{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:39:15Z","timestamp":1792406355553,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":48,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare population\u2010based rates and mechanisms of suicide\u2010related emergency department (ED) encounters among rural and urban youth in Kentucky and Arkansas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based cross\u2010sectional study using 2018\u20132021 Healthcare Cost and Utilization Project State Emergency Department Databases linked with U.S. Census population estimates. Suicide\u2010related ED encounters among youth aged 10\u201319 years were identified using diagnosis codes for suicidal ideation, suicide attempt, and intentional self\u2010harm. Counties were classified using the National Center for Health Statistics urban\u2010rural classification scheme. We calculated rates per 10,000 youth and rural\u2010to\u2010urban incidence rate ratios (IRRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Among 27,098 suicide\u2010related ED encounters, 11,243 (41.5%) occurred among rural youth. Rural youth had a 14% higher population\u2010based encounter rate than urban youth (IRR\u00a0=\u00a01.14; 95% CI, 1.12\u20131.17). Rural\u2013urban differences were greatest among youth aged 10\u201314 years (IRR\u00a0=\u00a01.26; 95% CI, 1.21\u20131.31), White youth (IRR\u00a0=\u00a01.21; 95% CI, 1.18\u20131.24), and females (IRR\u00a0=\u00a01.17; 95% CI, 1.13\u20131.20). Rates were lower among rural than urban Black youth (IRR\u00a0=\u00a00.86; 95% CI, 0.80\u20130.92). Mechanisms were similar across settings; suicidal ideation without self\u2010harm accounted for approximately 72% of encounters in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural youth experienced higher rates of suicide\u2010related ED encounters, particularly younger adolescents and females. Strengthening early identification and access to crisis and outpatient mental health services may help prevent rural youth from progressing to psychiatric emergencies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70235","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:39:32Z","timestamp":1792402772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Population\u2010Based Rates of Youth Suicide\u2010Related Emergency Department Encounters by Rural\u2010Urban Status"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6029-6902","authenticated-orcid":false,"given":"Laura M.","family":"Prichett","sequence":"first","affiliation":[{"name":"Division of General Pediatrics Department of Pediatrics Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Center for Suicide Prevention Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7990-5493","authenticated-orcid":false,"given":"Yurika","family":"Tarui","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics Department of Pediatrics Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Psychiatry MetroHealth Medical Center  Cleveland Ohio USA"},{"name":"Case Western Reserve University, School of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2021.07.013"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0002"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.3561"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2025.105925"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.21471"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.3188"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787\u2010022\u201002039\u2010x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2022.2042697"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019\u20101536"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000003500"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.4809"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13257"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023\u2010064800"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.2195"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.11.030"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2021.12.018"},{"issue":"108","key":"e_1_2_11_18_1","first-page":"1","article-title":"Issues in Developing a Surveillance Case Definition for Nonfatal Suicide Attempt and Intentional Self\u2010Harm Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD\u201010\u2010CM) Coded Data","volume":"2018","author":"Hedegaard H.","year":"2018","journal-title":"National Health Statistics Reports"},{"issue":"154","key":"e_1_2_11_19_1","first-page":"1","article-title":"NCHS Urban\u2010Rural Classification Scheme for Counties","volume":"166","author":"Ingram D. 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