Analysis of Multi-Domain Factors Influencing Mental Health and Suicide: A Comparative Study of Urban and Rural Areas at City, County, and District Levels in Korea

Background: This study assessed social determinants in urban and rural nationalities to identify regional factors associated with mental health and suicide.Methods: Data on 32 variables representing regional characteristics (sociodemographic, health and welfare, environmental, economic, and mental health status including suicide mortality) were collected at the municipal level (si/gun/gu) between 2017 and 2021.For the purpose of analysis, regions were categorized as urban (comprising "si" and "gu") and rural (comprising "gun"); and correlations were examined between stress perception rate, depressive mood experience rate, prevalence of depressive symptoms, and suicide rates.Simple linear regression analysis and multiple linear regression analysis were done.Results: Stress perception, depressive mood experience, and depressive symptom prevalence were higher in urban areas whereas suicide rates were higher in rural areas.Positive correlations were observed between stress, depressive mood, and depressive symptoms in both urban and rural areas (P < 0.001).However, the relationship between stress and suicide showed contrasting patterns: a negative correlation in urban areas (P = 0.007) and a positive correlation in rural areas (P = 0.016).In urban areas, sociodemographic and health and welfare factors were primary correlates.Conversely, rural areas showed correlations with certain health and welfare, environmental, and economic factors. Conclusion:The findings reveal distinct patterns in the relationships between stress, depression, and suicide between urban and rural areas.These results underscore the need for tailored suicide prevention policies and mental health interventions that address the unique characteristics of each region.