Journal article
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, Vol.41(4), e70094
09/2025
DOI: 10.1111/jrh.70094
PMCID: PMC12592758
PMID: 41199495
Appears in UI Libraries Support Open Access
Abstract
Purpose
To examine the relationship between individual- and county-level factors associated with mental health and substance use dependence (MHSUD) treatment among rural suicide decedents.
Methods
Cross-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.
Results
Of 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]).
Conclusions
By 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.
Details
- Title: Subtitle
- County-level vulnerability is associated with mental health and substance use treatment among rural suicide decedents: A national multi-year cross-sectional study
- Creators
- J Priyanka Vakkalanka - University of IowaVictor A Soupene - University of IowaJennifer Van Tiem - Iowa City VA Health Care SystemJames M Blum - University of IowaBarbara St Marie - College of Nursing, University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.41(4), e70094
- DOI
- 10.1111/jrh.70094
- PMID
- 41199495
- PMCID
- PMC12592758
- NLM abbreviation
- J Rural Health
- ISSN
- 1748-0361
- eISSN
- 1748-0361
- Publisher
- Wiley
- Grant note
- Centers for Disease Control and Prevention's National Violent Death Reporting System New Investigator Award from the American Public Health Association
For this study, Dr. J. Priyanka Vakkalanka was supported by the Centers for Disease Control and Prevention's National Violent Death Reporting System New Investigator Award from the American Public Health Association.
- Language
- English
- Date published
- 09/2025
- Academic Unit
- Occupational and Environmental Health; Epidemiology; Emergency Medicine; Addiction Medicine; Family and Community Medicine; Nursing; Anesthesia; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9985024149102771
Metrics
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