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Research: Suicide Rates Remain Higher in Rural Areas [1]

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Date: 2025-07-07

A new study has found that suicide rates in rural communities continues to be higher than those in urban areas, largely due to challenges with accessing mental health resources.

Rural residents face more challenges than just access when it comes to mental health, according to the research led by a team at East Tennessee State University. The research shows that rural residents are hit with a triple whammy – challenges to access, stigma and high risk jobs – that leads to higher suicide rates.

“There are a lot of interconnected reasons. First, rural areas often lack access to mental health care,” professor Qian Huang, lead researcher on the project, said in an email interview with the Daily Yonder.

“Many rural counties are designated Health Professional Shortage Areas (HPSA), especially for mental health providers. That means fewer people available to help, longer wait times, and longer travel distances to care.”

Researchers at the ETSU’s Center for Rural Health and Research and the National Opinion Research Center’s Center for Rural Health Analysis looked at data from the National Vital Statistics System for deaths between 2018 and 2020.

Previous studies had shown that between 2000 and 2018, suicide rates in rural areas were higher than they were in urban areas, and researchers said they wanted to see what recent statistics showed.

Between 2018 and 2020, the suicide rate again increased across the country, but more so in rural areas, the researchers found. When looking at urban areas overall, researchers found that suicide rates averages about 14 suicides per 100,000. Looking at the overall rural area, average rates neared 20 per 100,000.

Rural residents who were over 25 had strikingly high suicide rates. For rural residents between 25-34 the suicide rate was 28.8 per 100,000, and for those between the ages of 45-54, the rate was 25.3 per 100,000 – 1.7 times higher than those in urban areas. Rural residents over 85 had a suicide rate of 25.7 per 100,000, compared to 20.2 per 100,000 for 85-year-old urban residents. Children between 5 and 14 had the lowest suicide rates at 2.2 for rural residents and 1.3 for urban residents.

Rates varied in different parts of the country. In western states (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming), suicide rates were 26.6 per 100,000 in rural areas, and 14.7 in urban areas. Alaska had the highest rates, with up to 38.48 suicides in rural areas per every 100,000 residents, the research showed.

The researchers also noted that there is a “suicide belt” across the country stretching from Virginia and West Virginia through Tennessee, Missouri, Oklahoma, Colorado, New Mexico, and Arizona.

Beyond lack of access, the second challenge to mental health is stigma, Huang said. In many rural communities, mental health struggles are still not openly discussed which may prevent people from seeking help. When coupled with greater economic stress, social isolation, longer EMS waiting times and limited transportation, all of which can impact mental health, rural residents face an uphill climb to access help even when they need it, she said.

Even their jobs can put them at risk.

“And finally, certain industries that are more common in rural areas — like agriculture, mining, and construction — are physically and mentally demanding and have been associated with higher suicide risk,” she said.

Although suicide is a leading cause of death in the U.S. regardless of where one lives, the rate of suicides in rural communities is growing, according to the Centers for Disease Control and Prevention (CDC).

Suicide accounted for more than 48,000 deaths in 2021, or approximately one every 11 minutes. But between 2000 and 2020, the increase in suicides in rural areas was nearly double what it was in urban areas. Rural suicides rose 46% in non-metro areas, the CDC reported, and 27.3% in metro areas. Rural residents are 1.5 times more likely to visit an emergency room for nonfatal self-harm than urban residents are, according to the CDC.

“Many of these areas are heavily rural and face persistent challenges: provider shortages, economic hardship, social isolation, and insufficient behavioral health infrastructure,” Huang said. “These same areas are also often referred to as parts of the ‘diabetes belt,’ the ‘dementia belt,’ and regions of persistent poverty — indicating overlapping structural health and socioeconomic vulnerabilities.

“This pattern really highlights that suicide is not just about individual risk — it’s also about the broader environment,” Huang said “Where people live, and what they have access to, matters tremendously.”

Huang said the study indicates that rural suicide is a persistent public health crisis that needs tailored solutions to address it.

“One-size-fits-all approaches won’t work,” she said.

To help those in rural communities, policy makers need to focus on solutions that impact their communities’ needs, as well as overall recommendation such as recruiting and retaining mental health professionals to rural communities, and addressing the drivers and causes of higher suicide rates — poverty, unstable housing, unemployment and lack of transportation, which can fuel mental health struggles, Huang said.

“I was really surprised by how consistently rural areas had higher suicide rates — across every demographic group we looked at: age, sex, and race/ethnicity and across US regions,” Huang said. “It wasn’t limited to one population or one region. Even in states or regions where overall suicide rates were lower — like the Northeast — rural communities still faced much higher risk compared to urban ones. That really highlights the need to focus on place-based solutions.”

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