Studies from across the world find higher rates of suicide in rural versus urban areas (Plotnikov, 2001; Yip, 2001; Yip et al., 2000). In China, for example, the rate is two to five times greater in rural regions (Ji et al., 2001; Jianlin, 2000; Phillips et al., 1999; Yip, 2001). Higher rates in rural regions have also been documented for young males in Australia (Wilkinson and Gunnell, 2000) and in the Ukraine (Kryzhanovskaya and Pilyagina, 1999). Even among adolescents in Greece, where the suicide rate is relatively low, urban areas report significantly lower rates than rural areas (Beratis, 1991). In China (Yip et al., 2000), unlike Australia for example (Morrell et al., 1999), the usual pattern of more suicides among men than women is reversed in rural areas due to the very high female suicide rate, especially among young women (Ji et al., 2001; Yip, 2001; Yip et al., 2000).

Like the United States (see below), suicide rates are higher in rural areas in China. In 1998, women in rural China completed suicide at a rate of over 30 per 100,000 for ages 25–34 and 45–64, with increasing rates at older ages (WHO, 2001a). The male rate surpasses that for women starting at age 55, with over 129 per 100,000 dying by suicide over the age of 75 in rural China (WHO, 2001a). In comparison, the overall rate for females and males in urban China is 6.8 per 100,000 in 1998, with the highest rate for males over 75 at about 32 per 100,000 (WHO, 2001a).

Suicide rates vary greatly across the United States, with higher rates generally in the western states. New Jersey is the lowest with 6.4/100,000 in 1998. Nevada and Alaska are the highest with rates in excess of 21/ 100,000 (Murphy, 2000). Mapping the rates by county (see Appendix A and Figure 2-2) illustrates that those counties with the highest rates are predominantly in the western states with lowest population density. Counties with the lowest rates (7.5 suicides per 100,000) appear to be clustered in the central United States. Finally, counties classified with intermediate rates are largely in the eastern portion of the United States. Population density has been suggested as a factor in these differences (Saunderson and Langford, 1996). Examining the suicide rates by urbanization in the United States reveals that the rates are higher in less populated area compared to densely populated cities (Figure 2-3). For the most part this difference is a reflection of the decrease in firearm suicides with urbanization (Figure 2-4). This relationship of suicide by firearms and population density is even more dramatic when suicide among elderly persons is explored. Among the elderly, suicide by firearms decreases dramatically with increased urbanization (Figure 2-5), but non-firearm suicides are more common in urban areas. When controlling for education, employment status, and divorce rate, Birckmayer and Hemenway (2001) also found that living in urban areas was associated with increases in U.S. suicide rates for non-firearm suicides among adults.



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