Mental Health & Prevention 34 (2024) 200335 Available online 17 March 2024 2212-6570/© 2024 The Author(s). Published by Elsevier GmbH. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Characteristics of suicide prevention programs implemented for young people in rural areas: A systematic review of the literature Ms Laura Grattidge a, b, * , Dr Ha Hoang a , Dr David Lees c , Dr Denis Visentin d , Dr Jonathan Mond a, e, f , Mr Stuart Auckland a a Centre for Rural Health, University of Tasmania, Launceston, Australia b Manna Institute, Armidale, Australia c School of Nursing, University of Tasmania, Launceston, Australia d School of Health Sciences, University of Tasmania, Launceston, Australia e School of Medicine, Western Sydney University, Parramatta, Australia f Rural Clinical School, Australian National University, Goulburn, Australia A R T I C L E INFO Keywords: Mental health Rural Suicide prevention Systematic review Youth Young people ABSTRACT Background: For young living in rural areas around the world, suicide is a leading cause of death, stressing the need to understand characteristics of programs aiming to impact suicide and related behaviours. Aim: A systematic literature review aimed to synthesise the evidence and explore characteristics of programs seeking to impact suicidal behaviours (rates, attempts, ideation) for young people in rural areas. Method: Data sources: Electronic databases EMBASE, Medline, PsycINFO and Scopus. Study eligibility criteria, participants, and interventions: Studies measuring suicide-related outcomes (rates, attempts, ideation) for youth (people aged 12–25 years) in rural areas worldwide, published 1 January 2000 to 6 June 2023. Study appraisal and synthesis: Data were thematically analysed, exploring intervention characteristics. Mixed Methods Appraisal Tool assessed study quality. Results: Eleven (11) studies met the selection criteria. Studies impacting suicides and attempts were often mul- tiple strategies, multi-layered, combining universal, selective, and indicated programs, implemented across systems and settings, including public-health psychoeducation, referral mechanisms, crisis lines, postvention, peer support, outreach, means restriction, mindfulness, and gatekeeper training. Psychoeducation and mind- fulness contributed to decreased suicidal ideation. Community-level partners were central to efforts, including working groups, networks, Indigenous people, people with lived experience, volunteers, and peers. Conclusions: Varied programs have capacity to reduce suicide rates and related behaviours among young people in rural areas, with communities and schools as crucial settings. Programs implemented across levels show promise at reducing the number of young people who end their lives by suicide or attempt to do so, demon- strating a need for program evaluations and continued, long-term outcome monitoring. 1. Introduction In geographically and culturally diverse rural communities around the world, suicide is a complex social and public health issue impacting people of all ages. It is the leading cause of death for young people aged 10–24 years, across all genders, worldwide (Australian Institute of Health & Welfare, 2021b; Glenn et al., 2020; World Health Organiza- tion, 2023). Just over three quarters (77.0 %) of all suicides worldwide occur in low and middle income countries, with the highest in the world reported being in Lesotho, Africa (87.5 per 100,000) (Integrated African Health Observatory, 2022; World Health Organization, 2023). Rural areas have higher rates of suicide than urban counterparts (Casant & Helbich, 2022). For example, in Australia suicide rates in areas outside of major cities rates are higher (Australian Institute of Health & Welfare, 2022; Life in Mind, 2022). Suicide-related behaviours (suicidal ideation and suicidal intent/self-harm behaviour), are primary risk factors for suicide (Planellas & Calder´ on, 2022), and in rural areas, rates of suicide and related behaviours have been noted as being higher for older and younger people, Indigenous people, farmers and agricultural producers, and LGBTIQ+ people (Australian Bureau of Statistics, 2022; Australian * Corresponding author at: Locked Bag 1322, Launceston, Tasmania 7250, Australia. E-mail address: Laura.Grattidge@utas.edu.au (M.L. Grattidge). Contents lists available at ScienceDirect Mental Health & Prevention journal homepage: www.elsevier.com/locate/mhp https://doi.org/10.1016/j.mhp.2024.200335 Received 9 January 2024; Received in revised form 7 March 2024; Accepted 7 March 2024