Suicide is a public health problem that takes the lives of more than 40,000 Americans every year. The impact of suicide is far reaching, effecting families and communities while also carrying a large economic burden. Previously, suicide rates have been shown to be higher and increasing more rapidly in rural areas than in urban areas. Reasons suicide rates are higher in rural areas have been attributed to factors such as high socioeconomic deprivation and a lack of availability of mental health services. However, few studies exist that examine how these factors impact rural and urban areas differently. The following study examines patterns and trends in suicide rates over a 15-year period, stratified by gender, age, and geographic location. It then examines the relationship between a variety of contextual factors and suicide rates, and whether the associations vary by geographic location.
All individuals who died by suicide between 2000 and 2014, were between ages 25 and 64, and resided in the US at the time of death were included in the study. Suicide decedents were aggregated in five three-year periods at the county level and combined with population data to calculate suicide rates and standardized mortality ratios (SMRs). Numerous contextual variables were collected at the county level and reduced to measure socioeconomic deprivation, social fragmentation, social capital, provider availability, veteran population, gun availability, and drinking establishments. Suicide rates and trend tests were calculated over time, smoothed SMRs were calculated and mapped, and negative binomial regression was used to find factors associated with suicide rates.
The results show increasing suicide rates across all groups, regardless of age, gender, or geographic location. Suicide rates increase 23% overall, with the greatest increase in rural areas (40.6%). The youngest age group, 25 to 34, had the greatest difference between rural and urban counties, with the most rural counties having suicide rates 2.2 times higher than large metro counties in the final study period. SMRs show an excess risk for suicide across the western US and throughout portions of Appalachia and the Ozark mountains. Two contextual variables, social capital and psychiatrist ratio, were associated with decreased suicide rates, while four variables, socioeconomic deprivation, social fragmentation, veterans, and gun availability, were associated with increased suicide rates. Deprivation and gun shops varied by geographic location, with deprivation having a greater impact in rural counties compared to large metro counties and gun shops having less impact in rural counties compared to large metro counties.
These findings show that suicide rates are still higher in rural areas than urban areas and multiple factors are associated with increasing suicide rates. Existing suicide prevention programs, such as those used in schools, colleges, and police departments, may be successful if adapted to communities with high suicide rates. Improving the socioeconomic outlook and promoting connectedness within a county may also be useful to reduce suicide rates. Additional research is necessary to understand variations by age, gender, and method of suicide and to evaluate how effective suicide prevention programs are at the county level.