Assessment of suicidal ideation and community perspectives on risk and protective factors related to suicide among workers in Big Sky, Montana: implications for prevention strategies

Abstract

Statement of problem: Suicide is a critical public health issue, particularly in rural communities that face unique mental health challenges. The Western United States, including Montana, is often referred to as the "American Suicide Belt" due to its significantly higher suicide rates. Montana consistently ranks among the top five states for suicide, with a 2020 rate of 25.9 per 100,000 compared to the national rate of 13.4. In Big Sky, a resort town with 3,000 residents and 1,500- 2,500 employees, issues such as high alcohol misuse, mental illness, and suicide are pervasive. A 2017 health assessment revealed that 36% of residents experienced chronic depression, with many reporting inadequate access to mental health support. The COVID-19 pandemic further exacerbated these behavioral health crises. Methods: To address these challenges, a Workforce Needs Assessment study was conducted in partnership with Montana State University and the Yellowstone Club Community Foundation. Utilizing a community-based participatory research approach and the socio-ecological model framework, this mixed-method study involved online surveys and focus groups. Data were collected between summer 2022 and spring 2023, with 920 participants and a 10% non-participation rate. Four focus groups included a session for Hispanic residents to ensure cultural representation. Results: The study identified significant stressors among Big Sky's workforce, including housing insecurity, financial struggles, and depression. While average levels of suicidal ideation were low, individuals with severe depression or feelings of isolation exhibited notably higher risk. Protective factors, such as individual resilience, community support, and intergenerational mentorship, were critical in mitigating these risks. Participants emphasized the need for improved mental health resource accessibility, stigma reduction, and the creation of safe, supportive spaces. Conclusion: These findings underscore the urgent need for targeted, culturally appropriate interventions to address the mental health challenges in Big Sky and similar rural communities.