240290 Suicides in Urban and Rural Counties in the United States, 2006

Monday, October 31, 2011: 8:50 AM

Morgan Valley, MS , Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
Holly Hedegaard, MD, MSPH , Colorado Department of Public Health and Environment, Denver, CO
Veronica Searles, BS , School of Medicine, University of Colorado, Denver, CO
Marian E. Betz, MD, MPH , Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
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.

Learning Areas:
Public health or related research

Learning Objectives:
1. Describe the demographic, mental health, and suicide method characteristics of suicides in 2006 in the United States. 2. Recognize differences among suicide victims along the urban-rural gradient. 3. Discuss the strengths and limitations of the National Violent Death Reporting System as a tool for research and public health interventions

Keywords: Suicide, Rural Mental Health Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As an MD/PhD candidate collaborating with Dr. Marian Betz's research team I have been involved in interpreting study data and preparing a paper for submission summarizing our findings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.