Table 1 Model Variable Description

County demographics

 Size. Indicator variables were created for the three county populations: < 250,000, between 250,000 and 750,000, and over 750,000).

U.S. Census Population Estimates (2016)^a

 Income inequality which reflects the difference between the 80^th and 20^th income percentiles

American Community Survey, 5-year estimates (2016)^a

 High school graduation rate

EDFacts (2015), in the RWJ database

 Percent of population that are Black

U.S. Census Population Estimates (2016)^a

 A designated mental health professional shortage area

Health Resources and Services Administration (HRSA; https://www.hrsa.gov)

 Designated medically underserved county

Health Resources and Services Administration (HRSA; https://www.hrsa.gov)

Health care related variables, population adjusted

 Number of physically unhealthy days or days an individual indicates they were not feeling well

Behavioral Risk Factor Surveillance System (2016)^a

 Primary care physician rate based on number of physicians in a county

Area Health Resource File/American Medical Association (2015)^a

 Community MH centers per capita to indicate outpatient services

American Health Resources File (2019)^a

 Health care expenditure or total amount of costs from health care: Total Medicare expenditures per year

Dartmouth Atlas of Health Care (2015)^a

 Percent of drug treatment services paid by Medicaid^b

IMS Institute for Healthcare Informatics (2016), in amfAR Opioid and Health Indicator database

 Presence of one or more medical schools in the county

Association of American Medical Colleges (AAMC)

 Mental health providers per capita (psychiatrists, psychologists, counselors, and social workers)

CMS, National Provider Identification (2017)^a

Crime-related variables

 Number of police officers per total county population

Uniform Crime Report (2011)^c

 Key Stepping Up indicators, population adjusted: Jail population per capita (average daily number of individuals in jail divided by the total county population)

Bureau of Justice Statistics (2015), in the VERA Incarceration trends report

 Key Stepping Up indicators, population adjusted: Jail pretrial population per capita (average daily number of individuals in jail awaiting trial divided by the total county population)

Bureau of Justice Statistics (2015), in the VERA Incarceration Trends Report