{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:43:49Z","timestamp":1780062229915,"version":"3.54.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:00:00Z","timestamp":1739750400000},"content-version":"vor","delay-in-days":47,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To identify contributing circumstances to multiple\u2010death suicides in rural US counties from law enforcement and coroner\/medical examiner narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified multiple\u2010death suicides as multiple suicides (i.e., two or more decedents) from the National Violent Death Reporting System (NVDRS) between 2013 and 2021. We identified rural decedents from their residence in NVDRS using federal information processing codes linked to Rural\u2013Urban Continuum Codes. Quantitatively, we described demographic characteristics and circumstances leading to the suicide. From narrative law enforcement and coroner\/medical examiner reports, we generated codes describing demographic and circumstance information using Dedoose software. We then used inductive content analysis to identify themes related to multiple\u2010death suicides.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Among all multiple\u2010death suicides (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a050 multiple\u2010death suicides, 99 suicide decedents), decedents were mostly non\u2010Hispanic White (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a090; 91%), were male (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a054; 54%), and had a high school diploma or less (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a051; 56%). We identified four themes: meticulous and considerate planning (e.g., with notes, reasons, and next steps), mutual dependency (e.g., decedents were in separable), unbearable health conditions (e.g., pain, poor quality of life from chronic illnesses), and social factors of despair (e.g., financial strain, legal problems, and interpersonal violence).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Developing strategies for discussing suicidal ideation and improving access to financial resources and health care may reduce multiple\u2010death suicides in the rural United States, particularly among older adults with chronic health problems. Improving other public health initiatives such as interpersonal violence and chronic disease prevention and management may further prevent multiple\u2010death suicides.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70003","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T23:31:21Z","timestamp":1739835081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors associated with multiple\u2010death suicides among rural US decedents"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1701-552X","authenticated-orcid":false,"given":"Victor A.","family":"Soupene","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Iowa Health Care  Iowa City Iowa USA"},{"name":"Department of Epidemiology University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7497-7197","authenticated-orcid":false,"given":"Timothy","family":"Hays","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Iowa Health Care  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5164-1241","authenticated-orcid":false,"given":"Jonathan","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Health University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-3433","authenticated-orcid":false,"given":"J. Priyanka","family":"Vakkalanka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Iowa Health Care  Iowa City Iowa USA"},{"name":"Department of Epidemiology University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,17]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Suicide and Self\u2010Inflicted Injury","year":"2024"},{"key":"e_1_2_9_3_1","volume-title":"Suicide","year":"2024"},{"key":"e_1_2_9_4_1","volume-title":"Web\u2010Based Injury Statistics Query and Reporting System (WISQARS)","year":"2024"},{"key":"e_1_2_9_5_1","volume-title":"Suicide in Rural Areas","year":"2024"},{"key":"e_1_2_9_6_1","volume-title":"Suicide in Rural America as a Public Health Issue","year":"2024"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12532"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2012-040317"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.06.011"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12310"},{"key":"e_1_2_9_11_1","volume-title":"Rural Behavioral Health: Telehealth Challenges and Opportunities","year":"2016"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/cts.2020.42"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12448"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1027\/0227-5910\/a000224"},{"key":"e_1_2_9_15_1","volume-title":"National Violent Death Reporting System Web Coding Manual Version 6","year":"2022"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1139305"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-022-04495-w"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.su7302a1"},{"key":"e_1_2_9_19_1","unstructured":"Institute of Medicine National Research Council.Contagion of Violence: Workshop Summary.National Academies Press;2013."},{"key":"e_1_2_9_20_1","unstructured":"Rural\u2013Urban Continuum Codes.United States Department of Agriculture (USDA) Economic Research Service. Accessed June 1 2024.https:\/\/www.ers.usda.gov\/data\u2010products\/rural\u2010urban\u2010continuum\u2010codes\/"},{"key":"e_1_2_9_21_1","volume-title":"National Violent Death Reporting System User Guidelines","year":"2024"},{"key":"e_1_2_9_22_1","unstructured":"Dedoose Version 9.2.12 cloud application for managing analyzing and presenting qualitative and mixed method research data.SocioCultural Research Consultants LLC;2024."},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13596-w"},{"issue":"3","key":"e_1_2_9_24_1","first-page":"249","article-title":"Tales from the science education crypt: a critical reflection of positionality, subjectivity, and reflexivity in research","volume":"3","author":"Louis KS","year":"2002","journal-title":"Forum Qual Soc Res"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1037\/bul0000123"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0018697"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss7305a1"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.13519"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4720"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0830"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-014-0466-8"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7350.1355"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2008.01.004"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2004.06.007"},{"issue":"15","key":"e_1_2_9_35_1","first-page":"1","article-title":"Chronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta\u2010synthesis","volume":"13","author":"Brundisini F","year":"2013","journal-title":"Ont Health Technol Assess Ser"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2023.06.003"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16030469"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18189538"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1353\/eca.2017.0005"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518393112"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2010.300010"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.301945"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.7"},{"key":"e_1_2_9_44_1","volume-title":"Preventing Suicide: A Technical Package of Policies, Programs, and Practices","author":"Stone DM","year":"2017"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70003","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70003","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T06:34:39Z","timestamp":1778740479000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/jrh.70003"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70003","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2024-12-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70003"}}