Socioeconomic deprivation and suicide in Appalachia: The use of three socioeconomic deprivation indices to explain county-level suicide rates

Objective: West Virginia's (WV) suicide rate is 50% higher than the national average and is the highest in the Appalachian Region. Appalachia has several social factors that have contributed to greater socioeconomic deprivation, a known contributor of suicide. Given WV's high prevalence of suicide and poverty, the current study aims to examine the relationship between socioeconomic deprivation and suicide rates in WV.

Methods: The Townsend Deprivation Index (TDI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI) measured socioeconomic deprivation. Negative binomial regression models assessed the relationship between socioeconomic deprivation scores, individual index items, and suicide rates. Model comparisons evaluated the indices' ability to assess suicide rates. A backward selection strategy identified additional key items for examining suicide rates.

Results: There was a significant increase in suicide rates for every 10% increase in TDI (β = 0.04; p < 0.01), SDI (β = 0.03; p = 0.04), and SVI scores (β = 0.05; p < 0.01). Household overcrowding and unemployment had a positive linear relationship with suicide in TDI (β = 0.04, p = 0.02; β = 0.07, p = 0.01), SDI (β = 0.10, p = 0.02; β = 0.01, p<0.01), and the SVI (β = 0.10, p = 0.02; β = 0.03, p<0.01). The backwards selection strategy identified additional key items included by the SVI when assessing suicide.

Conclusion: Greater socioeconomic deprivation, measured by the TDI, SDI, and SVI, was significantly associated with higher suicide rates. Expanding unemployment benefits and increasing the availability of affordable housing, especially in rural areas, may be useful in reducing suicide rates. Our results suggest racial and ethnic minorities and adults living with a disability may benefit from targeted suicide prevention strategies.