Tuesday, March 8, 2022

Risk of Self-Harm Found Higher in Rural Areas Than Urban Areas

People living in rural areas in the United States appear to be at a greater risk of nonfatal self-harm than those living in urban areas, according to a report in the American Journal of Preventive Medicine.

The study findings may help “to generate a more complete picture of the rural−urban gap in the morbidity and mortality of suicidal behavior to guide prevention strategies in improving rural health,” wrote Jing Wang, M.D., M.P.H., of the National Center for Injury Prevention and Control and colleagues. The findings parallel what’s known of the rural-urban disparity in U.S. suicide rates.

The researchers used data from the Nationwide Emergency Department Sample (NEDS) to identify people 10 years or older who were seen in an emergency department for self-harm in 2018. The NEDS data included information on patients’ method of self-harm as well as the rural-urban designation for the patients’ counties of residence.

Among a weighted total of 488,000 emergency department visits for self-harm in the United States in 2018, 80.5% were by urban residents and 18.3% were by rural residents.

Overall, the age-adjusted emergency department visit rate for self-harm was 252.3 per 100,000 for rural residents, which was 1.5 times the rate for urban residents (170.8 per 100,000 residents), Wang and colleagues reported. Compared with urban residents, rural residents had higher risk for self-harm by all methods and across all age groups under 65.

The authors noted that females who lived in rural areas visited the emergency department more often for self-harm than male residents (313.1 per 100,000 for female residents vs. 195.1 per 100,000 for male residents); similar differences were seen when comparing females and males who lived in urban areas.

“Previous studies suggest unique risk factors among rural residents that may contribute to their increased risk for suicidal behavior, such as social isolation, lack of access to health care services, economic hardship, stigma around help seeking for mental health problems, and cultural and social beliefs encouraging self-sufficiency,” Wang and colleagues wrote. “The findings on the rural−urban gaps in self-harm by all mechanisms shown in this study underscore the importance of comprehensive primary suicide prevention strategies to address upstream risk factors in reducing the rural−urban disparity.”

For related information, see the SMI Adviser report “Improving Behavioral Health Services for Individuals With SMI in Rural and Remote Communities” and the Psychiatric News article “Patients Found Willing to Answer Routine Question on Firearm Access.”

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