A Review of the Literature on Rural Suicide
Abstract
Abstract.Background. Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide. Objective. This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. Description of studies. All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology. Results. Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas. Discussion. Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.
References
Aaron, R. , Joseph, A. , Abraham, S. , Muliyil, J. , George, K. , Prasad, J. (2004). Suicides in young people in rural southern India. Lancet, 363, 1117– 1118Agbayewa, M.O. (1993). Elderly suicide in British Columbia: An exploration of regional variation and related factors. Canadian Journal of Public Health, 84, 231– 236Agee, E. , Blank, M.B. , Fox, J.C. , Burkett, B.M. , Pezzoli, J. (1997). The introduction of computer-assisted telephone support in a community mental health center. Journal of Rural Community Psychology, E1, 1– 1Ahmed, M.K. , van Ginneken, J. , Razzaque, A. , Alam, N. (2004). Violent deaths among women of reproductive age in rural Bangladesh. Social Science & Medicine, 59, 311– 319Ajiki, W. , Fukunaga, T. , Saijoh, K. , Sumino, K. (1991). Recent status of the medical examiner system in Japan: Demographic variation of medicolegal deaths in Hyogo Prefecture and uncertainty in medicolegal investigations conducted by medical practitioners. Forensic Science International, 51, 35– 50Alexander, G.R. , Gibbs, T. , Massey, R.M. , Altekruse, J.M. (1982). South Carolina's suicide mortality in the 1970s. Public Health Reports, 97, 476– 482Allard, Y.E. , Wilkins, R. , Berthelot, J.M. (2004). Premature mortality in health regions with high aboriginal populations. Health Reports, 15, 51– 60Aoun, S. (1999). Deliberate self-harm in rural Western Australia: Results of an intervention study. Australian New Zealand Journal of Mental Health Nursing, 8, 65– 73Araki, S. , Murata, K. (1986). Social life factors affecting suicide in Japanese men and women. Suicide & Life-Threatening Behavior, 16, 458– 468Ashford, J.R. , Lawrence, P.A. (1976). Aspects of the epidemiology of suicide in England and Wales. International Journal of Epidemiology, 5, 133– 144Bancroft, J.H. , Skrimshire, A.M. , Reynolds, F. , Simkin, S. , Smith, J. (1975). Self-poisoning and self-injury in the Oxford area. Epidemiological aspects 1969-73. British Journal of Preventive & Social Medicine, 29, 170– 177Barry, M.M. , Doherty, A. , Hope, A. , Sixsmith, J. , Kelleher, C.C. (2000). A community needs assessment for rural mental health promotion. Health Education Research, 15, 293– 304Batt, A. , Tron, I. , Depoivre, C. , Trehony, A. (1919). Suicide attempts in Brittany (France). Distribution at the regional level. Encephale, 6, 619– 625Baume, P.J. , Clinton, M.E. (1997). Social and cultural patterns of suicide in young people in rural Australia. Australian Journal of Rural Health, 5, 115– 120Beautrais, A.L. (2003). Subsequent mortality in medically serious suicide attempts: A 5 year follow-up. Australian and New Zealand Journal of Psychiatry, 37, 595– 599Beeson, P.G. (2000). Some notes and data on rural suicide. Rural Mental Health, 25, 13– 15Beratis, S. (1986). Suicide in southwestern Greece 1979-1984. Acta Psychiatrica Scandinavica, 74, 433– 439Bogal-Allbritten, R. , Daughaday, L. (1990). Spouse abuse program services: A rural-urban comparison. Human Services in the Rural Environment, 14, 6– 10Bopp, M. , Gutzwiller, F. (1999). Changes in mortality in Switzerland since 1950. II: Regional differences within Switzerland. Journal Suisse de Medecine, 129, 799– 809Braden, J. , Beauregard, K. (1994). Health status and access to care of rural and urban populations (Rep. No. 18). Rockville, MD: Agency for Health Care Policy and ResearchBranas, C.C. , Nance, M.L. , Elliott, M.R. , Richmond, T.S. , Schwab, C.W. (2004). Urban-rural shifts in intentional firearm death: Different causes, same results. American Journal of Public Health, 94, 1750– 1755Bridges, F.S. , Clark, L.N. (2004). Suicide and homicide in rural areas of California. Psychological Reports, 95, 905– 906Buckwalter, K. , Smith, M. , Castor, C. (1994). Mental and social health of the rural elderly. In R. Coward, C.N. Bull, G. Kubulka, & J. Gallchu (Eds.), Health services for rural elders (pp. 203-232). New York: ApresquerBurnley, I.H. (1995). Socioeconomic and spatial differentials in mortality and means of committing suicide in New South