Why are suicide rates higher in rural areas?

by Rebecca Israel, MS, Reviewed by Charles Li, MD

June 15, 2020

  • Rural communities report higher rates of suicide than urban communities.

  • Populations of rural communities are less likely to have access to mental health care specialists.

  • Male firearm use drives the increased rate of suicide in rural areas.

Suicide in rural communities title page

Rural vs urban communities

Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties.

Source: Suicide Trends Among and Within Urbanization Levels by Sex, Race/Ethnicity, Age Group, and Mechanism of Death — United States, 2001–2015

The CDC released a report with the demographic details of suicides in every state between 2001 and 2015. The report outlined community type, age, sex, race, and mechanism of death differences.

Suicide rates in nonmetropolitan/rural counties are consistently higher than suicide rates in metropolitan counties. These trends also are observed by sex, race/ethnicity, age group, and mechanism of death.

CDC

Mental health care services

5% of rural counties do not have practicing psychiatrists and 47% do not have working psychologists

Source: Supply and Distribution of the Behavioral Health Workforce in Rural America

The U.S. Department of Health and Human Services outlined a key disparity between urban and rural populations: accessibility. 65% of rural counties do not have practicing psychiatrists and 47% do not have working psychologists. There are also care deserts, which are a number of counties clustered together that all do not have mental health care services.

In this case, receiving care is not as easy as hopping over to the county next door. Without mental health care, patients are unable to obtain a diagnosis, prescriptions, or therapies.

Source: HHS Understanding the Impact of Suicide in Rural America

The role of firearms

Across all urbanization levels, firearms were the most often used mechanism of death, with rates in nonmetropolitan/rural counties almost double those in large metropolitan and medium/small metropolitan counties.

CDC
Firearm suicide among men was 36% more common in rural counties than in urban counties.

Source: Urban–Rural Differences in Suicide in the State of Maryland: The Role of Firearms

To look deeper into this finding, researchers looked at 6196 suicide cases in Maryland from 2003 to 2015. They found that male firearm use drove the increased rate of suicide in rural areas.

“Our focus on Maryland demonstrates that the rural risk phenomenon is not limited to states with significant swathes of sparsely populated land, and is a problem for all states and that the study of rural risk factors like firearm use may be generalizable and contribute to a better understanding of the suicide risk factors even in the more densely populated states.”

Implications

There is no simple answer as to why suicide rates are higher in rural communities. Based on the available evidence, there is a significant association between suicide rates, lack of mental health care access, and firearm availability.

The availability of firearms strongly depends on government regulations. There is also little data on the prevalence of firearm ownership.

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