Suicidal Ideation Across the Lifespan Among Commercially Insured Outpatients: Retrospective Cohort Study

Background Suicide remains a leading cause of death in the United States and is on the rise. Limited evidence describes the current burden of suicidal ideation (SI) among commercially insured outpatients, a population that represents a large and rapidly expanding segment of those seeking care. Objective The objective of this study was to characterize the prevalence of SI among a national cohort of commercially insured individuals presenting for outpatient mental health services, and to examine differences across key demographic and social factors. Methods This was a retrospective evaluation of patients, aged 6 to 64 years, presenting for their first visit with an outpatient mental health -clinician between January 1, 2024, and October 31, 2025. The prevalence of SI (defined as a nonzero response on question 9 of the Patient Health Questionnaire-9) was compared by age, sex, and geography using regression analysis. Results Among 189,225 commercially insured individuals included in the analysis, mean age was 33.60 (SD 11.33) years. Among those reporting sex, 68% (34,168/50,378) identified as female, 29% (14,491/50,378) as male, and 3% (1719/50,378) as nonbinary. Most had a diagnosis of anxiety (56,176/189,225, 29.7%) or depression (50,075/189,225, 26.5%). In total, 18.6% (35,215/189,225) of individuals indicated some level of SI. Across age groups, SI was highest among adolescents (age 13‐17 years) with 32.8% (2107/6426) reporting any suicidality, and 4.8% (306/6426) reporting SI nearly every day ( P <.001). The population with the greatest SI comprised individuals identifying as nonbinary (644/1719, 37.5%; P <.001). SI increased as a function of patients’ social vulnerability ( P <.001) and varied by geography. Conclusions Nearly 1 in 5 individuals endorsed some degree of SI, with one third of adolescents reporting SI, proportions that are notably higher than estimates from the general US population. These findings underscore the need for comprehensive screening for SI and the expansion of clinical support for suicidal populations.