Wales, Australia, 1985-91. Social Science & Medicine, 41, 687– 698Caldwell, T.M. , Jorm, A.F. , Dear, K.B. (2004). Suicide and mental health in rural, remote, and metropolitan areas in Australia. Medical Journal of Australia, 181, 14– 14Cantor, C. , Coory, M. (1993). Is there a rural suicide problem?. Australian Journal of Public Health, 17, 382– 384Cao, W. , Wu, T. , An, T. , Li, L. (2000). Study on the mortality of injury in Chinese populations in urban and rural areas from 1990 to 1997. Chinese Journal of Epidemiology, 21, 327– 329(2002). Rural stress: Suicide information and education collection (Rep. No. 50). Calgary, Alberta, Canada: Center for Suicide Prevention, Canadian Mental Health Association
(1999). Preliminary analysis of Statistics Canada data: Urban and rural firearms deaths . Ottowa, Ontario, Canada: Canada Firearms Center
Ciarlo, J. , Wackwitz, J. , Wagenfeld, M. , Mohatt, D. , Selarney, P. (1996). Focusing on frontier: Isolated rural America . Denver, CO: Frontier Mental Health Services Resource NetworkClarke, C.S. , Bannon, F.J. , Denihan, A. (2003). Suicide and religiosity: Masaryk's theory revisited. Social Psychiatry & Psychiatric Epidemiology, 38, 502– 506Clayer, J.R. , Czechowicz, A.S. (1991). Suicide by aboriginal people in South Australia: Comparison with suicide deaths in the total urban and rural populations. Medical Journal of Australia, 154, 683– 685Crawford, P. , Brown, B. (2002). Like a friend going round: Reducing the stigma of mental health care in rural communities. Health and Social Care in the Community, 10, 229– 238Crombie, I.K. (1991). Suicide among men in the highlands of Scotland. British Medical Journal, 302, 761– 762Daeid, N.N. (1997). Suicide among the agricultural sector in Ireland; 1982-1994. Journal of the Irish Colleges of Physicians & Surgeons, 26, 180– 182de Joode, B.V. , Wesseling, C. , Kromhout, H. , Monge, P. , Garcia, M. , Mergler, D. (2001). Chronic nervous-system effects of long-term occupational exposure to DDT. Lancet, 357, 1014– 1016Dembling, B. , Merkel, L. (2003). Suicide in Virginia, 1979-1996: Working paper . Southeastern Rural Mental Health Research Center, University of VirginiaDesapriya, E.B.R. , Joshi, P. , Han, G. , Rajabali, F. (2004). Demographic risk factors in pesticide related suicides in Sri Lanka. Injury Prevention, 10, 125–Dorling, D. , Gunnell, D. (2003). Suicide: The spatial and social components of despair in Britain, 1980-2000. Transactions of the Institute of British Geographers, 28, 442– 460Dresang, L.T. (2001). Gun deaths in rural and urban settings: Recommendations for prevention. Journal of the American Board of Family Practice, 14, 107– 115Dudley, M. , Florio, T. (2002). Recent trends in youth and young adult suicide, indigenous and nonindigenous rates in metropolitan and rural areas. Australian and New Zealand Journal of Psychiatry, 36, A11–Dudley, M.J. , Kelk, N.J. , Florio, T.M. , Howard, J.P. , Waters, B.G.H. (1998). Suicide among young Australians, 1964-1993: An interstate comparison of metropolitan and rural trends - In reply. Medical Journal of Australia, 169, 500–Dudley, M. , Waters, B. , Kelk, N. , Howard, J. (1992). Youth suicide in New South Wales - urban rural trends. Medical Journal of Australia, 156, 83– 88Duran-Nah, J.J. , Colli-Quintal, J. (2000). Acute pesticide poisoning. Salud Publica de Mexico, 42, 53– 55Durkheim, E. (1952). Suicide . London: Routledge and Kegan PaulDyer, J. (1997). Harvest of rage . Boulder, CO: Westview PressEckersley, R. (2002). Taking the prize or paying the price? Young people and progress. In L. Rowling, G. Martin, & L. Walker (Eds.), Mental health promotion and young people: Concepts and practice (pp. 70-81). Sydney, Australia: McGraw-Hill AustraliaEddleston, M. (2000). Patterns and problems of deliberate self-poisoning in the developing world. QJM: An International Journal of Medicine, 93, 715– 731Farie, A.M. , Cowen, E.L. , Smith, M. (1986). The development and implementation of a rural consortium program to provide early, preventive, school mental health services. Community Mental Health Journal, 22, 94– 103Ferguson, S. , Blakely, T. , Allan, B. , Collings, S. (2004). Suicide rates in New Zealand: Exploring associations with social and economic factors (Rep. No. 10). Public Health Consultancy, Department of Public Health, Wellington School of Medicine and Health Sciences, University of OtagoFinkel, S.I. , Rosman, M. (1995). Six elderly suicides in a 