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Rural America Hit Hard by Recent Increase in Suicide Rates

September 10, 2019

Suicide rates among adults increased 41% in the United States between 1999 and 2016, with the most rapid growth occurring in rural areas, researchers reported in JAMA Network Open.

“While our findings are disheartening, we’re hopeful that they will help guide efforts to support Americans who are struggling, especially in rural areas where suicide has increased the most and the fastest,” said lead researcher Danielle Steelesmith, PhD, postdoctoral fellow at The Ohio State University Wexner Medical Center in Columbus.

The cross-sectional study provided a county-by-county picture of the 453,577 adults age 25 to 64 who died by suicide over the 18-year period. Some 77% of the decedents were men.

During the initial years of the study period, a median 15 per 100,000 county residents died by suicide, researchers reported. By the last 3 years of the study period, the median rose to 21.2 per 100,000 county residents. In rural counties, the suicide rate was 22 per 100,000 residents by the final years of the study.

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Overall, suicide rates were steepest in rural counties and in counties where residents had lower incomes and fewer resources. The highest county suicide rates were in the West (Colorado, New Mexico, Utah, and Wyoming), Appalachia (Kentucky, Virginia, and West Virginia), and the Ozarks (Arkansas and Missouri), the study found.

Deprivation, characterized by factors such as underemployment, poverty, and low educational attainment, was associated with increased rates of suicide, especially in rural areas, researchers reported. Social fragmentation and low social capital, also problems common in rural areas, were linked with suicide, too.

Among urban counties, those with gun shops tended to have higher rates of suicide. The study also found that high percentages of veterans in a county and lower rates of insurance coverage were associated with heightened suicide rates.

“Suicide is so complex, and many factors contribute,” Dr. Steelesmith said, “but this research helps us understand the toll and some of the potential contributing influences based on geography, and that could drive better efforts to prevent these deaths.” 

Suicide rates and concentration in rural areas are increasing over time, according to new research. Counties in red had the highest rates. Credit: The Ohio State University.

—Jolynn Tumolo


Steelesmith DL, Fontanella CA, Campo JV, Bridge JA, Warren KL, Root ED. Contextual factors associated with county-level suicide rates in the United States, 1999 to 2016. JAMA Network Open. 2019 September 4;2(9):e1910936.

Crane M. Suicide rates climbing, especially in rural America [press release]. Columbus, Ohio: The Ohio State University; September 6, 2019.


Submitted byduprebrad on September 13, 2019

What were the previous suicide rates in rural counties? The current difference of 21.2 vs 22.0 per 100,000 people doesn't seem statistically meaningful.
Why was the age cutoff at 64 years old?
The observation was that areas with gun shops tended to have higher rates of suicide. Were there actually counties with significant populations that did not have a gun shop?
Thank you,
Brad Dupre MD

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