Suicide in rural areas: An updated review of the literature.

Abstract

Suicide is a significant public health concern at a global level and occurs at a greater rate in rural compared with urban areas. A review of the literature on rural suicide indicates that a growing body of empirical, theoretical, and prevention work has been conducted on the topic, with an increasing number of countries represented and articles written. From an ecological perspective, current data and models suggest that our approach to understanding and preventing rural suicide must be multifaceted, addressing the individual level (e.g., traditional risk factors such as psychiatric illness), as well as the microsystem (e.g., family and peer relations), mesosystem (e.g., the interconnectedness between microsystems), exosystem (e.g., the rural community), and macrosystem (e.g., social norms) levels. Geographic and interpersonal isolation, agricultural or otherwise hazardous vocational demands, environmental and governmental policies, availability of means, lack of access to care and rural ideologies appear to contribute to suicide risk. Interventions must be community-driven, culturally acceptable and feasible within the context of available resources to be effective. Prospective research on risk and protective factors for rural suicide is required, as is development, implementation and assessment of interventions that are originated by, implemented in, and sensitive to the needs of rural communities.

A cohort study of regional migration and the risks of attempted suicide and violent assault injury

“…We note that these are the least frequent movers in our study (most migration is rural to urban not the other way around), and as a result, the total public health impact of these risks is comparatively small. Nevertheless, our observations are consistent with research that suggests moving to rural environments may increase geographical and interpersonal isolation 34 35. Our findings also suggest that the change from urban to rural may exacerbate the already higher risks of intentional injuries in rural areas.…”

Evaluation of the SCARF Well‐Being and Suicide Prevention Program for Rural Australian Communities

“…Research on suicidal behavior among rural and farming communities in Australia and internationally indicates the need for culturally appropriate, contextually sensitive, and tailored suicide prevention initiatives . Within Australia few rural suicide prevention programs have been delivered and evaluated …”

Ecological contributions to maternal‐infant functioning: Differences between rural and urban family contexts

“…In light of our findings, further research should explore possible contributors and mechanisms that underlie the noted differences in infant temperament and mother‐infant interactions between the communities studied. For example, examining contextual variables (e.g., limited access to, and utilization of, healthcare and child‐rearing resources) capable of altering child and family functioning should be considered, based on previous research (Hirsch & Cukrowicz, ). Although we did not collect information about specific, supportive perinatal care or resources available to mothers, we expect that a greater variety of services, such as breastfeeding guidance, coaching in infant massage and other infant‐soothing techniques (e.g., skin‐to‐skin interventions, video‐based interaction guidance; Hoffenkamp et al, ; Kozhimannil, ), is available in more metropolitan areas.…”

“…Measures of SES typically comprise a combination of parental education level, employment status, occupational prestige, and total household income (Ensminger & Fotherill, ). Although these variables may vary between certain urban and rural populations, additional factors including remoteness, social isolation, ideologies of individualism and self‐sufficiency, and limited access to supportive resources are likely more critical and unique to the rural‐urban distinction (Hirsch & Cukrowicz, ). In addition, a child's primary social network is more likely to be kin‐based in the rural context (Vernon‐Feagans & Cox, ), likely influencing early development.…”