Bereavement in Rural and Remote Areas: Sudden Deaths, Distance and Community

In the countries with data, people in rural and remote areas are more likely to be bereaved by a sudden death, through suicide, farm work or the sea, and they usually live further from the services that support bereaved people. Yet the best long-term evidence also suggests that close rural communities can soften some of the effects of bereavement on health. How rural people grieve has hardly been measured at all.

In a farming district, a fishing port or a remote settlement, a death is rarely private. Neighbours often knew the person who died. The farm or the boat may still need working the next morning. The nearest counsellor or bereavement group can be hours away by road, and the GP may be a friend of the family. The same closeness that brings practical help can make grief hard to hide, especially after a suicide. This study sets out what the data show about bereavement in rural and remote places across several countries, and where nobody has yet looked.

Sudden deaths weigh more heavily on rural communities

Around 42% of the world’s people lived in rural areas in 2025, according to World Bank estimates based on UN data^[4]. The evidence below comes mostly from high-income countries, and within them one pattern recurs: deaths that are sudden and unexpected, the kind that are hardest for families, make up a larger share of deaths in rural places.

Suicide shows this most clearly. In the United States, death registrations show that the age-adjusted suicide rate in the most rural (“noncore”) counties was 13.1 per 100,000 in 1999, 1.4 times the rate in the most urban counties. By 2017 it had reached 20.0 per 100,000, 53% higher than in 1999 and 1.8 times the urban rate of 11.1^[1]. We could not find a more recent national data brief with the same breakdown, so these figures are dated.

In Australia, suicide was the sixth leading cause of death in Remote and in Very Remote Australia in 2024, at age-standardised rates of 23.6 and 25.4 per 100,000. Nationally it was the 16th leading cause, and it did not appear in the top ten for major cities or regional areas^[5]. Rankings are not rates, so this is not a multiple of the city rate.

Behind each of these deaths are families, friends and neighbours who are bereaved. A higher rate of suicide in a place means more people living with a form of bereavement that the evidence links to particular needs, set out in our study of adults bereaved by suicide. Suicide is never the result of a single cause, and most people in rural areas, including those who are bereaved, do not experience suicidal crisis. Support works, and asking for help early is a sign of strength.

Farming and fishing bring sudden death close to home

Many rural families depend on two of the most dangerous kinds of work there are. In Great Britain, 23 workers died in agriculture, forestry and fishing in 2024/25 (provisional figures), against an average of 25 a year over the five-year period 2020/21–2024/25, and 4 members of the public also died in farm and related incidents. The sector’s fatal injury rate, 8.77 per 100,000 workers, is around 22 times the all-industry rate; just under a quarter of deaths (23%) involved being struck by a moving vehicle^[2]. On a family farm, a death at work is also a death at home.

Suicide risk is also higher in this work. A systematic review and meta-analysis of 32 studies from many countries found a pooled effect size of 1.48 for suicide among agricultural, forestry and fishery workers compared with reference groups, with an even higher excess in Japan^[6]. The studies used different comparison groups and measures, so 1.48 summarises an excess rather than giving one precise risk. In the United States, a review of research on farmers and their families found 30 relevant studies but “only one intervention evaluation study”^[7]. In Australia, earlier research cited by a 2018 study has identified farming populations as having higher suicide rates than metropolitan, rural and regional communities generally^[8].

Fishing communities face a different danger. Of 616 deaths in British commercial fishing between 1976 and 1995, 454 (74%) were accidents at work, and 394 of those fishermen (87%) drowned; the fatal accident rate was 52.4 times that for all workers in Great Britain^[9]. These are old figures, but the risk persists elsewhere: in the United States, 188 commercial fishermen died at work in 2010–2014, with rates of 21 to 147 deaths per 100,000 full-time workers depending on the fleet, “many times higher” than for all US workers^[10].

