Increased rates of suicide ideation and attempts in rural dwellers following the SARS-CoV-2 pandemic

Elizabeth Salt, Amanda T. Wiggins, Julie Cerel, Claire Marie Hall, Misty Ellis, Gena L. Cooper, Brian W. Adkins, Mary Kay Rayens

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS-CoV-2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS-CoV-2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS-CoV-2 to same months of the preceding year (3/18/2020-9/18/20; 3/18/2019-9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department). Methods: Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2-sample t-test, chi-square test of association, or Fisher's exact test. Findings: Suicidal ideation encounters increased in the 6 months post-SARS-CoV-2 when compared to the 6 months of the prior year (IRR = 1.19; P <.001). Males (IRR = 1.27, P <.001), those residing rural areas (IRR = 1.22, P =.01), and Black, non-Hispanic (IRR = 1.24, P =.024) were found to have increased rates of suicide ideation post-SARS-Cov-2. In adults, White, non-Hispanics (IRR = 1.16; P <.001) had increased rates of post-SARS-CoV-2. In the pediatric subset, those who were aged 14-17 (IRR = 1.50; P <.001), resided in rural areas (IRR = 1.61, P =.009), and idenitifed as Hispanic (IRR = 1.89; P =.037) or Black, non-Hispanic (IRR = 1.61, P =.009) had increased rates post-SARS-CoV-2. Conclusions: Our study identified rural dwellers to be at increased risk for suicide ideation.

Original languageEnglish
Pages (from-to)30-38
Number of pages9
JournalJournal of Rural Health
Issue number1
StatePublished - Jan 1 2023

Bibliographical note

Funding Information:
The authors would like to acknowledge the bioinformatics staff at the CCTS for their work on this project (NIH grant # UL1TR001998).

Publisher Copyright:
© 2022 National Rural Health Association.


  • demographics
  • emergency department
  • inpatient
  • rural
  • suicide attempt
  • suicide ideation
  • urban

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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