Community-based Suicide Interventions in Rural United States: A Scoping Review

Rural communities in the United States (US) are disproportionately burdened with higher suicide rates than non-rural ones, facing structural and cultural barriers that make it less likely for suicidal individuals to obtain help. Community-based interventions have been called for to address the need for integrative approaches relevant to the rural landscape. To facilitate increased adaptation/implementation of rural suicide prevention programming, we conducted a scoping review of the literature to evaluate the state-of-the-science. Following PRISMA-ScR guidelines, we searched for and identified relevant peer-reviewed literature across four databases, using dual screening/extraction throughout. We extracted information on key article characteristics, program descriptions, and methodological approaches to identify trends, gaps, and emergent themes. 29 articles were included in this review. Studies predominantly focused on suicide prevention for youth, particularly amongst Indigenous communities, with papers also concentrating on medical settings and US veterans. While a wide range of intervention and evaluation approaches were employed, few studies measured clinical outcomes, utilized theoretical frameworks or official rural definitions, or used comprehensive prevention strategies. This review offers investigators a guide to the existing evidence base and growing patterns in the field of suicide prevention in rural US areas. Results highlight the dearth of literature on prevention programming in this much needed yet overlooked area of study. Future intervention research should consider using context-specific rural classifications, relevant clinical outcomes, and comprehensive theory-backed strategies embedded in their approach.