Investigating Suicide Risk Factors Among Appalachian West Virginian Adults.

Introduction: Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services.

Purpose: This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian.

Region methods: Using 2021 Mountain State Assessment of Trends in Community Health (MATCH) survey data, we examined socioeconomic and related factors associated with lifetime suicide risk in WV, measured by the first item of the Suicide Behaviors Questionnaire-Revised (SBQ-R). Logistic regression models identified significant risk and protective factors. Models were stratified by rural residence using 2023 Rural-Urban Continuum Codes (RUCC) to examine rural-urban disparities, given WV's predominantly rural yet urban-diverse geography.

Results: In the weighted sample (N=372,665), 27.5% reported lifetime suicide risk. Those with suicidal thoughts were younger (median age 41), unmarried, in poorer health, and often enrolled in Medicaid. Despite WV's rural profile, 60.21% of respondents resided in urban-classified counties. Rural residents showed lower odds of suicidal thoughts or behaviors (aOR = 0.87), but factors such as substance use (aOR = 3.75), unmarried status (aOR = 1.51), and mental health disorders (aOR = 2.93) were significant risk factors.

Implications: Suicide risk factors in WV differ from broader suicidology findings, underscoring the need to address substance use, chronic pain, and mental health in prevention strategies. Further research is needed to explore regional differences in the Appalachian Region for better-targeted interventions.