From unplanned attempts to planned deaths: A comparative analysis of suicidal behavior in rural Türkiye

Suicidal behavior involves thoughts, plans, and acts aimed at self-harm and remains a major public health issue in rural settings due to limited mental health access and social isolation. This study analyzed 610 adults who presented with suicidal behavior in rural Türkiye between January 2020 and May 2024, comparing 538 nonfatal attempts with 72 deaths. Deaths were mostly premeditated (66.6%) and violent acts among older men (mean age 38.6 years; 88.9%), often widowed or divorced. Nonfatal attempts were primarily unplanned (82.2%) medication overdoses (92%) among younger women. Logistic regression showed that higher age, male sex, widowhood or divorce, retirement, and violent methods predicted mortality, while current psychiatric medication use was protective. Substance misuse and lack of psychiatric follow-up increased risk. These findings highlight gender and cultural differences in suicidal behavior and emphasize the need for stronger outpatient continuity, addiction services, and lethal means restriction in rural communities.