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Risk Factors for Suicide

Rural community members face challenges related to suicide risk that are often less prevalent in urban settings, including the five listed below.

Accessibility of Mental Healthcare

Access to mental healthcare is an essential part of preventing suicides but unfortunately, many rural residents struggle to access care for a number of reasons. First, there is a shortage of mental health practitioners in rural areas, which means patients may need to wait a long time before they can see a provider. Second, patients may worry about how to pay for mental health treatment. Even if they have health 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 any mental health treatment may be too high for patients to afford out of pocket. A third common barrier is reliable transportation to a mental health provider. Rural residents may need to travel farther to receive treatment and if they do not have access to transportation, they may not be able to access desperately needed care.

Substance Abuse

Among people who abuse alcohol and drugs, suicide is a leading cause of death. Approximately 7.9 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 alcohol abuse are estimated to be higher in rural adults compared to urban adults.


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 a barrier in any location, but can be even more pervasive in rural areas due to smaller populations and a concern about anonymity when seeking treatment. 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, as described above. 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 the aforementioned geographic distances and infrastructure 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. For many rural gun owners, a major reason they own a gun is for hunting or 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 their guns safely, more than half of all gun owners (in rural and urban areas) keep their gun loaded and easily accessible. In rural areas, where guns are more common, having greater access to firearms may contribute to rural-urban differences in suicide by firearms.

Despite these risk factors, there are also some characteristics specific to rural areas that may act as protective factors from suicide, such as community cohesiveness and a sense of family honor. These characteristics should be utilized and strengthened in suicide prevention programs in rural communities.

Resources to Learn More

Defines stigma and provides resources on how to reduce stigma.
Organization(s): National Alliance on Mental Illness

Substance Use and Suicide: A Nexus Requiring a Public Health Approach
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