Suicide rates highest in rural counties across country

Research by the Centers for Disease Control and Prevention published in the October 6, 2017 issues of Morbidity and Mortality Weekly Report, found the highest suicide rates across the country in 2013-2015 were in rural counties. While the overall suicide rate was just under 14 deaths per 100,000 people, in rural counties the rate was almost 20 deaths per 100,000 people.

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Consistent with the findings in the CDC report above, suicide rates in New Jersey are highest in three rural counties – Salem County at 15.3 deaths per 100,000 people, followed by 14.8 in Sussex County and 13.5 in Cape May County.

Suicide is the tenth leading cause of death in the U.S. and has been among the top causes continuously since 1975. Suicide is a preventable cause of death and as such, it behooves us all of us to know the risk factors, warning signs and actions to take to prevent a death. This is especially important for those of us who live in a rural area.

There are many factors that increase the risk of suicide. Listed below are those identified by the Centers for Disease and Prevention:

  • Previous suicide attempts
  • Family history of suicide
  • History of alcohol or drug abuse
  • History of violence
  • Depression or other mental illnesses
  • Significant stressful life events (job loss, death of relative, divorce, etc.)
  • Access to lethal methods

In addition to the risk factors, knowing the warning signs of suicide especially in someone with an increased risk, goes a long way to getting the person help. The following are common warning signs to look and listen for compiled from the Mayo Clinic and the American Association of Suicidology:

Talking about suicide.  
Listen for statements such as: "I'm going to kill myself," "I wish I were dead," "I wish I hadn't been born," “Everyone would be better off if I were dead.”


Getting the means together
Watch for means gathering behaviors such as: collecting pills, researching lethal doses, buying a gun.


Beware of wanting to be alone and isolation from social contact

Mood swings
Watch for mood changes such as being emotionally high or happy one day and sad, discouraged or depressed, the next


Preoccupation with death, dying or violence

Be aware of conversations focused on death or dying


Feeling trapped or hopeless about a situation

Listen for comments about not having a way out of a situation or not seeing any way for a situation to improve


Increasing use of alcohol or drugs

Watch for an increase use of drugs or alcohol.


Changing normal routine, including eating or sleeping patterns

Observe changes in daily routines and behaviors - eating more or less, sleeping more or less, etc.  


Engaging in risky or self-destructive behaviors
Watch for risk taking behaviors out of the norm for the person - such as using drugs or driving recklessly, running in front of trucks, trains.

Giving away belongings
Watch for prized possessions being given away, things being cleaned out 

Getting affairs in order
Watch for behaviors related to updating wills, making final arrangements, closing accounts when there is no other logical explanation for doing this


Saying goodbye

Be aware of the need to visit people as if they won't be seen again


 Developing personality changes
Watch for anxiousness or agitation, particularly when experiencing some of the warning signs listed above

The American Association of Suicidology’s uses a pneumonic for remembering the warning signs – IS PATH WARM?

Substance Abuse


A   Anger
Mood Changes


Someone is in imminent danger of suicide if he/she:

Threatens to hurt or kill him or herself
Talks about wanting to hurt or kill him or herself


Looks for ways to kill him/herself – pursues getting the means
Talks or writes about death, dying or suicide when these actions would be out of the ordinary

If someone you know is in imminent danger, below are some actions to take:

1. Stay with the person – don’t leave him or her alone

2. CALL 911

3. Encourage him or her to talk

4. Listen without judgement and avoid challenging what is being said.

Add the following National Suicide Prevention Lifeline number to your phone contacts:

1-800-273-TALK (1-800-273-8255)

For more information

American Association of Suicidology

National Suicide Prevention Lifeline

Mayo Clinic

Suicide Myths
Nevada Division of Public and Behavioral Health


Joanna Hayden, PhD, CHES is the principal of Associates for Health Education and Behavior, LLC, in Sparta, a practice focused on improving health through education. Her office offers individual and group health education, and individual health behavior change guidance.  For more information please see  To contact Dr. Hayden, email her

The opinions expressed herein are the writer's alone, and do not reflect the opinions of or anyone who works for is not responsible for the accuracy of any of the information supplied by the writer.

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