Mohatt NV, Kreisel CJ, Hoffberg AS, et al. - By conducting this systematic review, researchers sought to synthesize rural-specific factors associated with increased suicide risk. Articles published post-2003 investigating rural adult suicide in the United States were searched in OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar. A total of 1,058 records screened, of which 34 studies were included. Findings showed a strong association between access to firearms and increased rural US suicide rates, and additional individual level factors showing possible contribution to the disparity included substance use, economic stress, and behavioral health care utilization. The commonly identified factors at the community level included economic distress and access to care. It is necessary that suicide prevention efforts for the rural United States address access to lethal means, especially the use of firearms, and navigate limited access to quality behavioral health care.