1-year period in a rural midwestern community. International Psychogeriatrics, 7, 221– 230Gailiene, D. (2004). Suicide in Lithuania during the years of 1990 to 2002. Archives of Suicide Research, 8, 389– 395Garenne, M. , Kahn, K. , Tollman, S. , Gear, J. (2000). Causes of death in a rural area of South Africa: An international perspective. Journal of Tropical Pediatrics, 46, 183– 190Gausche, M. , Seidel, J.S. , Henderson, D.P. , Ness, B. , Ward, P.M. , Wayland, B.W. (1989). Pediatric deaths and emergency medical services (EMS) in urban and rural areas. Pediatric Emergency Care, 5, 158– 162Gerrard, N. (2003). Farm stress: Resiliency in rural people . Regina, Saskatchewan, Canada: Saskatchewan Agriculture and FoodGibbons, R.D. , Hur, K. , Bhaumik, D.K. , Mann, J.J. (2005). The relationship between antidepressant medication use and rate of suicide. Archives of General Psychiatry, 62, 165– 172Goldcamp, M. , Hendricks, K.J. , Myers, J.R. (2004). Farm fatalities to youth 1995-2000: A comparison by age groups. Journal of Safety Research, 35, 151– 157Goto, H. , Nakamura, H. , Miyoshi, T. (1994). Epidemiological studies on regional differences in suicide mortality and its correlation with socioeconomic factors. Tokushima Journal of Experimental Medicine, 41, 115– 132Gunderson, P. , Donner, D. , Nashold, R. , Salkowicz, L. , Sperry, S. , Wittman, B. (1993). The epidemiology of suicide among farm residents or workers in five north-central states, 1980- 1988. American Journal of Preventive Medicine, 9, 26– 32Gutierrez Garcia, J.M. (1998). Predominance of urban suicides over rural suicides in Spain. Actas Luso-Espanolas de Neurologia, 26, 111– 115Hargarten, S.W. , Karlson, T.A. , O'Brien, M. , Hancock, J. , Quebbeman, E. (1996). Characteristics of firearms involved in fatalities. Journal of the American Medical Association, 275, 42– 45Hartley, D. , Bird, D. , Dempsey, P. (1999). Mental health and substance abuse. In T. Ricketts (Ed.), Rural health in the United States (pp 159-178). New York: Oxford University PressHassan, R. (1995). Suicide explained: The Australian experience . Melbourne, Australia: Melbourne University PressHatzitolios, A.I. , Sion, M.L. , Eleftheriadis, N.P. , Toulis, E. , Efstratiadis, G. , Vartzopoulos, D. (2001). Parasuicidal poisoning treated in a Greek medical ward: Epidemiology and clinical experience. Human & Experimental Toxicology, 20, 611– 617Hawton, K. , Fagg, J. , Simkin, S. , Harriss, L. , Malmberg, A. , Smith, D. (1999). The geographical distribution of suicides in farmers in England and Wales. Social Psychiatry & Psychiatric Epidemiology, 34, 122– 127Heffernan, J.B. (1999). Mental health and ministry: The vital connection (Rep. No. 7). National Association for Rural Mental HealthHill, S.A. , Pritchard, C. , Laugharne, R. , Gunnell, D. (2005). Changing patterns of suicide in a poor, rural county over the 20th century. Social Psychiatry and Psychiatric Epidemiology, 40, 601– 604Hirsch, J.K. , Duberstein, P. , Conner, K.R. , Heisel, M.J. , Beckman, A. , Franus, N. , Conwell, Y. (in press). Future orientation and suicide ideation and attempts in depressed adults ages 50 and over. American Journal of Geriatric Psychiatry, 14, 752– 757Holzer, C.E. III , Ciarlo, J. (2000). Mental health service utilization in rural and nonrural areas (Rep. No. 20). Denver, CO: Frontier Mental Health Services Resource Network, University of DenverHoyt, D.R. , Conger, R.D. , Valde, J.G. , Weihs, K. (1997). Psychological distress and help seeking in rural America. American Journal of Community Psychology, 25, 449– 470Hu, Z. , Liu, X. , Huo, K. , Zhang, W. (1992). Survey of suicidal mortality rate in several districts of Sichuan province. Journal of West China University of Medical Sciences, 23, 443– 445Humes-Noyes, B. (1980). Community mental health prevention and health promotion programs in rural communities. Journal of Rural Community Psychology, 1, 34– 46Hutchinson, G. , Daisley, H. , Simeon, D. , Simmonds, V. , Shetty, M. , Lynn, D. (1999). High rates of paraquat-induced suicide in southern Trinidad. Suicide & Life-Threatening Behavior, 29, 186– 191Isometsa, E. , Heikkinen, M. , Henriksson, M. , Marttunen, M. , Aro, H. , Lonnqvist, J. (1997). Differences between urban and rural suicides. Acta Psychiatrica Scandinavica, 95, 297– 305Jegesy, A. , Harsanyi, L. , Angyal, M. (1995). A detailed study on suicides in Baranya County (Hungary). International Journal of Legal Medicine, 108, 