Suicides in Urban and Rural Counties in the United States, 2006

OBJECTIVE: Suicide rates are higher in rural areas; it has been hypothesized that lack of access to care and isolation play a role. We compared completed suicides by urban-rural locale. METHODS: This cross-sectional analysis of suicides in 15 states used 2006 data from the National Violent Death Reporting System. Urban-rural nature of the victim's resident county was categorized into three a priori groups (urban; rural-adjacent to urban; and rural-not adjacent to urban). We examined associations between urban-rural setting and each suicide variable with separate logistic regressions adjusted for age, gender, race and ethnicity. RESULTS: Of 8,871 reported suicides, most victims were male (78%) and white (90%); the median age was 45. Most victims (65%) had 1+ social stressors identified as contributing factors; rural victims were less likely to have job or financial problems but there were otherwise no geographic differences. In all areas, most suicides were by firearm (48-67%), with fewer by hanging (15-24%) or overdose (13-20%). Victims in rural-not-adjacent areas were more likely than urban victims to use firearms, after multivariate adjustment (AOR 2.25; 95%CI:1.89-2.67). Victims in rural-not-adjacent areas were less likely to have a psychiatric diagnosis (AOR 0.63, 95%CI 0.53-0.75) or current mental health care (AOR 0.74; 95%CI0.61-0.90), though reported depressed moods preceding the suicide were similar in all areas (38-39%), CONCLUSIONS: Both urban and rural suicide victims commonly had social stressors or depressed moods, but rural victims were less likely to be receiving mental health care. A better understanding of geographic patterns could inform suicide prevention efforts.