Suicides in Urban and Rural Counties in the United States, 2006-2008

Background: Suicide rates are higher in rural areas. It has been hypothesized that inadequate access to care may play a role, but studies examining individual decedent characteristics are lacking. Aims: We sought to characterize the demographic, socioeconomic, and mental health features of individual suicide decedents by urban-rural residence status. Method: We analyzed suicides in 16 states using 2006-2008 data from the National Violent Death Reporting System and examined associations between decedent residence type and suicide variables with separate logistic regressions adjusted for age, sex, race, and ethnicity. Results: Of 17,504 analyzed suicides, 78% were in urban, 15% in rural adjacent, and 8% in rural nonadjacent locations. Rural decedents were less likely than urban decedents to have a mental health diagnosis or mental health care, although the prevalence of depressed moods appeared similar. Most suicides were by firearm, and rural decedents were more likely than urban decedents to have used a firearm. Conclusion: Rural decedents were less likely to be receiving mental health care and more likely to use firearms to commit suicide. A better understanding of geographic patterns of suicide may aid prevention efforts.