title: Determinants of adolescent suicidal ideation: rural versus urban.
abstract: OBJECTIVE
  The existing literature on disparities between rural and urban adolescents as they pertain to suicidal behavior is limited; identifying these distinctions could be pivotal in the decision of how to efficiently allocate scarce resources to reduce youth suicide rates. This study aimed to identify dissimilarities in predictors of suicidal ideation across the rural/urban threshold, as ideation is one of the most important predictors of suicide. Given that substance abuse is generally considered one of the strongest risk factors for suicidal behavior, a secondary aim was the isolation of the differences in usage of particular substances between rural and urban adolescents, and their effects on the likelihood of suicidal ideation, which is something that previous studies have had difficulty addressing.
  
  
  METHODS
  A global test determined that individual predictors of suicidal ideation differed across rural and urban adolescents, and simply including a rural/urban indicator in a multiple regression would result in biased estimates. Therefore, this paper assessed rural/urban differences among a comprehensive list of traditionally perceived risk and protective factors via bivariate analyses and separate multiple full-information-maximum-likelihood regressions, which account for missing data.
  
  
  RESULTS
  Somewhat contrary to the extant literature, the findings indicate important differences among predictors of suicidal ideation for rural and urban youths.
  
  
  CONCLUSIONS
  These differences should be taken into consideration when developing plans to combat adolescent suicide. The results further indicate that analyzing potential predictors of suicidal ideation for rural and urban adolescents via bivariate analyses alone, or a rural/urban indicator in a multiple regression, is not sufficient.
authors.affiliation: Department of Health Policy and Administration, Washington State University, Spokane, Washington.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D003863:Depression / Q000523:psychology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D012424:Rural Population; D019966:Substance-Related Disorders / Q000523:psychology; D059020:Suicidal Ideation; D014505:Urban Population; D014861:Washington
keywords: adolescents; rurality; social determinants of health; substance abuse; suicidal ideation