150– 153Jeyaratnam, J. (1990). Acute pesticide poisoning: A major global health problem. World Health Statistics Quarterly, 43, 139– 144Ji, J. , Kleinman, A. , Becker, A.E. (2001). Suicide in contemporary China: A review of China's distinctive suicide demographics in their sociocultural context. Harvard Review of Psychiatry, 9, 1– 12Jianlin, J. (2000). Suicide rates and mental health services in modern China. Crisis, 21, 118– 121Jong, M. (2004). Managing suicides via videoconferencing in a remote northern community in Canada. International Journal of Circumpolar Health, 63, 422– 428Joseph, A. , Abraham, S. , Muliyil, J.P. , George, K. , Prasad, J. , Minz, S. (2003). Evaluation of suicide rates in rural India using verbal autopsies, 1994-9. British Medical Journal, 326, 1121– 1122Judd, F. , Cooper, A.M. , Fraser, C. , Davis, J. (2006). Rural suicide - people or place effects?. Australian and New Zealand Journal of Psychiatry, 40, 208– 216Kalediene, R. , Petrauskiene, J. (2004). Inequalities in daily variations of deaths from suicide in Lithuania: Identification of possible risk factors. Suicide & Life-Threatening Behavior, 34, 138– 146Kalediene, R. , Starkuviene, S. , Petrauskiene, J. (2004). Mortality from external causes in Lithuania: Looking for critical points in time and place. Scandinavian Journal of Public Health, 32, 374– 380Kane, C.F. , Ennis, J.M. (1996). Health care reform and rural mental health: Severe mental illness. Community Mental Health Journal, 32, 445– 462Karki, P. , Hansdak, S.G. , Bhandari, S. , Shukla, A. , Koirala, S. (2001). A clinico-epidemiological study of organophosphorus poisoning at a rural-based teaching hospital in eastern Nepal. Tropical Doctor, 31, 32– 34Kay, F. , Hazell, T. (1999). Rural youth suicide. Responsibility, curriculum resources on youth suicide . Newcastle, Australia: Commonwealth Department of Health and Human ServicesKelleher, M.J. , Corcoran, P. , Keeley, H.S. (1997). The service implications of regional differences in suicide rates in the Republic of Ireland. Irish Medical Journal, 90, 1–Kelleher, K.J. , Taylor, J.L. , Rickert, V.I. (1992). Mental health services for rural children and adolescents. Clinical Psychology Review, 12, 841– 852Kelly, C.B. , Weir, J. , Rafferty, T. , Galloway, R. (2000). Deliberate self-poisoning presenting at a rural hospital in Northern Ireland 1976-1996: Relationship to prescribing. European Psychiatry, 15, 348– 353Kelly, S. , Charlton, J. , Jenkins, R. (1995). Suicide deaths in England and Wales, 1982-1992: The contribution of occupation and geography. Population Trends, 80, 16– 25Kessler, R.C. , McGonagle, K.A. , Zhao, S.Y. , Nelson, C.B. , Hughes, M. , Eshleman, S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States - results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8– 19Kirwan, P. (1991). Suicide in a rural Irish population. Irish Medical Journal, 84(1), 14– 15Klaber, A. (2006). Trends in suicide rates in urban and rural areas across Trent region, 1988-1998 . University of Sheffield, England: Public Health GIS UnitKondrichin, S.V. , Lester, D. (1991). Suicide in Belarus. Crisis, 19, 167– 171Kreitman, N. , Carstairs, V. , Duffy, J. (1991). Association of age and social class with suicide among men in Great Britain. Journal of Epidemiology and Community Health, 45, 195– 202Kryzhanovskaya, L. , Pilyagina, G. (1999). Suicidal behavior in the Ukraine, 1988-1998. Crisis, 20, 184– 190Kurosu, S. (1991). Suicide in rural areas: The case of Japan 1960-1980. Rural Sociology, 56, 603– 618Lambert, D. , Agger, M.S. (1995). Access of rural AFDC medicaid beneficiaries to mental health services. Health Care Financing Review, 17, 133– 145LaMendola, W. (1997). Telemental health services in frontier areas: Provider and consumer perspectives (Rep. No. 19). Denver, Colorado: Frontier Mental Health Services NetworkLester, D. (1990). Suicide in mainland China by sex, urban/rural location, and age: Preliminary data. Perceptual & Motor Skills, 71, 1090–Levin, H.S. , Rodnitzky, R.L. , Mick, D.L. (1976). Anxiety associated with exposure to organophosphate compounds. Archives of General Psychiatry, 33, 225– 228Levin, K.A. , Leyland, A.H. (2005). Urban/rural inequalities in suicide in Scotland, 1981-1999. Social Science & Medicine, 60, 2877– 2890Li, Z.J. , Chen, S.Y. , Zhou, J. , Wu, Y.Q. (2004). The study of poisoning-suicide-attempted patients in emergency departments of 25 hospitals in China. Chinese Journal