The impact of behavioral health parity on suicide attempts among military beneficiaries in the U.S

Abstract In October 2016, the U.S. Military Health System (TRICARE) launched a system-wide behavioral health parity reform aimed at reducing financial barriers and expanding provider availability. While parity laws improve financial protection and service use, evidence regarding their impact on downstream health outcomes remains limited. This study examines the effect of TRICARE’s parity reform on medically attended suicide attempts across distinct beneficiary populations including active-duty service members (ADSMs), military retirees, and dependents. The analysis leverages a natural experiment created by the reform, utilizing comprehensive medical claims data spanning from 2015 through 2020 (over 140 million person-quarters). I employ fixed-effects interrupted time-series design and fixed-effects distributed-lag specification to estimate both immediate level shifts and changes in the trajectory of suicide attempts. Parity was associated with significant reductions in suicide attempts, with substantial heterogeneity across beneficiary groups. Military retirees and dependents—for whom parity mitigated both financial and non-pecuniary access constraints—experienced immediate and steadily increasing declines over time, totaling 241 and 435 fewer attempts per 100,000 beneficiaries, respectively, over 3.5 years post-parity. These declines were equivalent to average reductions of approximately 17 and 29 attempts per 100,000 per quarter. In contrast, ADSMs, who already faced no cost-sharing, exhibited a small initial decline but no sustained trajectory of reduction. Behavioral health parity policies that address both financial and provider barriers can significantly lower suicide attempt risk. However, the divergence in parity effects between ADSMs and non-active-duty beneficiaries suggests that such reforms alone may be insufficient in contexts where cultural and structural barriers continue to impede help-seeking and access to mental health care.