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(September 17, 2019) Suicide rates are rising in the United States, particularly among rural communities. Regional characteristics such as poverty, social fragmentation, and health insurance coverage may help explain the trend, according to new research. The findings are particularly salient for individuals with serious mental illness, who often face even greater challenges with employment, social isolation, and access to health care than the general population.

A team of researchers from Ohio State University recently explored a number of socioeconomic factors to determine their effects on county-level suicide rates. They also examined how the impact of these factors may change depending on whether a community is rural, suburban, or urban.

The research authors analyzed all instances of death by suicide for individuals aged 25-64 years-old between January 1999 and December 2016 using the National Center for Health Statistics National Vital Statistics System. Counties of residence for each individual were identified and classified as large metropolitan, small metropolitan, micropolitan, or rural. Variables that were examined included deprivation, which included measures of education, employment, and welfare assistance; social fragmentation, which included measures of single-person households and home renters; social capital, which included measures of available charities, recreation sites, and civic and religious organizations; residents without health insurance and the presence of gun shops.

Study results

More than 450,000 deaths by suicide occurred over the study period, with the median county-level suicide rate increasing from 15.0 per 100,000 in 1999-2001 to 21.2 per 100,000 in 2014-2016. Although the greatest number of suicides occurred in large metropolitan areas, suicide rates were higher and increased more quickly in rural localities, suggesting a worrying trend for less-populated areas like Appalachia, the Ozarks, and some Western parts of the country.

Across all counties, increased deprivation, social fragmentation, and the percentage of residents without health insurance were all associated with increased county suicide rates. For example, counties with the highest amount of social fragmentation were associated with an increase in suicide rate of nearly 10 percent, compared to counties with more social connectedness.

When comparing variables across county geography, the researchers found that deprivation was particularly salient for rural areas in relation to suicide rates. They suggest that in rural areas, socioeconomic factors such as unemployment or poverty may present barriers that are even more difficult to overcome than in metropolitan areas because they represent entrenched, long-term community challenges. In addition, social isolation and lack of access to health care may further exacerbate the effects of deprivation on suicide rates in rural communities.

The findings support existing research on the detrimental effects of socioeconomic deprivation and lack of social connectedness on suicide risk, and also suggest that some of these elements may be uniquely relevant in rural communities. These risk factors can be even more pronounced among individuals with serious mental illness, 24% of whom live below the federal poverty line and often face social isolation due to their illness. Special attention should be paid to addressing economic opportunity and social support systems for populations at high risk for suicide, including individuals with serious mental illness.