Number of Drinking Establishments Linked to Suicide Rates in Rural Communities

A new study funded by the National Institute on Alcohol Abuse and Alcoholism found that suicides – both completed and attempted – occurred at greater rates in rural community areas with greater bar densities. The study was published in the December issue of Alcoholism: Clinical & Experimental Research.

Researchers examined data – including population characteristics such as age, and place characteristics such as number of alcohol outlets – from 581 zip-code areas in California from 1995 to 2000. They also obtained numbers of hospitalizations for injuries caused by suicide attempts.

"Although one cannot make the strong statement that more bars cause more suicides, our findings are at least consistent with what we would expect if patronizing bars or other alcohol outlets were in fact causally related to suicide," said Fred W. Johnson, associate research scientist at the Prevention Research Center and corresponding author for the study.

The results showed that completed suicides were more common in less populous zip-code areas, such as rural communities, and in zip-code areas with larger proportions of older, lower-income whites, but less common in zip code areas with larger proportions of blacks and Hispanics. Suicide attempts were also more common in rural zip codes, but those who attempted suicide were younger, and included blacks and Hispanics as well as whites.

"This suggests that the suicide rate is higher in rural areas," said Johnson. "The absolute count of suicides may be higher in urban areas because of their much greater population compared to rural areas, but the rate of suicides, the number of suicides per population, is greater in rural areas."

These results could be due to some contextual effect that affects both drinkers and non-drinkers, commented Dennis M. Gorman, interim director of the Health Science Center at Texas A&M University.

"For example, rural places with lots of bars might be depressing places to live in due to isolation, lack of social ties, etc.," Gorman said. "This 'depressing' context would affect all who live there, both drinkers and non-drinkers. The authors seem to suggest such a contextual protective effect when explaining the negative correlation between restaurants and suicides; that [restaurants] are located in areas in which suicides typically do not occur. In this case, it is not the restaurant per se that has a protective effect, but the context or area in which these are located that matters."

Both Johnson and Gorman said these findings highlight a growing problem in rural America.

"Most alcohol problems are not caused by the alcohol dependent, but by ordinary people who drink too much on a given occasion, leading to motor vehicle, pedestrian, and bicycle accidents," said Johnson. "All of these problems are related to alcohol outlets, as are more sinister problems such as homicide, assault, domestic violence, child abuse, and child neglect. This study suggests that suicide may be one of the more severe problems related to alcohol outlets, and further suggests that one way to reduce suicides and other problems related to alcohol outlets is to reduce the number of outlets, particularly bars."