of Epidemiology, 25, 285– 287Lindqvist, P. , Johansson, L. (2000). Teenage suicides in northern Sweden: An interview study of investigating police officers. Injury Prevention, 6, 115– 119Lingren, H. (1995). Rural families facing economic and emotional stress (Rep. No. NF93-155). Lincoln, NE: Cooperative Extension, Institute of Agriculture and Natural Resources, University of Nebraska-LincolnLipschitz, A. (1995). Suicide prevention in young adults (age 18-30). Suicide and Life Threatening Behavior, 25, 155– 170Liu, X. , Tein, J.Y. , Zhao, Z. , Sandler, I.N. (2005). Suicidality and correlates among rural adolescents of China. Journal of Adolescent Health, 37, 443– 451London, L. , Flisher, A.J. , Wesseling, C. , Mergler, D. , Kromhout, H. (2005). Suicide and exposure to organophosphate insecticides: Cause or effect?. American Journal of Industrial Medicine, 47, 308– 321Lotrakul, M. (2005). Suicide in the north of Thailand. Journal of the Medical Association of Thailand, 88, 944– 948Mainous, A.G. , Kohrs, F.P. (1995). A comparison of health status between rural and urban adults. Journal of Community Health, 20, 423– 431Malmberg, A. , Hawton, K. , Simkin, S. (1997). A study of suicide in farmers in England and Wales. Journal of Psychosomatic Research, 43, 107– 111Mandelman, J. (September 29, 1999). Forum focuses on rural suicide. Daily Star,Mansfield, P.K. , Preson, D.B. , Crawford, C.O. (1988). Rural-urban differences in women's psychological well-being. Health Care for Women International, 9, 289– 304Mao, Y. , Moloughney, B.W. , Semenciw, R.M. , Morrison, H.I. (1992). Indian reserve and registered Indian mortality in Canada. Canadian Journal of Public Health, 83, 350– 353(2003). Rural suicide prevention: Seeds of safety . Marshfield, WI: National Children's Center for Rural and Agricultural Health and Safety
McAlpine, D.E. , Panser, L.A. , Swanson, D.W. , O'Fallon, W.M. , Melton, L.J. III (1990). Suicide in Olmsted County, Minnesota, 1951 through 1985. Mayo Clinic Proceedings, 65, 13– 22McLoone, P. (1996). Suicide and deprivation in Scotland. British Medical Journal, 312, 543– 544Meystadt, D. (1984). Religion and the rural population: Implications for social work. Social Casework, 65, 219– 226Micciolo, R. , Williams, P. , Zimmermann-Tansella, C. , Tansella, M. (1991). Geographical and urban-rural variation in the seasonality of suicide: Some further evidence. Journal of Affective Disorders, 21, 39– 43Middleton, N. , Gunnell, D. , Frankel, S. , Whitley, E. , Dorling, D. (2003). Urban-rural differences in suicide trends in young adults: England and Wales, 1981-1998. Social Science & Medicine, 57, 1183– 1194Middleton, N. , Whitley, E. , Frankel, S. , Dorling, D. , Sterne, J. , Gunnell, D. (2004). Suicide risk in small areas in England and Wales, 1991-1993. Social Psychiatry & Psychiatric Epidemiology, 39, 45– 52Mishara, B.L. , Daigle, M.S. (1997). Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: An empirical investigation. American Journal of Community Psychology, 25, 861– 885Mokhovikov, A. , Donets, O. (1996). Suicide in the Ukraine: Epidemiology, knowledge, and attitudes of the population. Crisis, 17, 128– 134Monsey, B. , Owen, G. , Ziernan, C. , Lambert, L. , Hyman, V. (1995). What works in preventing rural violence . St. Paul, MN: Amherst H. Wilder FoundationMorgan, K.O. , Morgan, S. (1997). Health care state rankings 1997: Health care in the 50 United States . Lawrence, KS: Morgan Quitno PressMorrell, S. , Taylor, R. , Slaytor, E. , Ford, P. (1999). Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985-1994. Social Science & Medicine, 49, 81– 91Morris, P. , Maniam, T. (2000). Suicide in Fiji: A review of the literature. Asia-Pacific Journal of Public Health, 12, 46– 49Morrison, H.I. , Semenciw, R.W. , Morison, D. , Mao, Y. (1995). Mortality among Canadian fruit and vegetable farmers. In H.H. McDuffie, J.A. Dosman, K.M. Semchuk, S.A. Olenchock, & A. Senthilselvan (Eds.), Agricultural health and safety: Workplace, environment, sustainability. Boca Raton, FL: CRC PressMotohashi, Y. , Kaneko, Y. , Sasaki, H. (2005). Lowering suicide rates in rural Japan. Akita Journal of Public Health, 2, 105– 106Mulder, P. , Chang, A. (1997). Domestic violence in rural communities: A literature review and discussion. Journal of Rural Community Psychology, E1, 1–Nagami, H. , Nishigaki, Y. , Matsushima, S. , Matsushita, T. , Asanuma, S. , Yajima, N. (2005). Hospital-based survey of pesticide poisoning in Japan, 1998-2002. International Journal of Occupational & Environmental Health, 11, 180– 184(1993). Healthy people 2000 review: Health, United States . Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics
