Suicide in Rural Areas
The issue of suicide is especially important to address in rural areas because there are nearly twice as many suicides in the most rural counties compared to the most urban counties. This gap has widened from 1999 to 2017. Rates of suicide are increasing in both urban and rural areas, but they are increasing more quickly in rural areas. Rural areas face unique challenges to addressing suicide, including barriers to mental health treatment, such as:
- Fewer healthcare services and facilities
- Mental health workforce shortages
- Transportation and infrastructure limitations that present challenges to accessing care in-person or remotely
- Financial constraints among rural residents, combined with a lack of affordable services
Suicide risk is not distributed equally across all rural populations, however. Particular groups of rural residents are more vulnerable or face additional constraints to preventive services. These populations include veterans, Native Americans, farmers, and people who are lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+). By understanding the unique challenges these groups face, rural communities and stakeholders can design more effective programs to prevent suicides. Further, it is important to recognize the vast diversity among rural people and places and know that not all approaches to suicide prevention will work the same in different contexts.
Rural veterans are more likely than urban veterans to die by suicide. The main healthcare provider for veterans is the Veterans Health Administration (VHA). For rural veterans, however, accessing care through the VHA may require them to travel a significant distance because VHA facilities are typically located near metropolitan areas. There are also few resources available for veterans who may have mental health concerns or suicidal thoughts. One review of resources for suicide prevention found 20 practices that were specific to veterans and one for rural communities, but none specific to rural veterans. However, 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 in 2018, with the goal of engaging states in veteran suicide prevention efforts. Several of the first states to participate have large rural populations such as Kansas and Montana.
People who are American Indian or Alaska Native (AI/AN) have a much higher rate of suicide than the general U.S. public. AI/AN people are also more likely to live in rural areas. 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. 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 people from seeking mental health services.
In addition to some of the risk factors faced by all rural community members, farmers in particular face uncertainty about the future of their business and often struggle financially; both are stressors that could result in suicidal thoughts or attempts. The stigma that exists around mental health may be even stronger in farming communities. Farming culture enforces the idea that farmers are "tough", which may make people less likely to reach out for help if they are struggling. Farmers are also often under pressure to keep their family farm operating. This pressure can add more stress and also serve as a barrier to getting help if that means time away from their work. Despite some disagreement about how to best calculate suicide rates in farmers, it is clear that they face elevated rates of suicide compared with the general public.
Individuals who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) face increased risk of suicide across the U.S. For example, among young people, LGBTQ+ youth consider suicide three times more than their heterosexual peers. 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 less likely to have as many resources as urban or suburban areas (or they may be harder to access). Higher suicide rates among LGBTQ+ 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
Aid Resource Guide for Farm Crisis Support
Offers resources for farmers in crisis, including mental health support, legal support, dealing with disasters, and help with financial issues.
Organization(s): Farm Aid
Planning Committee on Improving Care to Prevent Suicide
among People with Serious Mental Illness
This report offers detailed findings from a committee tasked with discussing ways to prevent suicide among the subset of the population with serious mental illness.
Organization(s): The National Academies of Sciences
Populations in Youth Suicide Prevention: Rural and LGBTQ+Youth
Presentation introducing issues of rural youth LGBTQ+suicide risk factors and prevention.
Author(s): Faucett, B. & Belyeu, N.
Organization(s): Children's Safety Network
Suicide Clusters Among American Indian and Alaska
Native Communities: A Review of the Literature and Recommendations
Provides information about suicide clusters within the AI/AN population and provides concrete ideas for how to prevent AI/AN suicide.
Organization(s): Substance Abuse and Mental Health Services Administration
Together with Veterans: Rural Veterans Suicide
Offers resources supporting a community-based participatory approach to implement an evidence-based suicide prevention intervention for veterans and their families living in rural areas.
Organization(s): U.S. Department of Veterans Affairs, Western Interstate Commission for Higher Education Mental Health Program
Trends in Suicide by Level of Urbanization
– United States, 1999-2015
Describes differences in rates of suicide in rural compared to urban areas from 1999-2015.
Author(s): Kegler, S., Stone, D., & Holland, K.
Organization(s): Centers for Disease Control and Prevention