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

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.