(2001). Suicide rates among persons 15 years of age and over by sex, region, and urbanization level, 1996-1998 . Hyattsville, MD: Centers for Disease Control and Prevention, National Center for Health Statistics
(2001). Health statistics . Wellington, NZ: New Zealand Health Information Service
Obafunwa, J.O. , Busuttil, A. (1994). A review of completed suicides in the Lothian and borders region of Scotland (1987-1991). Social Psychiatry and Psychiatric Epidemiology, 29, 100– 106Otto, K.R. , Spate, H.F. (1975). Suicidal trends in urban and rural districts of Brandenburg. Psychiatrie, Neurologie und Medizinische Psychologie, 27, 239– 246Oyama, H. , Goto, M. , Fujita, M. , Shibuya, H. , Sakashita, T. (2006). Preventing elderly suicide through primary care by community-based screening for depression in rural Japan. Crisis, 27, 58– 65Oyama, H. , Koida, J. , Sakashita, T. , Kudo, K. (2004). Community-based prevention for suicide in elderly by depression screening and follow-up. Community Mental Health Journal, 40, 249– 263Oyama, H. , Watanabe, N. , Ono, Y. , Sakashita, T. , Takenoshita, Y. , Taguchi, M. (2005). Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry & Clinical Neurosciences, 59, 337– 344Page, A.N. , Fragar, L.J. (2002). Suicide in Australian farming, 1988-1997. Australian and New Zealand Journal of Psychiatry, 36, 81– 85Paldy, A. , Puskas, N. , Farkas, I. (1988). Pesticide use related to cancer incidence as studied in a rural district of Hungary. Science of the Total Environment, 73, 229– 244Pasewark, R. , Fleer, J. (1993). Suicide in Wyoming, 1960-1975. Journal of Rural Community Psychology, 12, 39– 41Patton, G. , Burns, J. (1997). Scope for preventive intervention in youth suicide: A risk factor approach. National Health and Medical Research Council, , 1– 64Paykel, E.S. , Abbott, R. , Jenkins, R. , Brugha, T.S. , Meltzer, H. (2000). Urban-rural mental health differences in Great Britain: Findings from the National Morbidity Survey. Psychological Medicine, 30, 269– 280Pecyna, S.M. (1993). Death of choice in the subpopulation of people aged 60 and more in psycho-epidemiological studies in the years 1978-1991. Polish Population Review, 3, 138–Peek-Asa, C. , Zwerling, C. , Stallones, L. (2004). Acute traumatic injuries in rural populations. American Journal of Public Health, 94, 1689– 1693Pesonen, T.M. , Hintikka, J. , Karkola, K.O. , Saarinen, P.I. , Antikainen, M. , Lehtonen, J. (2001). Male suicide mortality in eastern Finland - urban-rural changes during a 10-year period between 1988 and 1997. Scandinavian Journal of Public Health, 29, 189– 193Pesonen, T.M. , Tacke, U. , Karkola, K.O. , Hintikka, J. , Lehtonen, J. (2004). Gender-related changes in suicide rates and methods in eastern Finland from 1988 to 1997. Nordic Journal of Psychiatry, 58, 327– 332Petrauskiene, J. , Kalediene, R. , Starkuviene, S. (2004). Methods of suicides in Lithuania and their associations with demographic factors. Medicina, 40, 905– 911Petti, T.A. , Leviton, L.C. (1986). Rethinking rural mental health services for children and adolescents. Journal of Public Health Policy, 7, 5877– 5877Phillips, M.R. , Li, X. , Zhang, Y. (2002). Suicide rates in China, 1995-99. The Lancet, 359, 835– 840Phillips, M.R. , Yang, G.H. , Zhang, Y.P. , Wang, L.J. , Ji, H.Y. , Zhou, M.G. (2002). Risk factors for suicide in China: A national case-control psychological autopsy study. Lancet, 360, 1728– 1736Pickett, W. , King, W.D. , Faelker, T. , Bienefeld, N. (1999). Suicides among Canadian farm operators. Chronic Diseases in Canada, 20, 105– 110Pickett, W. , King, W.D. , Lees, R.E.M. , Bienefeld, M. , Morrison, H.I. , Brison, R.J. (1998). Suicide mortality and pesticide use among Canadian farmers. American Journal of Industrial Medicine, 34, 364– 372Pires, D.X. , Caldas, E.D. , Recena, M.C.P. (2005). Pesticide use and suicide in the state of Mato Grosso do Sul, Brazil. Cadernos de Saude Publica, 21, 598– 604Pratt, D.S. (1990). Occupational health and the rural worker: Agriculture, mining, and logging. Journal of Rural Health, 6, 399– 417Pritchard, C. (1996). Suicide in the People's Republic of China categorized by age and gender: Evidence of the influence of culture on suicide. Acta Psychiatrica