections among them, providing a structured basis for cross-state comparison.
RESULTS:
Across the 15 states, most suicide prevention policies demonstrated limited incorporation of systems thinking. Policies frequently focused on isolated interventions (e.g., restricting access to lethal means, improving mental health treatment, promoting safe messaging) without linking them to other interventions or to broader social, economic, or healthcare determinants. Causal relationships, when articulated, were sparse instead of accounting for the multiple factors that create or prevent risks. While several policy levers were commonly mentioned across states, their packaging varied considerably. For example, two states facing similar demographic and structural challenges often proposed different intervention sets, suggesting that policy construction could benefit from more evidence-based alignment.
CONCLUSION:
Our framework illustrates the utility of applying systems mapping to narrative state policy documents, enabling structured comparisons that are otherwise difficult to achieve. The finding that most states emphasize isolated interventions rather than interconnected systems underscores a critical limitation in current policy design. Without explicit recognition of how factors such as social determinants, healthcare access, and economic conditions interact, state policies may miss opportunities for synergistic and sustainable impact, or they may ignore potential unintended consequences. By making policy structures and causal reasoning explicit, our approach can support more systematic and methodological policy development. This may, in turn, improve implementation fidelity, facilitate evaluation, and enhance cross-state learning. Ultimately, the framework highlights the need for suicide prevention policies that better reflect the complexity of suicide as a public health problem.
Suicide is a leading cause of death in the United States (U.S.), ranking among the top ten causes across most age groups and contributing to significant public health and societal burden. Despite national efforts, suicide rates have remained persistently high over the past two decades. Prevention policies are largely developed and implemented at the state level, yet each state publishes policies in lengthy narrative formats that are challenging to systematically compare. This creates barriers to understanding how states align with evidence-based recommendations, such as the Centers for Disease Control and Prevention's (CDC) suicide prevention package, and to assessing whether policies reflect suicide's complexity as a system of interrelated determinants. The objective of this study is to develop and apply a framework for systematically analyzing state-level suicide prevention policies, with a focus on whether and how systems thinking is represented, and to identify similarities and differences in policy approaches across states.
METHODS:
We selected 15 U.S. states using purposive sampling to ensure diversity of geography, demographics, and policy context, and continued sampling until thematic saturation was reached. Guided by a systems map of suicide, we manually extracted policy initiatives from state policy documents. Each initiative was coded as a concept (e.g., "increase access to mental health treatment") and, when specified, causal relationships (e.g., "financial stability and access to care enable mental health treatment") were also identified. This approach enabled consistent extraction of both discrete policy levers and the connections among them, providing a structured basis for cross-state comparison.
RESULTS:
Across the 15 states, most suicide prevention policies demonstrated limited incorporation of systems thinking. Policies frequently focused on isolated interventions (e.g., restricting access to lethal means, improving mental health treatment, promoting safe messaging) without linking them to other interventions or to broader social, economic, or healthcare determinants. Causal relationships, when articulated, were sparse instead of accounting for the multiple factors that create or prevent risks. While several policy levers were commonly mentioned across states, their packaging varied considerably. For example, two states facing similar demographic and structural challenges often proposed different intervention sets, suggesting that policy construction could benefit from more evidence-based alignment.
CONCLUSION:
Our framework illustrates the utility of applying systems mapping to narrative state policy documents, enabling structured comparisons that are otherwise difficult to achieve. The finding that most states emphasize isolated interventions rather than interconnected systems underscores a critical limitation in current policy design. Without explicit recognition of how factors such as social determinants, healthcare access, and economic conditions interact, state policies may miss opportunities for synergistic and sustainable impact, or they may ignore potential unintended consequences. By making policy structures and causal reasoning explicit, our approach can support more systematic and methodological policy development. This may, in turn, improve implementation fidelity, facilitate evaluation, and enhance cross-state learning. Ultimately, the framework highlights the need for suicide prevention policies that better reflect the complexity of suicide as a public health problem.