How farming families grieve these deaths has been studied far less than how often they happen. Interviews with 25 members of Australian farming families bereaved by suicide or accidental death identified four connected themes: “acceptance of risk, normalization of death, pragmatic behavior patterns and connection to place”. The authors argue that such deaths are not always experienced as “violent” or “traumatic” in the way that bereavement research tends to assume^[11].

Close communities may protect health after a partner dies

The strongest evidence on rural bereavement outcomes comes from a single record-linkage study in Northern Ireland, which followed 296,125 married couples through death records for 2001–2009. It asked whether the “widowhood effect”, the raised risk of death for a person whose spouse has died, differs between urban, rural and intermediate areas^[3].

In every type of area, and for both men and women, the effect was greatest in the first six months after a spouse’s death. After that, the pattern diverged for men. Widowed men in urban areas still had 1.35 times the hazard of death of married men, while for widowed men in rural areas the figure fell to 1.09, a difference that was not statistically significant. Among women the effect weakened in all areas (rural 1.06, not significant; urban 1.09)^[3]. The authors suggest this may reflect “variation in social support provided by the wider community”, and note that men in urban areas remained at increased risk while women did not. The study measured deaths, not grief or wellbeing, and an observational design cannot show that rural life itself causes the difference.

Other evidence points in the same direction. A large population survey in South Australia, drawing on 23,588 interviews conducted between 2001 and 2007 about the death of “someone close”, found greater reliance on friends, rather than close relatives, for hands-on care at the end of life in rural settings^[12]. In rural places, friends often carry part of the caring role.

This is a strength services can build on, though the same closeness can work against people whose bereavement carries stigma. Our study of older widowed people covers the widowhood effect in more depth.

In small communities, a suicide touches many people, and stigma can travel fast

When a community is small, a single death reaches far beyond the immediate family. A random-digit-dial survey of 1,736 adults in the US state of Kentucky found that 48% (weighted) had been exposed to suicide in their lifetime, meaning they knew someone who had died by suicide. People exposed to suicide were twice as likely as others to have diagnosable depression and more likely to report suicidal thoughts (9% against 5%), and feeling close to the person who died increased the odds of depression and anxiety^[13]. The survey covered the whole state, not rural residents alone, so it shows how far exposure spreads rather than a rural-specific rate.

Stigma is a recurring concern. In an online study of 536 rural Australians with personal experience of suicide, participants showed higher levels of suicide stigma than earlier Australian community samples, as well as higher levels of knowledge about suicide^[8]. This was a self-selected sample, so it cannot tell us how common stigma is across rural Australia, but it suggests that knowledge alone does not remove it.

Isolation matters too. A UK-wide survey, the 2010 UCL Bereavement Study, identified 3,193 adults bereaved by a sudden death (from any cause, in any area). It found that loneliness after the death was linked to a higher likelihood of a later suicide attempt (adjusted odds ratio 1.19 per point on an eight-item loneliness measure) and of suicidal thoughts (1.24), even after accounting for the size of a person’s social network^[14]. The study did not compare rural and urban respondents, but it shows that loneliness, not only the number of people around someone, is linked to risk.

Distance and thin services shape care before and after a death

Bereavement often follows a period of caring. A qualitative study in Victoria, Australia, notes that people in rural and regional areas “are less likely to have local healthcare services and may be physically isolated”, and that even where support exists, the time it takes to travel there can put people off using it. In interviews with 12 bereaved cancer carers, isolation during bereavement, made worse by the COVID-19 pandemic, was a central theme^[15].

The people providing that support feel the strain. Professionals offering grief and loss support in rural, regional and remote Western Australia described the “Jack of all trades” role they had to fill, difficulty getting professional development, and particular challenges in delivering post-bereavement services^[16].

