Journal article
Examining contextual differences in suicide by rural-urban designation and military status, 2009-2019: a cross-sectional analysis of the National Violent Death Reporting System
Injury prevention, Vol.31(2), pp.121-127
04/2025
DOI: 10.1136/ip-2024-045430
PMCID: PMC13075480
PMID: 40011043
Abstract
To evaluate differences in mental health and substance use circumstances by rurality and military affiliations among suicide decedents.
Multiyear (2009-2019) cross-sectional study of adult suicide decedents reported to the National Violent Death Reporting System. We classified suicide decedents into a four-level variable by geography (urban/rural) and military status and evaluated the prevalence of current and past alcohol and substance use problems, mental health problem recognition and mental illness treatment. We estimated prevalence ratios using multiple imputation chain equations to account for missing data and log-binomial regression models and present stratified estimates by military and rural classification.
There was no significant relationship between rural-military classification and alcohol use problem. Compared with urban civilians, other groups had a lower risk identified of having a substance use problem: urban military (adjusted prevalence ratio (aPR): 0.65; 95% CI: 0.60 to 0.71), rural military (aPR: 0.57; 95% CI: 0.50 to 0.66) and rural civilians (aPR: 0.95; 95% CI: 0.90 to 1.00). Recognition of a mental health problem was lower among both rural military (aPR: 0.88; 95% CI: 0.81 to 0.96) and rural civilians (aPR: 0.89; 95% CI: 0.86 to 0.92). The likelihood of current mental treatment was lower in other groups (urban military (aPR: 0.93; 95% CI: 0.89 to 0.96); rural military (aPR: 0.87; 95% CI: 0.81 to 0.94); and rural civilian (aPR: 0.89; 95% CI: 0.85 to 0.92)). There was no evidence of effect modification by military and rural classification for any outcome.
Mental health outcomes by military affiliation and urbanicity/rurality may need to be independently assessed as social determinants of health.
Details
- Title: Subtitle
- Examining contextual differences in suicide by rural-urban designation and military status, 2009-2019: a cross-sectional analysis of the National Violent Death Reporting System
- Creators
- J Priyanka Vakkalanka - University of IowaEliezer Santos Leon - University of IowaJon Davis - University of IowaCameron Williams - University of IowaCarri Casteel - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Injury prevention, Vol.31(2), pp.121-127
- DOI
- 10.1136/ip-2024-045430
- PMID
- 40011043
- PMCID
- PMC13075480
- NLM abbreviation
- Inj Prev
- ISSN
- 1353-8047
- eISSN
- 1475-5785
- Publisher
- BMJ PUBLISHING GROUP
- Grant note
- National Center for Injury Prevention and ControlViolent Death Reporting System programmes based in US statesNational Violent Death Reporting System partner organisations: the Safe States AllianceAmerican Public Health AssociationUS Department of JusticeHarvard University Injury Control Research CenterJoyce FoundationNational Institute for Occupational Safety and Health
Authors would like to acknowledge participating Violent Death Reporting System programmes based in US states, territories and jurisdictions; participating state/territory/jurisdiction agencies, including state/territory/jurisdiction health departments, vital registrars' offices, coroners'/medical examiners' offices, crime laboratories and local and state/territory/jurisdiction law enforcement agencies and the National Violent Death Reporting System partner organisations: the Safe States Alliance, American Public Health Association, International Association of Chiefs of Police, National Association of Medical Examiners, National Association for Public Health Statistics and Information Systems, National Violence Prevention Network, Council of State and Territorial Epidemiologists and Association of State and Territorial Health Officials; federal agencies, including the US Department of Justice, Bureau of Justice Statistics; other stakeholders, researchers and foundations, including Harvard University Injury Control Research Center and the Joyce Foundation; the National Institute for Occupational Safety and Health and National Center for Health Statistics, Centers for Disease Control and Prevention. Preliminary findings from this work will be presented at the American Public Health Association's Annual meeting in November 2023.
- Language
- English
- Electronic publication date
- 02/26/2025
- Date published
- 04/2025
- Academic Unit
- Occupational and Environmental Health; Epidemiology; Emergency Medicine; Injury Prevention Research Center
- Record Identifier
- 9984795376202771
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