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Suicide among patients in the Veterans Affairs health system: Rural-urban differences in rates, risks, and methods

Author

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  • McCarthy, J.F.
  • Blow, F.C.
  • Ignacio, R.V.
  • Ilgen, M.A.
  • Austin, K.L.
  • Valenstein, M.

Abstract

Objectives: Using national patient cohorts, we assessed rural-urban differences in suicide rates, risks, and methods in veterans. Methods: We identified all Department of Veterans Affairs (VA) patients in fiscal years 2003 to 2004 (FY03-04) alive at the start of FY04 (n = 5 447 257) and all patients in FY06-07 alive at the start of FY07 (n = 5 709 077). Mortality (FY04-05 and FY07-08) was assessed from National Death Index searches. Census criteria defined rurality. We used proportional hazards regressions to calculate rural- urban differences in risks, controlling for age, gender, psychiatric diagnoses, VA mental health services accessibility, and regional administrative network. Suicide method was categorized as firearms, poisoning, strangulation, or other. Results: Rural patients had higher suicide rates (38.8 vs 31.4/100 000 personyears in FY04-05; 39.6 vs 32.4/100 000 in FY07-08). Rural residence was associated with greater suicide risks (20% greater, FY04-05; 22% greater, FY07-08). Firearm deaths were more common in rural suicides (76.8% vs 61.5% in FY07-08). Conclusions: Rural residence is a suicide risk factor, even after controlling for mental health accessibility. Public health and health system suicide prevention should address risks in rural areas.

Suggested Citation

  • McCarthy, J.F. & Blow, F.C. & Ignacio, R.V. & Ilgen, M.A. & Austin, K.L. & Valenstein, M., 2012. "Suicide among patients in the Veterans Affairs health system: Rural-urban differences in rates, risks, and methods," American Journal of Public Health, American Public Health Association, vol. 102(S1), pages 111-117.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2011.300463_7
    DOI: 10.2105/AJPH.2011.300463
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    Cited by:

    1. Scott D. Landes & Andrew S. London & Janet M. Wilmoth, 2018. "Mortality Among Veterans and Non-veterans: Does Type of Health Care Coverage Matter?," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 37(4), pages 517-537, August.
    2. Christopher Tencza & Andrew C. Stokes & Samuel Preston, 2014. "Factors responsible for mortality variation in the United States: A latent variable analysis," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 31(2), pages 27-70.
    3. Judith Casant & Marco Helbich, 2022. "Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review," IJERPH, MDPI, vol. 19(5), pages 1-15, February.

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