A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States

Nathaniel V. Mohatt, Carlee J. Kreisel, Adam S. Hoffberg, Leah Wendleton Mph, Sarah J. Beehler

Research output: Contribution to journalReview articlepeer-review


Purpose: Suicide rates continue to be significantly higher in rural compared to urban communities in the United States, with the suicide rate disparity continuing to grow since 1999. This systematic review synthesizes rural-specific factors related to increased suicide risk. Methods: OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar were searched for articles published after 2003 investigating rural adult suicide in the United States. Selection criteria were: (1) study participants > 18 years old; (2) included rural participants or communities; (3) included suicidal self-directed violence outcomes; (4) within the United States; (5) published after 2003; (6) presented peer-reviewed original data; (7) identified rural-specific risk or protective factors for suicide or barriers to treatment. Findings: Of the 1,058 records screened, 34 studies were included. The strength of evidence was relatively stronger for individual level factors including lethal means, alcohol and substance use. Conclusions: Access to firearms is strongly related to elevated rural US suicide rates, with substance use, economic stress, and behavioral health care utilization as additional individual level factors that may contribute to the disparity. At the community level, economic distress and access to care were commonly identified factors. Future research should better quantify how risk factors contribute to rural suicide and examine interdependence across social-ecological levels. Suicide prevention efforts for the rural United States must address access to lethal means, in particular the use of firearms, and navigate limited access to quality behavioral health care.

Original languageEnglish (US)
JournalJournal of Rural Health
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
: This work was supported by a Pathway to Partnership award from the US Department of Veterans Affairs (VA) Office of Rural Health, in partnership with the VA Office of Mental Health and Suicide Prevention and implemented by the Rocky Mountain MIRECC. Funding provided by the Office of Rural Health. Visit www.ruralhealth.va.gov to learn more. Funding

Publisher Copyright:
© 2020 National Rural Health Association


  • mental health
  • public health
  • rural health
  • suicide prevention
  • systematic review

PubMed: MeSH publication types

  • Journal Article
  • Review

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