Scandinavica, 93, 362– 367Qin, P. , Mortensen, P.B. (2001). Specific characteristics of suicide in China. Acta Psychiatrica Scandinavica, 103, 117– 121Quan, H. , Arboleda-Florez, J. (1999). Elderly suicide in Alberta: Difference by gender. Canadian Journal of Psychiatry, 44, 762– 768Quevillon, R.P. , Trenerry, M.R. (1983). Research on rural depression - implications of social networks for theory and treatment. International Journal of Mental Health, 12, 45– 61Rancans, E. , Salander Renberg, E. , Jacobsson, L. (2001). Major demographic, social, and economic factors associated to suicide rates in Latvia 1980-98. Acta Psychiatrica Scandinavica, 103, 275– 281Ratnayeke, L. (1998). Reaching the suicidal in rural communities. In R.J. Kosky, H.S. Eshkevari, R.D. Goldney, & R. Hassan (Eds.), Suicide prevention: The global context (pp. 269-271). New York: PlenumRenwick, M.Y. , Olsen, G.G. , Tyrrell, M.S. (1982). Suicide in rural New South Wales: Comparison with metropolitan experience. Medical Journal of Australia, 1, 377– 380Roberts, L.W. , Battaglia, J. , Epstein, R.S. (1999). Frontier ethics: Mental health care needs and ethical dilemmas in rural communities. Psychiatric Services, 50, 497– 503Roca De Togores, L.A. , Rubio, S.P. , Sanchez, S.P. , Rodriguez, C.D. , Villar, G.A. (2002). Suicide attempts attended at a health center. Atencion Primaria, 29, 547– 552Rogers, F.B. , Madsen, L. , Shackford, S. , Crookes, B. , Charash, W. , Morrow, P. (2005). A needs assessment for regionalization of trauma care in a rural state. American Surgeon, 71, 690– 693Rowley, T.D. (1995). Understanding rural America (Rep. No. 710). Washington, DC: Economic Research Service, Department of Agriculture(1996). Looking forward, looking back - Report of the Royal Commission on Aboriginal Peoples (Rep. No. 1). Ottawa, Canada: Supply and Services Canada
Rygnestad, T. (1992). Suicide in Norway. Changes in the 20th century with special emphasis on the development during the last 20 years. Tidsskrift for Den Norske Laegeforening, 112, 38– 42Sadowski, L.S. , Munoz, S.R. (1996). Nonfatal and fatal firearm injuries in a rural county. JAMA: The Journal of the American Medical Association, 275, 1762– 1764Saftlass, A.F. , Blair, A. , Cantor, R.P. , Hanrahan, L. , Anderson, H.A. (1987). Cancer and other causes of death among Wisconsin farmers. American Journal of Internal Medicine, 11, 119– 129Sakamoto, S. , Tanaka, E. , Neichi, K. , Ono, Y. (2004). Where is help sought for depression or suicidal ideation in an elderly population living in a rural area of Japan?. Psychiatry & Clinical Neurosciences, 58, 522– 530Saunderson, T. , Haynes, R. , Langford, I.H. (1998). Urban-rural variations in suicides and undetermined deaths in England and Wales. Journal of Public Health Medicine, 20, 261– 267Saunderson, T.R. , Langford, I.H. (1996). A study of the geographical distribution of suicide rates in England and Wales 1989-92 using empirical Bayes estimates. Social Science & Medicine, 43, 489– 502Schorr, V. , Crabtree, D.A. , Wagner, D. , Wetterau, P. (1989). Difference in rural and urban mortality: Implications for health education and promotion. Journal of Rural Health, 5, 67– 80Scott, G. , Ciarrochi, J. , Deane, F. (2003). The increasing incidence of suicide: Economic development, individualism and social integration. The International Scope Review, 5, 9–Shajahan, P.M. , Cavanagh, J.T.O. (1998). Admission for depression among men in Scotland, 1980-95: retrospective study. British Medical Journal, 316, 1496– 1497Singh, G.K. , Siahpush, M. (2002). Increasing rural-urban gradients in US suicide mortality, 1970-1997. American Journal of Public Health, 92, 1161– 1167Snowdon, J. , Harris, L. (1992). Firearms suicides in Australia. Medical Journal of Australia, 156, 79– 83Stack, S. (1982). Suicide - a decade review of the sociological literature. Deviant Behavior, 4, 41– 66Stallones, L. , Cook, M. (1992). Suicide rates in Colorado 1980-1989: Metropolitan, non-metropolitan and farm comparisons. Journal of Rural Health, 8, 139– 142Stark, C. , Hopkins, P. , Gibbs, D. , Rapson, T. , Belbin, A. , Hay, A. (2004). Trends in suicide in Scotland 1981-1999: Age, method, and geography. BioMed Central Public Health, 4, 49–(2002). Suicides and suicide rate by sex and age groups . Ottawa, Ontario, Canada: Health Statistics Division
