Advertisement

Rural–Urban Comparisons in the Rates of Self-Harm, U.S., 2018

      Introduction

      This study compares rural and urban differences in the rates of nonfatal self-harm in the U.S. in 2018.

      Methods

      Nationwide Emergency Department Sample and Census data were analyzed to calculate the RR of emergency department visits for self-harm between rural and urban residents. The analyses were conducted in 2021.

      Results

      Among a weighted total of 488,000 emergency department visits for self-harm in the U.S., 80.5% were urban residents, and 18.3% were rural residents. In both settings, poisoning was the most common mechanism for self-harm, followed by cutting. Firearm-related self-harm and suffocation each accounted for <2% of total self-harm cases. Overall, the age-adjusted emergency department visit rate for self-harm was 252.3 per 100,000 for rural residents, which was 1.5 (95% CI=1.4, 1.6) times greater than the rate for urban residents (170.8 per 100,000 residents). The rates of self-harm among rural residents were higher than those of urban residents for both male and female residents, for all age groups except people aged ≥65 years, and by all mechanisms.

      Conclusions

      Comprehensive suicide prevention strategies tailored to rural communities may mitigate the rural–urban disparity in morbidity from suicidal behavior.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Kochanek KD
        • Xu JQ
        Arias E. Mortality in the United States, 2019.
        NCHS Data Brief. 2020; 395 (Accessed November 19, 2021): 1-8
        • Ivey-Stephenson AZ
        • Crosby AE
        • Jack SPD
        • Haileyesus T
        • Kresnow-Sedacca MJ.
        Suicide trends among and within urbanization levels by sex, race/ethnicity, age group, and mechanism of death - United States, 2001-2015.
        MMWR Surveill Summ. 2017; 66: 1-16https://doi.org/10.15585/mmwr.ss6618a1
        • Pettrone K
        • Curtin SC.
        Urban–rural differences in suicide rates, by sex and three leading methods: United States, 2000–2018.
        NCHS Data Brief. 2020; 373 (Accessed March 1, 2022): 1-8
        • Center for Disease Control and Prevention, National Center for Injury Prevention and Control
        Web-Based Injury Statistics Query and Reporting System (WISQARS).
        Centers for Disease Control and Prevention, Atlanta, GA2021 (Updated December 2. Accessed January 14, 2022)
        • Wang J
        • Sumner SA
        • Simon TR
        • et al.
        Trends in the incidence and lethality of suicidal acts in the United States, 2006 to 2015.
        JAMA Psychiatry. 2020; 77: 684-693https://doi.org/10.1001/jamapsychiatry.2020.0596
        • Rao CR.
        Linear Statistical Inference and Its Applications.
        2nd ed. John Wiley & Sons, New York, NY1973
        • Hirsch JK
        • Cukrowicz KC.
        Suicide in rural areas: an updated review of the literature.
        J Rural Ment Health. 2014; 38: 65-78https://doi.org/10.1037/rmh0000018
        • Mohatt NV
        • Kreisel CJ
        • Hoffberg AS
        • Wendleton L
        • Beehler SJ.
        A systematic review of factors impacting suicide risk among rural adults in the United States.
        J Rural Health. 2021; 37: 565-575https://doi.org/10.1111/jrh.12532
        • Nestadt PS
        • Triplett P
        • Fowler DR
        • Mojtabai R.
        Urban-rural differences in suicide in the State of Maryland: the role of firearms.
        Am J Public Health. 2017; 107: 1548-1553https://doi.org/10.2105/AJPH.2017.303865
        • Stone D
        • Holland K
        • Bartholow B
        • Crosby A
        • Davis S
        • Wilkins N.
        Preventing suicide: a technical package of policies, programs, and practices.
        National Center for Injury Prevention and ControlCenters for Disease Control and Prevention, Atlanta, GA2017 (Accessed November 19, 2021)
        • Substance Abuse and Mental Health Services Administration
        Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2020 (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55) (Published Accessed January 11, 2022)
        • Cwik JC
        • Teismann T.
        Misclassification of self-directed violence.
        Clin Psychol Psychother. 2017; 24: 677-686https://doi.org/10.1002/cpp.2036
        • Office of the Surgeon General (U.S.), National Action Alliance for Suicide Prevention (U.S.)
        2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention.
        HHS, Washington, DC2012 (Accessed November 19, 2021)
        • Peltzman T
        • Gottlieb DJ
        • Levis M
        • Shiner B.
        The role of race in rural-urban suicide disparities.
        J Rural Health. 2021; (In press. Online June 15)https://doi.org/10.1111/jrh.12603