ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025
County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
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5 authors.
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Abstract
purposeTo examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents.
methodsCross-sectional study (2013-2022) study of the National Violent Death Reporting System and the County Health Rankings. Primary exposures included individual- (demographic, clinical conditions) and county-level (average number of mentally unhealthy days, percentage of uninsured adults, rate of mental health providers/county, percentage of unemployed adults, rate of social associations, percentage of adults driving alone during long commutes, rate of primary care physicians/county, and income inequality ratios) factors of the decedent. The outcome was ever receipt of MHSUD treatment. We used multivariable logistic regression to measure the association between individual- and county-level factors and MHSUD treatment receipt.
resultsOf 42,021 rural suicides, 30% had MHSUD treatment receipt. Decedent-level factors associated with lower MHSUD treatment included male, sex, older age, racial/ethnic minorities, and residence in the Midwest or Northeast. MHSUD treatment was lower in rural counties with greater vulnerability (e.g., higher average number of mentally unhealthy days [aOR = 0.75, 95% CI: 0.68, 0.81], lower rate of primary care physicians/county [aOR = 0.92, 95% CI: 0.85, 0.99], lower rate of mental health providers/county [aOR = 0.76, 95% CI: 0.70, 0.81]).
conclusionsBy focusing within rural US counties, we found considerable variability in county-level risk factors for MHSUD treatment among suicide decedents. Research and public health efforts may consider disaggregating county-level factors when tailoring rural suicide prevention interventions in addition to improving MHSUD clinical infrastructure for both vulnerable individuals and counties.
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