Rural suicide: A systematic review and recommendations

Suicide is a public-health concern that has been linked to multiple biological, psychological, and social risk factors. Rural living is purported to be a unique risk for suicide for myriad reasons. Yet there are some concerns with rural suicidology, notably regarding defining and operationalizing “rural.” Furthermore, the last comprehensive review of rural suicide is approximately 10 years old. With this in mind, in the current review, we offer (a) a comprehensive and updated overview of the operationalization and variability of rural in rural suicidology and (b) a summary of differences in direct and indirect suicide factors between rural and nonrural regions and whether potential differences depend on how rural is operationalized. Results indicate a high degree of heterogeneity in defining rural, rendering conclusions about both direct and indirect rural suicide risks unclear. We therefore present a set of recommendations for rural suicidologists to apply to enhance the understanding of suicide and, ultimately, prevent death by suicide in rural regions.