Author ORCID Identifier
Semester
Fall
Date of Graduation
2024
Document Type
Dissertation
Degree Type
PhD
College
School of Public Health
Department
Epidemiology
Committee Chair
Ruchi Bhandari
Committee Member
Caroline P. Groth
Committee Member
Summer D. Hartley
Committee Member
Mary Christensen
Abstract
INTRODUCTION: The Appalachian region, spanning 13 states from New York to northern Mississippi, experiences the suicide rates in the United States (U.S.), underscoring a public health crisis exacerbated by persistent socioeconomic challenges. West Virginia (WV), the only state entirely within Appalachia, serves as a focal point for understanding the broader suicide crisis in the region, as WV has the highest suicide rates in the region. Moreover, the state has several unique socioeconomic factors, like increased poverty, lower educational attainment, limited access to healthcare, and a high prevalence of chronic pain and substance that may contribute to elevated rates of suicide. This dissertation addresses gaps in understanding suicide in WV by: (1) identifying and discussing the discrepancies in suicide risk measures used in state-based and national population-based surveys (2) examining the relationship between socioeconomic deprivation and suicide rates in WV (3) exploring socioeconomic and related factors of lifetime suicide risk in WV.
METHODS: This dissertation employed a mixed-methods approach. First, a two-part systematic review was conducted to identify suicide risk measures used across large state-based and national population-health surveys. Second, negative binomial regression models were used to assess the relationship between socioeconomic deprivation, using three preestablished indices, and suicide rates. Lastly, logistic regression models were used to examine the factors associated with suicide risk among WV adults using data collected from the 2021 MATCH survey.
RESULTS: The results from the systematic review revealed significant variability in how suicide risk is measured, with implications for surveillance, policy, and targeted prevention strategies. Aim two analyses demonstrated a strong association between deprivation indices and suicide rates, highlighting several key index items that have particular relevance when examining suicide rates in WV. Aim three analyses identified rural-urban disparities in risk factors, emphasizing the need for region-specific prevention efforts.
CONCLUSION: The findings from this dissertation underscore the importance of enhancing surveillance methods to better capture suicide incidence and prevalence, informing long-term prevention strategies. Findings also highlighted key socioeconomic factors which may contribute to suicide risk in WV, underscoring the urgent need for tailored, region-specific interventions. By addressing gaps in measurement and examining the influence of socioeconomic deprivation and rural-urban disparities, this work provides actionable insights to inform targeted interventions and improve suicide prevention efforts in Appalachia, particularly in WV
Recommended Citation
Caswell, Erin Delaney, "An Appalachian Perspective on Suicide: A Focus on West Virginia’s Unique Context" (2024). Graduate Theses, Dissertations, and Problem Reports. 12639.
https://researchrepository.wvu.edu/etd/12639
Included in
Epidemiology Commons, Other Mental and Social Health Commons, Other Public Health Commons, Rural Sociology Commons
