Widening rural-urban disparities in youth suicides, United States, 1996-2010.
OBJECTIVE
Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities.


OBJECTIVE
To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum.


METHODS
Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years.


METHODS
Rates of suicide per 100,000 persons.


RESULTS
Across the study period, 66,595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100,000, respectively) and females (4.40 and 2.39 per 100,000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females).


CONCLUSIONS
Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus.
Cynthia A
CA
Fontanella
College of Social Work, The Ohio State University, Columbus.
Danielle L
DL
Hiance-Steelesmith
Center for Biostatistics, The Ohio State University, Columbus.
Gary S
GS
Phillips
Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio5Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus.
Jeffrey A
JA
Bridge
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus.
Natalie
N
Lester
Bureau of Research and Evaluation, Ohio Department of Mental Health and Addiction Services, Columbus.
Helen Anne
HA
Sweeney
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus.
John V
JV
Campo
D000293:Adolescent; D001237:Asphyxia; D005260:Female; D005389:Firearms; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012424:Rural Population; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult