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 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.
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
Suicide is a leading cause of death among people who misuse alcohol and other
drugs. Approximately 19.3 million
adults aged 18 and older 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 higher among rural adults aged 18 and older compared to urban adults, and
substances are often used to cope with mental health and social challenges.
Access to Firearms
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 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
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)
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
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