IMPORTANCE Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities. OBJECTIVE To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum. DESIGN, SETTING, AND PARTICIPANTS Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years. MAIN OUTCOMES AND MEASURES Rates of suicide per 100 000 persons. RESULTS Across the study period, 66 595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100 000, respectively) and females (4.40 and 2.39 per 100 000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females). CONCLUSIONS AND RELEVANCE Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.

BACKGROUND AND OBJECTIVES: Suicide in elementary school-aged children is not well studied, despite a recent increase in the suicide rate among US black children. The objectives of this study were to describe characteristics and precipitating circumstances of suicide in elementary school-aged children relative to early adolescent decedents and identify potential within-group racial differences.

IMPORTANCE Suicide is a leading cause of death among school-aged children younger than 12 years but little is known about the epidemiology of suicide in this age group. OBJECTIVE To describe trends in suicide among US children younger than 12 years by sociodemographic group and method of death. DESIGN, SETTING, AND PARTICIPANTS Period trend analysis of national mortality data on suicide in children aged 5 to 11 years in the

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This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...