Defense Date

5-14-2024

Graduation Date

Summer 8-2024

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

Committee Chair

Alison Colbert

Committee Member

James Schreiber

Committee Member

Tracy Hellem

Committee Member

Peter Buerhaus

Keywords

suicide, rural, altitude, Montana, prescribers, mental health

Abstract

Introduction: Suicide is increasingly prevalent in rural areas across the United States, especially in the western Rocky Mountain states. The connection between suicide and rural residency is not well understood, nor is the relationship between the distribution of prescribers, altitude, and suicide. Purpose: This retrospective quantitative study aimed to describe the characteristics of individuals who died by suicide in Montana and investigate the associations among rurality, distribution of prescribers, altitude, and suicide rate. Methods: Montana suicide mortality data for 2013-22 was used to describe individual characteristics. A second dataset was created for each Zip Code Tabulation Area (ZCTA) level in Montana. It included suicide rate (by residence), rurality (e.g., urban, large rural, small rural, or isolated small rural areas), altitude, postal location, and prescribers’ ratio (e.g., primary care and mental health) by population. The study used ordinal regression to investigate relationships among altitude, rurality, and prescriber ratio on suicide ratios. Results: There were 2,872 suicides in Montana. Sixty percent (1,742) of the victims lived in rural areas, 34.7% (996) in urban areas, and 4.7% (134) didn't reside or specify a residence. Nearly 40% were single, 79.4% were male, and 20% had served in the armed forces. Firearm usage was the leading cause of death, accounting for 63.6% of the cases. Of the 361 ZCTAs, over 50% (185) were isolated small rural towns. Montana had 3,887 primary care and mental health prescribers, which included 50% physicians, 33% nurse practitioners, and 17% physician assistants. The ordinal regression analysis revealed that as the ratio of prescribers increased, so did the likelihood of transitioning to a higher suicide ratio category; however, during the test of assumptions, it was found the parameter estimates were unstable. Altitude and RUCA categories did not show significant coefficients. Conclusion: The findings, specific to Montana, contradict much of the literature. This study found that environmental factors such as altitude, rurality, and the distribution of prescribers were not associated with Montana’s suicide ratios.

Language

English

Additional Citations

Brown, A., Hellem, T., Schreiber, J., Buerhaus, P., & Colbert, A. (2022). Suicide and altitude: A systematic review of global literature. Public Health Nursing, 39, 1167–1179. https://doi.org/10.1111/phn.13090

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