Whether rural families get less end-of-life care varies by country. In Japan, a nationwide survey of bereaved relatives of adults who died of cancer in 2021 (1,226 responses) found lower quality of care in rural areas: the widest gap was in multidisciplinary care coordination, 78.3% in rural areas against 87.7% elsewhere (adjusted odds ratio 0.43), and relatives reported that the person had been free from physical distress in 29.8% of rural deaths against 42.3%^[17]. In South Australia, by contrast, the large population survey found no difference between rural and urban respondents in reported use of specialist palliative care, or in reported need for more support^[12]. Those data are now more than 15 years old.

Some approaches reach people where they live. In a US trial offering video visits from a palliative care nurse to rural family caregivers, 90 of 215 caregivers (41.8%) had the person they cared for die during the study. Of those, 84% chose to continue visits with the same nurse afterwards, resuming on average 7.2 days after the death. Most faced difficulties with grief and coping (56%) and with relationships and support (52%), both before and after the death, alongside practical problems with income, housing and dealing with community services^[18]. For more on what follows the end of caring, see our study of carers after caring.

What the evidence asks of us

The figures describe more sudden deaths, further from help, among community ties that can both protect and isolate. They suggest these priorities:

• Work with the community, not around it. In South-west England, a largely rural region with coastal and low-income areas, a community engagement programme found that people valued support offering “connection with others, peer support without judgement”, and concluded that “local community organizations are well placed to support people at end of life”, in partnership with palliative care and bereavement services^[19]. The Northern Ireland findings suggest community support may already be doing protective work^[3]. Funding farming, fishing and rural welfare groups to support bereaved members builds on that.
• Bring support to people, and keep it continuous. Where travel time is a barrier^[15], support delivered remotely by a clinician families already know can reach people within days of a death, and rural caregivers in the US trial took it up readily^[18]. That support should cover money, housing and practical needs, not only grief.
• Invest in rural end-of-life care. The Japanese findings identify care coordination as a target for improving rural palliative care^[17], and rural professionals need training and backup for bereavement work they often do alone^[16].
• Treat stigma and loneliness as part of postvention. After a suicide in a small community, many people are affected^[13], and loneliness after a sudden death is a recognised risk^[14]. Stigma reduction in farming communities needs to be adapted to rural life and work^[8].
• Fund the research that is missing. Suicide among farmers needs intervention studies, not only counts^[7]. Almost nothing is known, from any country, about prolonged grief, depression, work or income after bereavement in rural compared with urban populations, and very little about bereavement in rural areas of low- and middle-income countries. Population registers in the Nordic countries and elsewhere could answer these questions.

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. Where it discusses suicide, it follows the Samaritans’ media guidelines.

Why we're publishing this

Rural and remote communities are often left out of bereavement research, and the services built on it are mostly designed in and for cities. Farming, fishing and rural welfare organisations already support people through deaths at work, deaths by suicide and deaths far from hospital, frequently with little funding. We publish this to put the available evidence in one place, so those organisations can make their case to funders and policymakers, and to show plainly how much is still unknown.

How to read this data

The figures come from different kinds of source. US suicide rates and Australian rankings are national death registrations (counts, not estimates), and Great Britain’s workplace deaths are recorded under its injury reporting regulations; the 2024/25 figures are provisional. The world rural population share is a World Bank estimate. The Northern Ireland widowhood study follows a cohort of nearly 300,000 married couples through death records, the strongest design here, but it measures deaths, not grief. The meta-analysis of farm, forestry and fishery workers pools studies with different comparison groups. The South Australian and Japanese studies are large surveys; the Kentucky survey is a random sample of one state. The rural Australian stigma study used a self-selected sample, and the other Australian and English studies are small qualitative studies, which describe experiences rather than measure how common they are.

Definitions of “rural” and “remote” differ between countries, so figures from different countries are not directly comparable, and nothing here should be read as a trend across countries. Most of the evidence comes from the US, Australia, the UK and Japan. We found no population-level study, anywhere, comparing grief, mental health or income after a death in rural and urban areas.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual person or family. If you are worried about yourself or someone close to you, please speak to a GP or another qualified professional.

Sources

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