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 accessOne-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 MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Arias E. Mortality in the United States, 2019.NCHS Data Brief. 2020; 395 (Accessed November 19, 2021): 1-8
- 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
- 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
- Web-Based Injury Statistics Query and Reporting System (WISQARS).Centers for Disease Control and Prevention, Atlanta, GA2021 (Updated December 2. Accessed January 14, 2022)
- 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
- Linear Statistical Inference and Its Applications.2nd ed. John Wiley & Sons, New York, NY1973
- Suicide in rural areas: an updated review of the literature.J Rural Ment Health. 2014; 38: 65-78https://doi.org/10.1037/rmh0000018
- 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
- 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
- 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)
- 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)
- Misclassification of self-directed violence.Clin Psychol Psychother. 2017; 24: 677-686https://doi.org/10.1002/cpp.2036
- 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)
- 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
Article Info
Publication History
Published online: March 03, 2022
Identification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
