Suicidal Thoughts, Plans, and Attempts by Non-Metropolitan and Metropolitan Residence
Our objectives were to compare trends in the prevalence of suicidal thoughts, plans, and attempts among residents of non-metropolitan, small metropolitan, and large metropolitan areas, as well as to identify demographic, social, and economic factors associated with suicidal thoughts, plans, and attempts.
We used data from the National Survey on Drug Use and Health (NSDUH) for the years 2010-2016, restricted to adults ages 18 years and older. We combined these seven years of data into a single dataset and used descriptive and bivariate analyses to examine the prevalence of suicidal thoughts, plans, and attempts among individuals in non-metropolitan, small metropolitan, and large metropolitan counties. We then ran 4 logistic regression models for each of the 3 suicide variables for a total of 12 models.
The overall mean prevalence of suicidal thinking from 2010-2016 was significantly higher (P < .05) among non-metropolitan and small metropolitan adults (4.1% and 4.2%, respectively) than large metropolitan adults (3.7%). The overall mean prevalence of suicidal plans from 2010-2016 varied significantly (P < .001) by county type and was highest among residents of non-metropolitan (1.3%) counties. The overall mean prevalence of suicidal attempts from 2010-2016 did not vary significantly by county type.
Interestingly, among residents of non-metropolitan areas, having ever served in the military was protective against suicidal thoughts, plans, and attempts. However, the exact mechanism explaining this relationship is unclear. Given that individuals in this study who had a history of military service also had higher educational attainment than those with no service history, it may be that education is a mediator. Another possible explanation is selection bias. Compared to the general population, individuals with current or former military experience are more likely to die from a suicide attempt and also are more likely to use a handgun. Because individuals surveyed as part of the NSDUH are living, and because surveillance data on suicide deaths cannot be linked to NSDUH data due to participant confidentiality, this is a limitation of the present study.
Coupled with prior evidence indicating that non-metropolitan areas have higher suicide rates, our findings suggest that suicide prevention interventions should be further targeted toward non-metropolitan counties. Additional research could be useful for determining the mechanism(s) at work and how they might be channeled in ways that reduce suicidal thoughts and behaviors among those in non-metropolitan areas.