• Anne Rhodes, Jennifer Bethell, R Liisa Jaakkimainen, Julie Thurlow, Julie Spence, Paul S Links, and David L Streiner.
• Suicide Studies Unit, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8. rhodesa@smth.toronto.on.ca
• Gen Hosp Psychiatry. 2008 Nov 1;30(6):552-60.

ObjectiveSuicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship.MethodA cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time.ResultsThe rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males.ConclusionsThe rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.

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