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Research / Funded grants

2020 Standard Research Grant

Exploring Place-Based Differences in Adolescent Suicide, Mental Health, and Suicide Mechanism

2 research findings from this AFSP-funded study.

Research finding · April 2025

The number of emergency department visits for suicidal thoughts and behaviors varied by geography during COVID-19

The COVID-19 pandemic has had profound effects on mental health, with increases in depression, anxiety, and suicidal thoughts and behaviors reported worldwide. While overall suicide rates showed mixed trends during the pandemic, certain communities may have experienced a disproportionate mental health burden. Identifying geographic clusters of depression and suicide-related emergency department (ED) visits can provide insight into the regions most affected and guide targeted interventions. However, little research has examined the spatial and temporal patterns of these mental health crises before and during the pandemic. Understanding these shifts is crucial for addressing disparities and improving access to mental health care in vulnerable areas.

With her AFSP-funded grant, Dr. Maragaret Sugg analyzed ED visit data from North Carolina between 2017 and 2021, identifying geographic clusters of depression and suicide-related outcomes before and during the pandemic. She found that the mental health burden remained high, with rural communities experiencing the largest increases in the co-occurrence of depression and suicide-related ED visits during the pandemic. While urban areas continued to have persistent mental health clusters, new rural clusters emerged, particularly in western North Carolina. These findings highlight the need for sustained and geographically targeted mental health interventions, especially in rural regions that may face barriers to care. Addressing these disparities through improved access to crisis support and community-based mental health services could help mitigate the long-term impact of the pandemic on suicide risk.

Citation: Ryan, S. C., Desjardins, M. R., Runkle, J. D., Wertis, L., & Sugg, M. M. (2023). Evaluating co-occurring space-time clusters of depression and suicide-related outcomes before and during the COVID-19 pandemic. Spatial and spatio-temporal epidemiology, 47, 100607. https://doi.org/10.1016/j.sste.2023.100607

This finding comes from an AFSP-funded study — see the grant below ↓

Research finding · April 2023

The COVID-19 Pandemic impacted frontline workers and their children

While the COVID-19 pandemic impacted everyone, research shows that some populations were affected differently than others. Dr. Maggie Sugg found unique mental health challenges faced by frontline and essential workers.

When examining data from people who contacted the Crisis Text Line during the pandemic, Dr. Sugg found that essential workers seeking help were more likely to report suicidal thoughts than non-essential workers. Additionally, children of essential workers aged 13 and under also reported significant stress, including suicidal thoughts. These findings show us that supportive interventions and mental health resources are needed, not only for frontline essential workers, but for their children, too.

This finding comes from an AFSP-funded study — see the grant below ↓

The grant behind this work · 2020 Standard Research Grant

Exploring Place-Based Differences in Adolescent Suicide, Mental Health, and Suicide Mechanism

Margaret Sugg, PhD

Margaret Sugg, Ph.D.

Appalachian State University

Amount awarded
$99,990 Focus area
Psychosocial

Inside the Research

There are geographic differences in suicide rates, with higher rates found in rural areas than urban areas. Efforts will focus on identifying the individual and community-level social, environmental, and economic risk factors for adolescent suicide for specific locations. This may lead to better understanding of rural-urban disparities in suicide rates.

Key Findings

  • The COVID-19 pandemic was associated with increased reports of stress and anxiety, substance abuse, bereavement, and isolation particularly among young people and underrepresented communities.
  • Findings from Dr. Suggs’s crisis-text-line-based research demonstrated the significant burden shouldered by frontline essential workers, who exhibited an alarming trend in suicidal thoughts. Children of frontline essential workers also reported significant stress.
  • In addition to addressing the needs of our frontline essential workers, we also need to understand that their children have increased stress, anxiety, and suicidal ideation, and are need of more targeted mental health interventions as well.

