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Charles E. Gessert, MD, MPH

Correspondence: Requests for reprints should be sent to Charles E. Gessert, MD, MPH, Division of Education and Research, St Mary’s–Duluth Clinic, 400 E 3rd St, Duluth, MN 55805-1983 (e-mail: cgessert{at}smdc.org).

The research of Singh and Siahpush reported in the July 2002 issue of the Journal contributes substantially to our understanding of the changing demographics of suicide in the United States.¹ Most significantly, the authors have demonstrated that while suicide rates fell or remained static for most groups over the 28 years examined, they have risen substantially for rural men.

While the fact of high and rising suicide rates for rural men is indisputable, the causes remain obscure. The authors suggest that rurality may serve as a marker for low levels of social integration and that social and demographic changes may have affected rural areas more adversely than urban areas. However, these explanations are not wholly satisfying. Density of population is, at best, a poor marker of social integration, in that many rural residents know their neighbors well, while anonymity is more characteristic of urban life. And while social and demographic changes have affected rural areas significantly in recent decades, other powerful forces have been at work in urban areas; the net effect of these changes is open to question in both settings. Finally, male–female differences in rural suicide rates remain unexplained.

Consideration of agrarian cultural values may provide additional insights into high rural male suicide rates. In an examination of the family farm in America, Hanson noted that the farmer—especially the male farmer—tends to place high value on self-reliance and independence, while distrusting government, innovation, and authoritarianism.² In rural culture, health tends to be understood in terms of continuing ability to work and meet responsibilities,³ and independence may be seen as including selfreliance in the face of illness.⁴ The nature of social contracts may also differ between rural and urban communities, with greater emphasis on charity and less emphasis on entitlement in rural areas.⁵ Additionally, geographic and cultural barriers to seeking mental health services in rural areas may be significant.⁶ Taken together, dependence and help seeking—for physical or mental needs—may be much less acceptable in rural culture than in urban culture. In this light, cultural context may go further to explain high suicide rates than the putative social isolation of rural communities.

Ultimately, suicide reflects a determination that death is preferable to life. Such a determination cannot be understood without a thorough understanding of the culture in which it occurs.

References

1. Singh GK, Siahpush M. Increasing rural–urban gradients in US suicide mortality, 1970–1997. Am J Public Health.2002;92:1161–1167.[Abstract/Free Full Text]

2. Hanson VD. Fields Without Dreams: Defending the Agrarian Idea. New York, NY: Free Press; 1996.

3. Sellers SC, Poduska MD, Propp LH, White SI. The health care meanings, values, and practices of Anglo-American males in the rural Midwest. J Transcult Nurs.1999;10:320–330.[Abstract/Free Full Text]

4. Thorson JA, Powell FC. Rural and urban elderly construe health differently. J Psychol.1992;126:251–260.[ISI][Medline]

5. Brown KH. Outside the Garden of Eden: rural values and healthcare reform. Camb Q Healthcare Ethics.1994;3:329–337.[ISI][Medline]

6. Hoyt DR, Conger RD, Valde JG. Psychological distress and help seeking in rural America. Am J Community Psychol.1997;25:449–470.[ISI][Medline]

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This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Gessert, C. E. Search for Related Content PubMed PubMed Citation Articles by Gessert, C. E. Related Collections Rural Health Men's Health