Steenland, K. , Jenkins, B. , Ames, R.G. , Omalley, M. , Chrislip, D. , Russo, J. (1994). Chronic neurological sequelae to organophosphate pesticide poisoning. American Journal of Public Health, 84, 731– 736Stokes, L. , Stark, A. , Marshall, E. , Narang, A. (1995). Neurotoxicity among pesticide applicators exposed to organophosphates. Occupational and Environmental Medicine, 52, 648– 653Strawn, B.D. , Hester, S. , Brown, W.S. (1998). Telecare: A social support intervention for family caregivers of dementia victims. Clinical Gerontologist, 18, 66– 69Svenson, J.E. , Spurlock, C. , Nypaver, M. (1996). Pediatric firearm-related fatalities. Not just an urban problem. Archives of Pediatrics Adolescent Medicine, 150, 583– 587Taylor, R. , Page, A. , Morrell, S. , Harrison, J. , Carter, G. (2005). Social and psychiatric influences on urban-rural differentials in Australian suicide. Suicide & Life-Threatening Behavior, 35, 277– 290Thompson, T.R. (1987). Childhood and adolescent suicide in Manitoba - a demographic study. Canadian Journal of Psychiatry-Revue Canadienne de Psychiatrie, 32, 264– 269Thu, K. , Lasley, P. , Whitten, P. , Lewis, M. , Donham, K.J. , Zwerling, C. (1989). Stress as a potential risk factor for agricultural injuries: Comparative data from the Iowa Farm Family Health and Hazard Survey (1994) and the Iowa Farm and Rural Life Poll (1989). Journal of Agromedicine, 4, 181– 192Turvey, C. , Stromquist, A. , Kelly, K. , Zwerling, C. , Merchant, J. (2002). Financial loss and suicidal ideation in a rural community sample. Acta Psychiatrica Scandinavica, 106, 373– 380(2003). Measuring rurality: What is rural? . Washington DC: Economic Research Service
van der Hoek, W. , Konradsen, F. (2005). Risk factors for acute pesticide poisoning in Sri Lanka. Tropical Medicine & International Health, 10, 589– 596Varnik, A. , Wasserman, D. (1992). Suicides in the former Soviet republics. Acta Psychiatrica Scandinavica, 86, 76– 78Vougiouklakis, T. , Boumba, V.A. , Mitselou, A. , Peschos, D. , Gerontopoulos, K. (2005). Trends in suicide mortality in the deprived region of Epirus (northwest Greece) during the period 1998-2002. Medicine, Science & the Law, 45, 39– 46Wagenfeld, M. (2000). Organization and delivery of mental health services to adolescents and children with persistent and serious mental illness in frontier areas (Rep. No. 16). Frontier Mental Health Services Resource Network, University of DenverWagenfeld, M. , Murray, J.D. , Mohatt, D.F. , De Bruyn, J. (1994). Mental health and rural America 1980-1993: An overview and annotated bibliography . Rockville, MD: Office of Rural Health Policy, Health Resources and Services AdministrationWatanabe, N. , Hasegawa, K. , Yoshinaga, Y. (2005). Suicide in late life in Japan: Urban and rural differences. International Psychogeriatrics, 7, 253– 261Whitley, E. , Gunnell, D. , Dorling, D. , Smith, G.D. (1999). Ecological study of social fragmentation, poverty, and suicide. British Medical Journal, 319, 1034– 1037(2003). Country reports and charts . Geneva: Author
(1990). Public health impact of pesticides used in agriculture . Geneva: World Health Organization
Wilkinson, K.P. , Israel, J.D. (1984). Suicide and rurality in urban society. Suicide & Life-Threatening Behavior, 14, 187– 199Willis, L.A. , Coombs, D.W. , Drentea, P. , Cockerham, W.C. (2003). Uncovering the mystery: Factors of African American suicide. Suicide & Life-Threatening Behavior, 33, 412– 429Yan, C. , Dong, H. , Xu, Y. , Zhang, S. , Wang, Y. , Zhu, W. (2000). A cross-sectional study on injuries in the residents of Shijiazhuang city. Chinese Journal of Preventive Medicine, 34, 206– 208Yang, G.H. , Zhou, L.N. , Huang, Z.J. , Chen, A.P. (2004). The trend and geographic distribution of suicide in Chinese population. Chinese Journal of Epidemiology, 25, 280– 284Yip, P. , Callanan, C. , Yuen, H. (2000). Urban-rural and gender differentials in suicide rates: East and west. Journal of Affective Disorders, 57, 99– 106Yip, P.S. (2001). An epidemiological profile of suicides in Beijing, China. Suicide & Life-Threatening Behavior, 31, 62– 70Yip, P.S. , Liu, K.Y. , Hu, J. , Song, X.M. (2005). Suicide rates in China during a decade of rapid social changes. Social Psychiatry & Psychiatric Epidemiology, 40, 792– 798Zhang, J. , Conwell, Y. , Zhou, L. , Jiang, C. (2004). Culture, risk factors, and suicide in rural China: A psychological autopsy case control study. Acta Psychiatrica Scandinavica, 110, 430– 437Zhao, S. , Qu, G. , Peng, Z. , Peng, T. (1994). The sex ratio of suicide rates in China. Crisis, 15, 44– 48
