Risk Factors for Suicide

Rural community members face challenges related to suicide risk that are often less prevalent in urban settings, including access to mental healthcare, geographic isolation, stigma, at-risk substance use, access to firearms, and socioeconomic factors.

Lack of Access to Mental Healthcare

Access to mental healthcare is an essential part of preventing suicides. However there are many rural barriers to accessing mental healthcare. First, there is a shortage of mental health practitioners in rural areas, which may result in long wait times to see a provider. Second, patients may worry about how to pay for mental health treatment. Even with insurance, some mental health services are not covered by certain health plans, and incomes are lower and rates of uninsurance are higher in rural areas. Without health insurance coverage, the cost of mental health treatment may be too high for patients to afford out-of-pocket. A third barrier is reliable transportation to a mental health provider. Rural residents may need to travel further for treatment, and if they lack transportation, they may not be able to access care.

Stigma

Stigma is a negative view of someone or something caused by shame or judgment. Stigma can also affect someone's view of themselves and may keep people from taking the first step in seeking treatment for mental illness or suicidal thoughts. Stigma around suicide and mental health is an issue in rural areas due to smaller populations and a concern about anonymity when seeking treatment. Stigma stemming from living in a tight-knight rural community can also increase risk for marginalized groups such as LGBTQ+ or racial/ethnic minorities. Reducing stigma within a community may decrease an individual's reluctance to seek help.

Geographic Isolation

Residents in rural areas are more likely to be geographically distant from neighbors, friends, and family, as well as mental healthcare facilities. If someone does not have reliable transportation, it may be more challenging for them to engage with the community. This can result in feelings of social isolation, which can increase the risk of suicide. Rural areas face unique constraints in addressing social isolation because of geographic distances and infrastructure challenges.

Substance Use

Suicide is a leading cause of death among people who misuse alcohol and other drugs. Approximately 20.4 million adults in the U.S. have a substance use disorder and a co-occurring mental illness, such as depression. It is estimated that 30-40% of suicide attempts occur while the person is under the influence of alcohol. Alcohol is a depressant, so it may increase an individual's depressed mood and it also decreases inhibitions, making the individual more likely to act on suicidal thoughts. Rates of heavy alcohol use are estimated to be higher in rural adults compared to urban adults, and substances are often used as a way to cope with mental health and social challenges.

Access to Firearms

Nearly half (46%) of rural adults report owning a gun, compared to 28% of suburban residents and 19% of urban residents. The top reasons for owning a gun, reported by rural individuals, are for protection, hunting, and sport shooting. Unfortunately, firearms are also the most common method of suicide, and one of the most lethal. The rate of suicide by firearms is higher in rural areas compared to urban areas. While many gun owners store guns safely, more than half of all gun owners (in rural and urban areas) keep their gun loaded and easily accessible. Greater access to firearms may contribute to increased rates of suicide by firearms in rural communities compared to urban communities in the United States.

Socioeconomic Factors

Socioeconomic status is an underlying social determinant of health and also a risk factor for suicide. Residents of rural areas are more likely to experience financial hardships, including poverty, lower income, poor housing quality and instability, unemployment, and lower education attainment. Rural farmers and ranchers are particularly likely to experience financial concerns due to variable prices for commodities, weather affecting crops, and increased debt. This increases stress and has led to higher rates of suicide.

Resources to Learn More

Preventing Suicide: A Technical Package of Policy, Programs, and Practices
Document
Highlights selected evidence-based strategies to help states and communities prevent suicide and the risk of suicide. Strategies discussed include strengthening household financial security, improving access and delivery of suicide care, developing protective environments and positive peer programs, teaching parents and families problem-solving skills, and methods to identify people at risk of suicide.
Author(s): Stone, D, Holland, K., Bartholow, B., etc.
Organization(s): National Center for Injury Prevention and Control. Centers for Disease Control and Prevention (CDC)
Date: 2017

StigmaFree
Website
Defines stigma and why it is a problem. Provides resources and recommendations on how to reduce stigma.
Organization(s): National Alliance on Mental Illness

Substance Use and Suicide: A Nexus Requiring a Public Health Approach
Document
Describes the relationship between substance use and suicide. Offers state and tribal professionals information and resources to collaborate and develop substance misuse and suicide prevention strategies.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 2016