Since the U.S. launched a new abbreviated 988 national suicide and crisis hotline, suicide deaths among adolescents and young adults have declined by 11% compared to predicted rates, according to a JAMA study released Wednesday.
Suicide rates have increased in the United States in recent decades, especially among young people. Overall, U.S. suicide deaths declined slightly in 2024 from their peak in 2022, the year 988 was released. A new study found an even bigger improvement when comparing quarterly suicide mortality rates for 15- to 34-year-olds with predictions. And states that saw the biggest increases in calls to Lifeline saw the biggest declines in suicide rates.
“I think all signs point to 988 being effective,” said Michael Liu, an investigator on the study and a medical resident at Brigham and Women’s Hospital in Boston. This is an observational study, meaning the team cannot claim a causal link between Lifeline use and reduced mortality. However, the results are consistent with previous research that found increased call volume was associated with decreased suicides, based on the influence of the popular 2017 Logic song, named after the hotline’s then-current phone number.
In the new study, researchers focused on young people aged 15 to 34 and analyzed data from the National Death Certificate Registry. Using data from 1999 to 2022, they estimated the expected number of suicide deaths per quarter from 2022 onwards and compared those numbers with actual mortality rates from July 2022 to December 2024.
The analysis comes as questions remain in many states about Lifeline’s long-term funding and advocates push to reverse the Trump administration’s decision last year to remove the “press three” option that connects callers to specialized services for LGBTQ+ youth. LGBTQ+ youth are at high risk for suicide, accounting for 10% of all consultations. At a Senate hearing Tuesday, Health Secretary Robert F. Kennedy Jr. promised to restore LGBTQ+ options.
“We’re working on that right now,” Kennedy told Sen. Tammy Baldwin (D-Wis.).
Since President Trump returned to office, the federal budget has maintained 988 funds. But the legislation he signed toward the end of his first term introducing the new lifeline did not guarantee long-term sustained federal support for the program, instead proposing an alternative funding model.
“Section 4 of the law says, ‘Hey, states, here’s an idea,'” said Jonathan Pirtle, a researcher at New York University’s School of Global Public Health who focuses on mental health policy implementation. The idea was a 988 toll, modeled after how states pay for 911. This usually looks like a low flat fee at the bottom of every cell phone bill. Funds are then used to support the system at the state level.
“At the end of the day, it really makes sense,” Pirtle said. “Crisis response is truly local.” But as of last summer, only 12 states had established these fees, and five had established other forms of recurring funding. A growing number of states are considering legislation that would create a funding mechanism for Lifeline, but many face an uphill battle with those who view it as another tax. Next year’s state budget is likely already under pressure from new Medicaid requirements.
Pirtle found the JAMA results promising. “These findings highlight the need to increase public awareness and communication about 988 so more people can reach out in times of need,” he said in an email.
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So far, the study authors say, there appears to be a dose-response pattern between state intake of 988 and reductions in youth suicide rates. Approximately 35,500 people aged 15 to 34 died by suicide between July 2022 and December 2024, compared to the predicted 39,900. (For older adults, who are less likely to use lifelines, the decline in suicide rates was much smaller after 988.)
Among young people, states including North Dakota, Virginia, Indiana, New York, and Rhode Island saw the largest declines in suicide mortality and the largest increases in calls to Lifeline. On average, these states experienced a 146% increase in calls and an 18% decrease in suicides over the study period compared to expectations, while states with the least increase in calls (24% on average) saw suicide rates drop by nearly 11%.
The authors believe this is the first study to examine the impact of Lifeline at a population level. However, more research is needed as the use and awareness of this line continues to grow.
In addition to unstable funding mechanisms, the cultural understanding of 988 continues to change. The volume of calls is increasing every year. States continue to adapt the 988’s role in emergency management, connecting it with other crisis responses in some places. And importantly, social norms about when people should call 988 have not yet been established. According to Pirtle’s research, the people who could benefit the most are the least likely to call.
“It’s not a perfect study, but I think this is the beginning of studies that show efficacy,” Liu said.
If you or someone you know may be considering suicide, please contact the 988 Suicide and Crisis Lifeline. Call or text 988 or chat. 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.
