Suicide has been a persistent public health problem in the United States. Whereas some other countries have been able to reduce their national rate, there has not been the same level of attention to the emerging evidence, data informed resource allocation, and level of national investment in suicide prevention in the United States. Although we have data collected on multiple potential etiological factors that could be linked and used for action, these data often sit in silos. As was concluded by a National Institutes of Health Pathways to Prevention workshop on youth suicide, data sources can be linked in order to approve surveillance, outreach, and to inform which clinical and community approaches work for whom and under what conditions. Many logistical, data interoperability, and practical issues with data linkage can be overcome. This project will conduct data linkage at the state level in Maryland using individual-level medical records linked with data on community contextual factors to study patient characteristics (e.g., age, gender, race, ethnicity); social determinants of health and socioeconomic context; clinical attributes (e.g., diagnoses, procedures); hospital encounter attributes (e.g., insurance payer, length of stay days); hospital attributes (e.g., urban, rural, teaching, private), and hospital location (county, city, postal zip code) in relation to suicide. We have three co-occurring national challenges/traumas in the United States right now: 1) the deadly COVID-19 pandemic and associated shelter in place order; 2) the economic impact of COVID, 3) civil unrest due to racial injustice. The effects of these national challenges disproportionately have affected people of color and have broadened the social and economic divide. As of June 19, 2020, we have lost approximately 120,000 Americans to COVID-19. This project will link data from multiple sources in Maryland to 1) identify predictors of youth suicide by race/ethnicity 2) study access to and continuity of mental health services before and during COVID-19 among youth by race/ethnicity.