A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States

Abstract

Purpose Suicide rates continue to be significantly higher in rural compared to urban communities in the United States, with the suicide rate disparity continuing to grow since 1999. This systematic review synthesizes rural‐specific factors related to increased suicide risk. Methods OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar were searched for articles published after 2003 investigating rural adult suicide in the United States. Selection criteria were: (1) study participants > 18 years old; (2) included rural participants or communities; (3) included suicidal self‐directed violence outcomes; (4) within the United States; (5) published after 2003; (6) presented peer‐reviewed original data; (7) identified rural‐specific risk or protective factors for suicide or barriers to treatment. Findings Of the 1,058 records screened, 34 studies were included. The strength of evidence was relatively stronger for individual level factors including lethal means, alcohol and substance use. Conclusions Access to firearms is strongly related to elevated rural US suicide rates, with substance use, economic stress, and behavioral health care utilization as additional individual level factors that may contribute to the disparity. At the community level, economic distress and access to care were commonly identified factors. Future research should better quantify how risk factors contribute to rural suicide and examine interdependence across social‐ecological levels. Suicide prevention efforts for the rural United States must address access to lethal means, in particular the use of firearms, and navigate limited access to quality behavioral health care.

The role of race in rural‐urban suicide disparities

“…In the United States, this gap appears to be growing over time 1 . Although there has been considerable research on the rural‐urban suicide disparity in the United States, 2–5 the impact of race on this disparity remains poorly understood; no recent studies have compared the relative risk for racial groups across rural and urban contexts or assessed changes in rural‐urban disparity after adjustment for race. This could represent a substantial limitation because in the United States, racial groups have distinctly different suicide rates and are not evenly distributed across geographic settings 6 .…”

Associations between Suicidal Ideation and Relatives’ Physical and Mental Health among Community Residents: Differences between Family Members and Lineal Consanguinity

“…Suicide not only brings a mental blow to the family but also causes a certain burden of disease and a negative impact on society [ 3 , 4 , 5 ]. In rural areas, the suicide rate was found to be higher than in urban neighborhoods in many countries around the world [ 6 , 7 , 8 ]. In China, although the recent suicide rate showed a downward trend [ 9 ], suicide is still one of the main causes of death for Chinese rural residents [ 10 ].…”

Resolving Key Barriers to Advancing Mental Health Equity in Rural Communities Using Digital Mental Health Interventions

“…In the United States, mental health problems and risk for suicide are inequitably higher among individuals living in rural compared with urban communities. 1 This problem is complicated by numerous barriers to adequate care that affect rural communities. 2 Individuals living in rural areas face stigma and have concerns about disclosing mental health problems or being seen by their neighbors when accessing mental health services.…”

“…2 Individuals living in rural areas face stigma and have concerns about disclosing mental health problems or being seen by their neighbors when accessing mental health services. 1,2 A culture of self-reliance also makes it less likely for individuals to seek mental health services. 1,2 For those who do want services, many live in federally designated mental health professional shortage areas, meaning mental health clinicians are scarce.…”

“…1,2 A culture of self-reliance also makes it less likely for individuals to seek mental health services. 1,2 For those who do want services, many live in federally designated mental health professional shortage areas, meaning mental health clinicians are scarce. Access to available clinicians may require traveling long distances, making attendance at sessions more challenging.…”