OBJECTIVES: Using national patient cohorts, we assessed rural-urban differences in suicide rates, risks, and methods in veterans. METHODS: We identified all Department of Veterans Affairs (VA) patients in fiscal years 2003 to 2004 (FY03-04) alive at the start of FY04 (n = 5,447,257) and all patients in FY06-07 alive at the start of FY07 (n = 5,709,077). Mortality (FY04-05 and FY07-08) was assessed from National Death Index searches. Census criteria defined rurality. We used proportional hazards regressions to calculate rural-urban differences in risks, controlling for age, gender, psychiatric diagnoses, VA mental health services accessibility, and regional administrative network. Suicide method was categorized as firearms, poisoning, strangulation, or other. RESULTS: Rural patients had higher suicide rates (38.8 vs 31.4/100,000 person-years in FY04-05; 39.6 vs 32.4/100,000 in FY07-08). Rural residence was associated with greater suicide risks (20% greater, FY04-05; 22% greater, FY07-08). Firearm deaths were more common in rural suicides (76.8% vs 61.5% in FY07-08). CONCLUSIONS: Rural residence is a suicide risk factor, even after controlling for mental health accessibility. Public health and health system suicide prevention should address risks in rural areas.
OBJECTIVES: Using national patient cohorts, we assessed rural-urban differences in suicide rates, risks, and methods in veterans. METHODS: We identified all Department of Veterans Affairs (VA) patients in fiscal years 2003 to 2004 (FY03-04) alive at the start of FY04 (n = 5,447,257) and all patients in FY06-07 alive at the start of FY07 (n = 5,709,077). Mortality (FY04-05 and FY07-08) was assessed from National Death Index searches. Census criteria defined rurality. We used proportional hazards regressions to calculate rural-urban differences in risks, controlling for age, gender, psychiatric diagnoses, VA mental health services accessibility, and regional administrative network. Suicide method was categorized as firearms, poisoning, strangulation, or other. RESULTS: Rural patients had higher suicide rates (38.8 vs 31.4/100,000 person-years in FY04-05; 39.6 vs 32.4/100,000 in FY07-08). Rural residence was associated with greater suicide risks (20% greater, FY04-05; 22% greater, FY07-08). Firearm deaths were more common in rural suicides (76.8% vs 61.5% in FY07-08). CONCLUSIONS: Rural residence is a suicide risk factor, even after controlling for mental health accessibility. Public health and health system suicide prevention should address risks in rural areas.
Authors: William B Weeks; Lewis E Kazis; Yujing Shen; Zhongxiao Cong; Xinhua S Ren; Donald Miller; Austin Lee; Jonathan B Perlin Journal: Am J Public Health Date: 2004-10 Impact factor: 9.308
Authors: Mark A Ilgen; Amy S B Bohnert; Rosalinda V Ignacio; John F McCarthy; Marcia M Valenstein; H Myra Kim; Frederic C Blow Journal: Arch Gen Psychiatry Date: 2010-11
Authors: John F McCarthy; Frederic C Blow; Marcia Valenstein; Ellen P Fischer; Richard R Owen; Kristen L Barry; Teresa J Hudson; Rosalinda V Ignacio Journal: Health Serv Res Date: 2007-06 Impact factor: 3.402
Authors: John F McCarthy; Marcia Valenstein; H Myra Kim; Mark Ilgen; Kara Zivin; Frederic C Blow Journal: Am J Epidemiol Date: 2009-02-27 Impact factor: 4.897
Authors: Peter C Britton; Kipling M Bohnert; Mark A Ilgen; Cathleen Kane; Brady Stephens; Wilfred R Pigeon Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2017-04-11 Impact factor: 4.328
Authors: John F McCarthy; Robert M Bossarte; Ira R Katz; Caitlin Thompson; Janet Kemp; Claire M Hannemann; Christopher Nielson; Michael Schoenbaum Journal: Am J Public Health Date: 2015-06-11 Impact factor: 9.308
Authors: Lilian Dindo; McKenzie K Roddy; Derrecka Boykin; Ken Woods; Merlyn Rodrigues; Tracey L Smith; Raquel D Gonzalez; Gala True Journal: J Behav Med Date: 2020-09-17
Authors: Laurel A Gaeddert; Alexandra L Schneider; Christin N Miller; Lindsey L Monteith; Lisa A Brenner; Jodie Katon; Claire A Hoffmire Journal: Res Nurs Health Date: 2020-08-22 Impact factor: 2.228