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The Effects of Urban and/or Rural Living Environments on Mental Health and Suicide Risk Across All Ages

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Guest Editor
1. European Centre for Environment and Human Health, Department of Public Health and Sport Sciences, University of Exeter, Penryn TR10 9FE, UK
2. Public Health, Cornwall Council, Truro TR1 3AY, UK
3. Health Determinants Research Collaborative (HDRC) Centre, Public Health, Cornwall Council, Truro TR1 3AY, UK
Interests: environmental epidemiologist; public health; mental health and wellbeing
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Special Issue Information

Dear Colleagues,

Suicide constitutes a profound societal and healthcare challenge, claiming approximately 700,000 deaths per year globally [1]. Given this, it is a global public health priority to reduce these preventable deaths [2]. Nevertheless, despite a large body of evidence supporting cost-effective interventions [3,4], suicide rates continue to rise, highlighting an urgent need for innovative approaches to prevention. This challenge is exacerbated in those with a diagnosable mental health condition such as Generalized Anxiety Disorder (GAD), mild/moderate depression, or Major Depressive Disorder (MDD), as well as stigma and reluctance among people not wishing to discuss their problems with healthcare providers [5]. This results in a large number of suicides remaining unknown to health and care systems [6] and requires alternative approaches to prevention efforts. In addition, there are a myriad of inter-related, complex factors (such as where someone lives, the environment, health inequalities, poor mental and/or physical health, and diverse social determinants of health) that increase the risk of poor mental health and suicide [7]. Improving our understanding of the factors leading to reduced mental wellbeing and developing diagnoses for mental conditions before crisis is reached in both those receiving support and those not accessing services would provide us with an opportunity to improve public health suicide prevention programmes globally. This could be achieved by using novel insights to identify and inform timely and adaptive personalised prevention initiatives [8]. Further research will help us develop a mix of informed policies that support the development of universal, selective, and indicated interventions [9], which includes early screening, diagnosis, treatment, and recovery from a mental illness [10].

Acknowledgements: This Special Issue has been delivered through the National Institute for Health and Care Research (NIHR) [HDRC Cornwall]. The views expressed are those of the author(s) and not necessarily those of Public Health, Cornwall Council, the NIHR or the Department of Health and Social Care.

References

  1. Lejeune, A., Glaz, A.L., Perron, P.-A., Sebti, J., Baca-Garcia, E. Walter, M., Lemey, C., Berrouiguet, S. Artificial intelligence and suicide prevention: a systematic review. European Psychiatry, 2022, 65(1), e19. https://doi.org/10.1192/j.eurpsy.2022.8
  2. Office for Health Improvement & Disparities. Prevention concordat for better mental health. 2023. Available online: https://www.gov.uk/government/collections/prevention-concordat-for-better-mental-health (accessed on 8 August 2025).
  3. Le, L.K.-D., Esturas, A.C., Mihalopoulos, C., Chiotelis, O., Bucholc, J., Chatterton, M.L., Engel, L. Cost-effectiveness evidence of mental health prevention and promotion interventions: A systematic review of economic evaluations. PLoS Medicine, 2021, 18(5), e1003606. https://doi.org/10.1371/journal.pmed.1003606
  4. Kadel, R., Stielke, A., Ashton, K., Masters, R., Dyakova, M. Social Return on Investment (SROI) of mental health related interventions—A scoping review. Frontiers in public health, 2022, 10, p. 965148. https://doi.org/10.3389/fpubh.2022.965148
  5. Khan, N.Z. and M.A. Javed, Use of artificial intelligence-based strategies for assessing suicidal behavior and mental illness: A literature review. Cureus, 2022, 14(7), e27225. doi:10.7759/cureus.27225
  6. Chappell, P. Suicide Annual Report 2021. 2021. Available online: https://www.cornwall.gov.uk/media/mzfnspc2/suicide-annual-report-2021_final.pdf (accessed on 8 August 2025)
  7. Chappell, P., et al., Study into suicide related inquest reports in Cornwall, Southwest of England during the time of the COVID-19 pandemic. Unpublished work, 2025.
  8. Boggs, J.M. and J.M. Kafka. A critical review of text mining applications for suicide research. Current Epidemiology Reports, 2022, 9(3), 126—134. https://doi.org/10.1007/s40471-022-00293-w
  9. Turecki, G., Brent, D.A., Gunnell, D., O’Connor, R.C., Oquendo, M.A., Pirkis, J. and Stanley, B.H. Suicide and suicide risk. Nature reviews. Disease Primers, 2019, 5, 74. https://doi.org/10.1038/s41572-019-0121-0
  10. Timmons, A.C., Duong, J.B., Fiallo, N.S., Lee, T., Vo, H.P.Q., Ahle, M.W., Comer, J.S., Brewer, L.C., Frazier, S.L., Chaspari, T. A call to action on assessing and mitigating bias in artificial intelligence applications for mental health. Perspectives on Psychological Science, 2023, 18(5), 1062-1096. https://doi.org/10.1177/17456916221134490

Dr. Richard Alan Sharpe
Guest Editor

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Keywords

  • mental health
  • self-harm
  • suicide
  • risk
  • prevention
  • rural
  • urban and environment

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Published Papers (1 paper)

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Research

21 pages, 1457 KB  
Article
A Pilot Qualitative Study to Better Understand the Factors Related to Suicides and Inform Public Health Action Across a Predominantly Coastal and Rural Area: Cornwall, Southwest of England
by Paula Chappell, Jane Horrell, Kerryn Husk, Beth Simons and Richard Alan Sharpe
Int. J. Environ. Res. Public Health 2026, 23(1), 35; https://doi.org/10.3390/ijerph23010035 - 25 Dec 2025
Viewed by 952
Abstract
Background: Better understanding factors leading to suicide and prevention opportunities is a global public health priority. This qualitative pilot study tested whether reviewing inquest recordings could generate insights during COVID-19 and inform public health prevention programmes across a predominantly rural and coastal area [...] Read more.
Background: Better understanding factors leading to suicide and prevention opportunities is a global public health priority. This qualitative pilot study tested whether reviewing inquest recordings could generate insights during COVID-19 and inform public health prevention programmes across a predominantly rural and coastal area where there are significant health inequalities. Methods: Fifty-five inquest recordings reached a suicide conclusion between March 2020 and January 2021. Stratified sampling was used to obtain two samples from each month. Template analysis was employed to thematically analyse data from 30 inquests. Results: Risk factors during this period were social isolation, anxiety, difficulty in routine creation and maintenance, low mood and economic impact. Remote working in a more rural/coastal area impacted both healthcare service users and staff. Lockdown and other multiple risk factors impacted those at increased risk of poor mental health and suicide. Conclusions: There is a need to identify those at risk and with deteriorating mental health. All age trauma-informed approaches are needed to prevent individuals from reaching crisis along with more equitable services and community support due to the complex nature of suicide. This requires consideration of digital access/exclusion, training, continuity of care and enhanced care of those with additional needs and multiple vulnerabilities. Full article
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