Suicide in rural areas: An updated review of the literature.

Suicide is a significant public health concern at a global level and occurs at a greater rate in rural compared with urban areas. A review of the literature on rural suicide indicates that a growing body of empirical, theoretical, and prevention work has been conducted on the topic, with an increasing number of countries represented and articles written. From an ecological perspective, current data and models suggest that our approach to understanding and preventing rural suicide must be multifaceted, addressing the individual level (e.g., traditional risk factors such as psychiatric illness), as well as the microsystem (e.g., family and peer relations), mesosystem (e.g., the interconnectedness between microsystems), exosystem (e.g., the rural community), and macrosystem (e.g., social norms) levels. Geographic and interpersonal isolation, agricultural or otherwise hazardous vocational demands, environmental and governmental policies, availability of means, lack of access to care and rural ideologies appear to contribute to suicide risk. Interventions must be community-driven, culturally acceptable and feasible within the context of available resources to be effective. Prospective research on risk and protective factors for rural suicide is required, as is development, implementation and assessment of interventions that are originated by, implemented in, and sensitive to the needs of rural communities.