Rural–Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada

Abstract

Background: Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas. Methods: We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ2 to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis. Results: Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain. Discussion: The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.

Self-harm and rurality in Canada: an analysis of hospitalization data from 2015 to 2019

“…We chose the Index of Remoteness because it is based on population size and accessibility to other regions. Thus, we were able to distinguish between rural and remote regions, unlike studies of self-harm and suicide using binary measures of rurality [ 14 , 17 , 19 , 66 ], which can obscure differences between diverse rural contexts. This is an important consideration in Canada, one of the least densely populated countries in the world, where residents of remote communities may experience place-specific risks.…”

“…Count and percentage distribution of self-harm hospitalizations and population, by sex, age group and rurality, Canada (excluding Quebec, Northwest Territories, and Yukon) 2015-2019 a Population estimated based on 5-year average; b The total count of self harm hospitalizations used for analysis of rural (denominator in %) was66,241 …”

Suicide and Suicide Attempts Among Patients Attending Primary Health Care Facilities in Uganda: A Medical Records Review

“… 39 Our findings differ from those in many developed countries such as US, Canada, among others, where suicide rates are higher among rural dwellers. 40 , 41 The number of non-fatal suicide attempts increased with the level of health facility that is, higher in hospitals than health centre IV or III, however, fewer individuals died by suicide from the hospitals, possibly due to the better emergency services offered by the hospitals compared to the lower health facilities.…”

Identifying the suicidal ideation risk group among older adults in rural areas: Developing a predictive model using machine learning methods

“…Consequently, there has been increased emphasis for communication regarding suicidal ideation in risk assessment in primary care (Silverman & Berman, 2014). Furthermore, older adults living in rural areas are more likely to neglect their care needs, thereby increasing their susceptibility to suicide due to social isolation and reduced access to mental health services (Chin et al, 2020; Reccord et al, 2021). Therefore, early detection of suicide risk groups and intervention is crucial in the prevention of suicide in older adults, especially individuals in rural settings (Berry et al, 2020; Chin et al, 2020).…”

“…Consequently, there has been increased emphasis for communication regarding suicidal ideation in risk assessment in primary care (Silverman & Berman, 2014). Furthermore, older adults living in rural areas are more likely to neglect their care needs, thereby increasing their susceptibility to suicide due to social isolation and reduced access to mental health services (Chin et al, 2020;Reccord et al, 2021).…”