Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.
J Rural Health. 2021 Jun;37(3):565-575. doi: 10.1111/jrh.12532. Epub 2020 Nov 18.
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.
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.
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.
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.
在美国，农村社区的自杀率仍然明显高于城市社区，自 1999 年以来，自杀率差距一直在扩大。本系统评价综合了与自杀风险增加相关的农村特有因素。
检索了 OVID Medline、EMBASE、OVID PsycINFO、Web of Science、SocINDEX、Cochrane 图书馆和 Google Scholar，以获取 2003 年后调查美国农村成年人自杀的文章。选择标准为：（1）研究参与者年龄>18 岁；（2）包括农村参与者或社区；（3）包括自杀性自我伤害的结果；（4）在美国境内；（5）发表于 2003 年后；（6）呈现同行评审的原始数据；（7）确定农村特有的自杀风险或保护因素或治疗障碍。
在筛选出的 1058 条记录中，有 34 项研究被纳入。证据强度相对较强的是个体层面的因素，包括致命手段、酒精和物质使用。
获得枪支与美国农村地区较高的自杀率密切相关，而物质使用、经济压力和行为保健服务的利用是可能导致这种差异的其他个体层面的因素。在社区层面，经济困境和获得保健服务是常见的因素。未来的研究应更好地量化风险因素如何导致农村自杀，并研究社会生态层面之间的相互依存关系。美国农村地区的自杀预防工作必须解决获得致命手段的问题，特别是枪支的使用问题，并解决高质量行为保健服务获取有限的问题。
