Trends in suicide by level of urbanization, United States, 1999–2015

During 1999–2015, suicide rates increased across all levels of urbanization, with the gap in rates between rural and urban areas widening over time, especially later in this time period. These disparities may reflect risk factors known to be more prevalent in rural areas such as limited access to mental health care, social isolation and opioid overdose, which is associated with increased risk of suicide. The gap in rates rose more dramatically after 2007-2008, possibly due to the economic recession, which disproportionately affected less urban areas.