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.


OBJECTIVE
We sought to characterize the demographic, socioeconomic, and mental health features of individual suicide decedents by urban-rural residence status.


METHODS
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.


CONCLUSIONS
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.
<location>University of Colorado School of Medicine, Aurora, CO, USA</location>
Veronica B
VB
Searles
<location>Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA</location> <location>Department of Psychology, Colorado State University, Fort Collins, USA</location>
Morgan A
MA
Valley
<location>Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, MD, USA</location>
Holly
H
Hedegaard
<location>Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA</location>
Marian E
ME
Betz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005389:Firearms; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
NVDRS; epidemiology; mental health; rural; suicide