137 - Understanding Rurality and Associated Suicide Risks: Perspectives of Adolescents and their Caregivers

Publication Number: 1127.137

Gwenyth M. Gasper, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Sophia Allen, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, United States; Jacqueline A. Pogue, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States; Hannah B.. Leavitt, Geisel School of Medicine at Dartmouth, Georgetown, TX, United States; Alyssa C. Helmling, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Nikolas G. Hernandez, Geisel School of Medicine at Dartmouth, White River Junction, VT, United States; Emma R. Jacobs, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Saskia L. Vanderwiel, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Hailey M. Cantwell, Children's Hospital at Dartmouth-Hitchcock, Concord, NH, United States; Vinisha Velmineti, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Christine Finn, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Alison Kapadia, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Maia Rutman, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; JoAnna Leyenaar, The Dartmouth Institute of Health Policy & Clinical Practie, Lebanon, NH, United States

Background: There is stark rural-urban disparity in youth suicide, with youth living in rural communities exhibiting a suicide rate nearly double that of their urban counterparts. Rural-residing youth also experience higher rates of poverty, geographic isolation, mental health stigma, and decreased access to care, all of which are well-documented drivers of poor mental health in these populations. However, there is a scarcity of literature exploring adolescent and caregiver perspectives on suicide risks and prevention strategies specific to rural settings.

Objective: To better understand how rural-residing individuals conceptualize "rurality" and the unique opportunities and challenges that exist in rural communities with regard to youth mental health and suicide risk.

Design/Methods: We leveraged community-based participatory research to conduct semi-structured interviews with rural-residing adolescents (ages 12-17 years) and caregivers, who presented to emergency departments in northern New England with suicidal ideation or attempt. Interview questions asked participants to define "rural," discuss what living in a "rural" area meant to them, and describe unique mental health and suicide risks in rural communities. Transcripts were de-identified, professionally transcribed, and coded using practical thematic analysis.

Results: We interviewed 27 adolescents (mean age 14.7 yrs; 88.9% female, 11.1% male) and 27 caregivers (mean age 46.7 yrs; 77.8% female, 22.2% male) (Table 1). Individual conceptualizations of "rurality" were diverse and highlighted both perceived advantages (quiet, scenic, safe, tight-knit community, connection to nature) and disadvantages (sparse infrastructure, limited resources, sense of isolation) of living in a rural community (Table 2). Both youth and caregivers mentioned ease of access to lethal means as a significant risk factor for youth suicide, and also discussed lack of mental health resources as a negative driver of poor mental health. Lack of youth activities was of particular concern, and perceived to contribute to a sense of social isolation. This was in contrast to frequent discussions around greater social visibility in rural communities, where "everyone knows everyone", a bittersweet sentiment for both youth and caregivers.

Conclusion(s): Results of this study illustrate the importance of considering unique rural contexts in suicide prevention efforts. Future implementation work intended to decrease suicide risk in rural communities should include discussions of resource availability and culturally sensitive safety planning to reduce access to lethal means in these populations.

Table 1. Demographic characteristics of study participants.


Table 2. Topics, themes, and representative quotes on rurality and associated suicide risks from the perspectives of youth and caregivers.