After the U.S. launched 988, a new shortened phone number for the national suicide and crisis hotline, suicide deaths among adolescents and young adults dropped 11% compared to projected rates, according to a JAMA study published Wednesday.
Suicide rates have been increasing in the U.S. for decades, especially among young people. Overall, the number of suicide deaths in the U.S. dropped slightly in 2024 from a peak in 2022 — the year that 988 was launched. The new research found even greater improvements when comparing the quarterly rate of suicide deaths among people ages 15 to 34 against projections. And the states that saw the biggest increases in answered calls to the lifeline experienced the largest decline in suicide rates.
“I think all signs point to the effectiveness of 988,” said Michael Liu, a researcher on the study and resident physician at Brigham and Women’s Hospital in Boston. It’s an observational study, which means the team cannot claim a causal relationship between the use of the lifeline and the decreased rates. But the results are consistent with previous research that found — based on the impact of a popular 2017 Logic song named after the hotline’s then-phone number — increased call volume was linked to fewer suicides.
In the new study, researchers analyzed data from a national registry of death certificates, focusing on young people ages 15 to 34. Data from 1999 to 2022 were used to estimate the expected number of quarterly suicide deaths from 2022 on, and those numbers were compared to the actual death rates from July 2022 through December 2024.
The analysis arrives as questions linger in many states about the lifeline’s long-term funding and as advocates push to reverse the Trump administration’s decision last year to remove the “press three” option that connected callers to specialized services for LGBTQ+ young people. Young LGBTQ+ people have a higher risk for suicidality and accounted for 10% of all calls. At a Senate hearing on Tuesday, health secretary Robert F. Kennedy Jr. committed to restoring the LGBTQ+ option.
“We are working on getting it up now,” Kennedy told Sen. Tammy Baldwin (D-Wis.).
The federal budget has maintained funding for 988 since President Trump returned to office. But the law that introduced the new lifeline, which he signed toward the end of his first term, did not ensure long-term sustainable federal support for the program, instead proposing an alternative funding model.
“Section 4 of the law pretty much says, ‘hey, states, here’s an idea,’” said Jonathan Purtle, a researcher at the New York University School of Global Public Health focused on the implementation of mental health policies. The idea was 988 telecom fees, modeled after the way states pay for 911. This typically looks like a low, flat fee at the bottom of every cellphone bill. The funds are then used to support the system at the state level.
“At the end of the day, that really makes sense,” Purtle said. “Crisis response is a really local thing.” But as of last summer, just 12 states had established those fees, while five set up a different form of recurring funding. More states are considering bills to implement a funding mechanism for the lifeline, but many face an uphill battle against those who see it as another tax. State budgets are already likely to be squeezed next year due to new Medicaid requirements.
Purtle found the JAMA results promising. “The findings highlight a need to enhance public awareness and communication about 988 so that more people reach out when they are in distress,” he said over email.
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For now, there seems to be a dose-response pattern in the association between state uptake of 988 and the drop in suicide rates among young people, per the study authors. Between July 2022 and December 2024, about 35,500 people ages 15 to 34 died by suicide, compared to a predicted 39,900. (Older adults, who are less likely to use the lifeline, saw a much smaller reduction in suicide rates after 988.)
Among young people, there were significant declines in suicide mortality among states including North Dakota, Virginia, Indiana, New York, and Rhode Island with the greatest increase in call volume to the lifeline. On average, those states saw a 146% increase in calls and an 18% reduction in suicides versus projections over the study period, while states with the smallest call-volume increase, an average of 24%, saw suicide rates fall nearly 11%.
The authors believe this is the first study to look at the impact of the lifeline on a population level. But there’s much more research needed as use and awareness of the line continue to grow.
In addition to unsettled funding mechanisms, the cultural understanding of 988 is still shifting. Call volume increases every year; states are continuing to adapt the role of 988 in the crisis care continuum, in some places connecting it with other crisis offerings. And critically, there’s still no established social norm for when a person should call 988. People who could benefit the most are the least likely to call, according to Purtle’s research.
“Although not a perfect study,” Liu said, “I think this is the start of a study that’s shown effectiveness.”
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.