The Role of Firearms in Rural-Urban Differences in Suicide in Maryland

A recent study found that Maryland’s rural-urban differences in suicide rates may be attributable to higher firearm suicide rates in rural areas.

Researchers examined data from 6,875 suicide deaths recorded in Maryland between 2003 and 2015. They used the U.S. Department of Agriculture’s Rural-Urban Continuum Codes to categorize counties of residence by population size and proximity to metropolitan areas (i.e., urbanicity). After removing non-Maryland residents, decedents with key missing data, and youth under the age of 15, they analyzed overall suicide rate, firearm suicide rate, and non-firearm suicide rate for each category of urbanicity, controlling for sex, age, and race/ethnicity. They also tested whether the association between urbanicity and suicide methods was more pronounced in some populations than others. 

The researchers found a 35 percent higher suicide rate in rural counties compared to the most urban counties. They also found a 66 percent higher firearm suicide rate in the most rural counties compared to the most urban counties, but no significant differences between urbanicity and non-firearm suicide rates. Further, men in rural counties were more likely to die by suicide than men in the most urban counties. The researchers concluded that higher suicide rates in rural Maryland counties are likely attributable to firearm suicides among men.

These findings suggest that suicide prevention services should target men in rural areas with access to firearms, and that rural suicide rates may be reduced by more robust rural gun safety initiatives.

Nestadt, P. S., Triplett, P., Fowler, D. R., & Mojtabai, R. (2017). Urban-rural differences in suicide in the state of Maryland: The role of firearms. American Journal of Public Health, 107(10), 1548–1553.