Contextual Factors Associated With County-Level Suicide Rates in the United States, 1999 to 2016

Key Points Question What are the spatial and temporal trends in suicide rates, how are contextual-level factors associated with suicide, and do these associations vary across the rural-urban continuum? Findings This cross-sectional study found that suicide rates in the United States increased from 1999 to 2016, with the greatest increase in rural counties. Deprivation had a disproportionately negative association with suicide rates in rural counties, the presence of gun shops and a higher percentage of uninsured individuals were associated with higher suicide rates, and high social capital was associated with lower suicide rates. Meaning Understanding geographical differences in suicide rates and community-level risk and protective factors can inform development and implementation of targeted suicide prevention strategies.