Help-seeking behavior among adults who attempted or died by suicide in Ontario, Canada

Introduction — This study aims to determine the relationship between rurality and help-seeking behavior prior to a suicide or suicide attempt.

Methods — Data from 2007 to 2017 were obtained from administrative databases held at ICES, which capture all hospital, emergency department (ED), and general practitioner (GP) visits across Ontario. Rurality was defined using the Rurality Index of Ontario scores. Help-seeking was based on accessing health services 1 year prior to the event.

Results — Among those who died by suicide (N = 9848), those living in rural areas were less likely to seek help from a psychiatrist (rural males: AOR = 0.42, 95% CI = 0.31–0.57; rural females: AOR = 0.46, 95% CI = 0.29–0.97) compared with those living in urban areas. We found a similar association among those who attempted suicide (N = 82,480) (rural males: AOR = 0.49, 95% CI = 0.43–0.56; rural females: AOR = 0.51, 95% CI = 0.46–0.57). Rural males and females were more likely to seek care from an ED for mental health reasons compared with urban males and females.

Conclusions — Among people who died by suicide, those living in rural areas are generally less likely to access psychiatrists and GPs and more likely to access EDs, suggesting that people living in rural areas may have less access to care than their urban counterparts.