Suicide among Specific Rural Populations

There are particular groups of rural residents who are more vulnerable or face additional constraints to preventive services that increase their risk of suicide. These populations include veterans, American Indians/Alaska Natives, farm workers, and people who are lesbian, gay, bisexual, transgender, queer/questioning, or intersex (LGBTQI+). By understanding the unique challenges these groups face, rural communities and partners can tailor programs to effectively prevent suicide.

Veterans

Rural veterans are more likely than urban veterans to die by suicide. One reason is that facilities run by the main healthcare provider for veterans, the Veterans Health Administration (VHA), are typically located near metropolitan areas, requiring veterans to travel significant distances. There are also few resources available specifically for rural veterans with mental health concerns or suicidal thoughts. One review found resources for suicide prevention specific to veterans and one for rural communities, but none specific to rural veterans.

In 2018, the U.S. Department of Veterans Affairs and the Substance Abuse and Mental Health Services Administration (SAMHSA) launched a Governor's Challenge to Prevent Suicide among Service Members, Veterans, and their Families with the goal of engaging states in veteran suicide prevention efforts. Several of the first states to participate, including Kansas and Montana, have large populations in rural areas.

American Indian/Alaska Native

American Indian or Alaska Native (AI/AN) communities have a higher rate of suicide than the general U.S. public and are more likely to live in rural areas. According to the CDC (via WISQARS, as of July 21, 2021), suicide rates among AI/AN are highest among youth and young adults, 22.7 per 100,000 people for AI/AN youth 15-24 and 27 per 100,000 people for AI/AN young adults 25-34. Higher suicide rates among AI/AN people are linked with historical trauma and discrimination, higher rates of alcohol and drug use, higher rates of poverty, and other social factors. Additionally, while there is a shortage of mental health providers in many rural areas, there are even fewer mental health providers who are AI/AN. This may prevent the AI/AN community from seeking mental health services.

Farmers

Farmers face elevated rates of suicide compared with the general public. Contributing factors include financial uncertainty, physical demands, poor mental health, and lack of social support. These stressors may result in suicidal thoughts or attempts. The stigma that exists around mental health may be even stronger in farming communities. Farming culture often enforces social norms that may make people less likely to reach out for social support from friends or family. For more information, see the RHIhub topic guide Rural Response to Farmer Mental Health and Suicide Prevention.

LGBTQI+

Individuals who identify as LGBTQI+ (lesbian, gay, bisexual, transgender, queer/questioning, or intersex) face increased risk of suicide across the U.S. LGBTQI+ youth consider suicide three times more than their heterosexual peers. According to the 2019 Youth Risk Behavior Survey, 66% of U.S. high school students who identify as lesbian, gay, or bisexual reported feeling sad or hopeless, 47% seriously considered suicide, 40% made a plan for how they would attempt suicide, 23% made an attempt, and 6% made an attempt that required medical attention in the 12 months prior to the survey.

Additionally, AI/AN LGBTQ youth experience housing instability, food insecurity, and involvement with the foster care system, all risk factors for suicide, at disproportionately higher rates than non-AI/AN LGBTQ youth. Both youth and adults who identify as LGBTQ in rural areas may feel less connected to broader LGBTQ communities, and may face more discrimination, resulting in higher minority stress. In turn, experiencing minority stress is associated with greater risk of suicide. Less populated areas are unlikely to have as many resources as urban or suburban areas. In addition, resources that are available may be harder to access. Higher suicide rates among LGBT individuals are caused by a variety of complex, overlapping issues; however, there is some evidence that a “positive social climate” may reduce this disparity.

Resources to Learn More

Special Populations in Youth Suicide Prevention: Rural and LGBTQ Youth
Presentation Slides
Slides from two presentations: 1) Adolescent Suicide Prevention and Intervention Efforts in Rural Communities; and 2) Effective Strategies and Tools for Gatekeepers and Trainers conducted at a Youth Suicide Prevention Community of Practice meeting on March 28, 2021 introducing issues of rural youth and LGBTQ suicide risk factors and prevention.
Author(s): Faucett, B. & Belyeu, N.
Organization(s): Children's Safety Network (CSN)
Date: 3/2012

Suicide Clusters within American Indian and Alaska Native Communities: A Review of the Literature and Recommendations
Document
Highlights research on suicide clusters within the AI/AN population provided by experts and representatives from CDC and Indian Health Service (IHS). Covers the risk factors for suicide clusters and the role of the media and technology. Offers recommendations for developing a community response plan and suggestions to enhance support for AI/AN communities.
Organization(s): Center for Mental Health Services, Substance Abuse and Mental Health Services Administration
Date: 2017

Together with Veterans
Website
Offers resources supporting a participatory approach to implement a community-based and evidence-based suicide prevention program for rural veterans and their families.
Organization(s): U.S. Department of Veterans Affairs

To Live To See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults
Document
Offers a variety of resources and tools for American Indian/Alaska Native (AI/AN) communities when developing a suicide prevention program. Suicide and suicide prevention related topics discussed include AI/AN culture, silence and myths, community response, community readiness, public health approach to prevention, promising programs, and SAMHSA's Strategic Prevention framework model.
Organization: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA)
Date: 2010

The Trevor Project
Website
Offers suicide prevention and crisis intervention services including training and help lines to support LGBTQ+ individuals under the age of 25.