Related Publications

  • Runkle, J. D., Sugg, M. M., Yadav, S., Harden, S., Weiser, J., & Michael, K. (2021). Real-Time Mental Health Crisis Response in the United States to COVID-19. Crisis. https://doi.org/10.1027/0227-5910/a000826
  • Runkle, J. D., Yadav, S., Michael, K., Green, S., Weiser, J., & Sugg, M. M. (2022). Crisis Response and Suicidal Patterns in U.S. Youth Before and During COVID-19: A Latent Class Analysis. Journal of Adolescent Health, 70(1), 48–56. https://doi.org/10.1016/j.jadohealth.2021.10.003
  • Harden, S. R., Runkle, J. D., Weiser, J., Green, S., & Sugg, M. M. (2021). Spatial Clustering of Adolescent Bereavement in the United States During the COVID-19 Pandemic. Journal of Adolescent Health, 69(1), 140–143. https://doi.org/10.1016/j.jadohealth.2021.04.035
Full scientific abstract

Suicide is the second leading cause of death among adolescents and has increased by 56% from 2007 to 2017. Research has shown a marked rural-urban disparity in suicide deaths for this age group. Identifying and establishing geographic hotspots along the rural-urban continuum in which adolescents are at greater risk for adverse mental health outcomes is a complex issue involving a combination of social, environmental, and/or economic variables related to spatial location.  We will leverage recent advances in spatial analytics paired with longitudinal mental health data from state-based surveillance systems to tease apart these dynamic and complex interactions.

Our focus will be on adolescent populations and the following primary mental health outcomes: emergency department visits for 1) Mood or Behavioral disorders (MBD) including anxiety, depression, major affective disorder, and schizophrenia; (2) Self-harm and Suicidal Attempts; (3) Aggression (4) Alcohol and Substance Abuse , as well as suicide-related deaths. The objective of this exploratory hypothesis-generating study is to identify geographic disparities in individual and community-level risk factors for adolescent suicide and suicide ideation.  More specifically we will address the following aims:

1) Perform a scoping review to map the state of the evidence on socio-environmental factors driving suicide risks in adolescents, with a particular focus on rural America.
H1.1 There will be a gap in the literature concerning the influence of socio-environmental determinants on adolescent suicide risk.

2) Identify spatial clusters of suicide, suicide ideation, access to lethal means, methods of suicide death, and underlying mental health conditions across the rural-urban gradient. 
H2.1 Increases suicide risk will cluster in rural areas compared to urban. 
H2.2 Lower suicide risk will cluster in areas with higher concentrations of mental health providers. 
H2.3 Suicide risk by lethal means will be higher in rural mountain locations.

3) Characterize individual and community-level factors associated with geographic hotspots of elevated suicide risk.
H3.1 Increases in social deprivation will co-occur with a higher risk of suicide in rural areas. H3.2 Rural communities with high poverty rates will have higher rates of suicide and emergency department visits for suicide ideation compared to their urban counterparts. 
H3.3: Gender-based differences across varying levels of social and environmental factors will drive individual-level risks.

4) Recommend strategies for enhanced school-based suicide prevention training for adolescents in the hardest-hit rural communities.
 
Results will identify geographic hotspots at increased risk for suicide across the urban-rural gradient and the underlying association between contextual personal and community-level risk factors.  Comprehensive statewide suicide prevention activities that address the full range of factors contributing to adolescent suicide and upstream mental health conditions are lacking. The team will partner with a student-based nonprofit, Helping Give Away Psychological Science, to develop an open-sourced tool for the mental health and school psychology community to evaluate mental health resource allocation and derive geographically-tailored suicide prevention planning. The next phase of this work will test the efficacy of regionally applied school-based programs on the reduction of suicide and other mental health risks using an implementation science approach.

Related Publications

  1. Runkle, J. D., Sugg, M. M., Yadav, S., Harden, S., Weiser, J., & Michael, K. (2021). Real-Time Mental Health Crisis Response in the United States to COVID-19. Crisis. https://doi.org/10.1027/0227-5910/a000826
  2. Runkle, J. D., Yadav, S., Michael, K., Green, S., Weiser, J., & Sugg, M. M. (2022). Crisis Response and Suicidal Patterns in U.S. Youth Before and During COVID-19: A Latent Class Analysis. Journal of Adolescent Health, 70(1), 48–56. https://doi.org/10.1016/j.jadohealth.2021.10.003
  3. Harden, S. R., Runkle, J. D., Weiser, J., Green, S., & Sugg, M. M. (2021). Spatial Clustering of Adolescent Bereavement in the United States During the COVID-19 Pandemic. Journal of Adolescent Health, 69(1), 140–143. https://doi.org/10.1016/j.jadohealth.2021.04.035

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