ABSTRACT
Purpose of the study: Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explore risk factors to suicide related admissions, using emergency room discharge data from Maryland. Methods: The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable, of suicide ideation emergency department discharge based on International Classification of Disease, 10th edition (ICD-10). We controlled for income based on zip code of residence, race, age, and gender. Results: Previous major depressive disorder diagnosis (OR = 79.30;95%CI 51.91-121.15), alcohol use disorder (OR = 6.87;95% CI 4.97-9.51), opioid use disorder (OR = 5.39;95% CI 3.63- 7.99), and cannabis use disorder (OR = 2.67;95% CI 1.37-5.18) were all positively associated with suicidal ideation discharge status. Conclusion: The study highlights the strong link between substance use disorder, depression and suicidal ideation admission, indicating the need for prevention and intervention, particularly among those in rural areas burden. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.