Understanding Rurality and Associated Suicide Risks: Perspectives of Adolescents and Caregivers

Children and adolescents living in United States rural communities exhibit a suicide rate nearly twice as high as their urban counterparts, yet their perspectives are under-represented in suicide prevention research. This study explores how rural-residing adolescents and their caregivers conceptualize rurality and describes their perceptions of suicide risks and opportunities for risk reduction in rural communities.

We conducted semi-structured interviews with rural-residing adolescents (ages 12-17 years) and their caregivers who presented to emergency departments in New Hampshire and Vermont with suicidal ideation or attempt. Interview questions asked participants to define "rural" and describe mental health and suicide risks specific to rural environments. Transcripts were de-identified, professionally transcribed, and coded using practical thematic analysis.

We interviewed 27 adolescents (mean age 14.7 years; 88.9% female) and 27 caregivers (mean age 46.7 years; 77.8% female). Emergent themes aligned with two domains: (i) the context of living in rural communities (structural attributes of rurality, interpersonal attributes of rurality, and duality of perspectives), and (ii) suicide risk factors perceived as unique to rural communities (ease of access to lethal means, barriers to accessing mental healthcare, role of stigma, and online resources and digital spaces). Adolescents and caregivers shared perspectives about lethal means access and healthcare barriers, while perspectives about rurality and online resources differed.

These findings can inform the design, implementation, and evaluation of suicide prevention initiatives in rural communities, accounting for community-specific risk factors and protective elements as conceptualized by adolescents and their caregivers with lived experience.