Public Health. 2025 Sep 4;248:105925. doi: 10.1016/j.puhe.2025.105925. Online ahead of print.
ABSTRACT
OBJECTIVES: This study examines rural vs. urban prevalence rates of depressive symptoms and serious suicidal thoughts and in a nationally representative sample of adolescents.
STUDY DESIGN: This nationally representative cross-sectional study examined data for 22,712 adolescents aged 12-17 years from the 2021 and 2022 National Survey on Drug Use and Health (NSDUH).
METHODS: Prevalence estimates of adolescent depressive symptoms and serious suicidal thoughts were produced overall and across three levels of rurality: large metro, small metro, and nonmetro. Rates were compared by Rao-Scott chi-square tests, and weighted multivariable logistic regressions compared associations between rurality and sociodemographic characteristics with each outcome.
RESULTS: Over half (54.45%) of adolescents reported ever experiencing a period of depressive symptoms, while 19.35% reported these feelings in the past year, and 13.18% reported serious thoughts of suicide in the past year. Rates of ever experiencing depressive symptoms (p = 0.31) or in the past year (p = 0.74) were not significantly different by rurality. Similarly, prevalence rates of serious suicidal thoughts did not differ significantly among adolescents in nonmetro (12.95%), small metro areas (13.71%), large metro (12.95%; p = 0.21). Ever experiencing depressive symptoms (aOR 7.18, 95%CI: 5.26-9.80) and past year depressive symptoms (aOR 5.98, 95%CI: 4.88-7.32) were related to increased odds of serious suicidal thoughts.
CONCLUSIONS: Findings show that over 50% of adolescents reported depressive symptoms and the strong link to serious suicidal thoughts indicates the need for improved early mental health interventions for adolescents across all levels of rurality.
PMID:40912038 | DOI:10.1016/j.puhe.2025.105925
