Background: Suicide in rural areas is affected by myriad factors, some of which are distinct from the experience of suicide in urban areas.The aims of the present study are to: (1) assess suicide predictors in rural and urban regions by comparing suicides to sudden-death controls; and, (2) compare the differences between rural suicides and urban suicides.Methods: The Psychological Autopsy method was utilised to investigate suicides over the age of 35 in QLD by interviewing next-of-kin and healthcare professionals in 2006-2008.A case-control study design was applied using sudden-deaths as controls.Initial information was gathered from the coroners office.Interviews were conducted by clinical interviewers in a semi-structured format using validated scales including the Bille-Brahe Social Support Scale, the NEO-FFI, Overt Aggression Scale, the Cumulative Illness Rating Scale, and SCID-I.The questionnaire also incorporated demographic information, life events and past suicidality.Cases and controls were divided into two groups: those living in urban regions and those living in rural regions.Results: The study involved 50 suicide cases and 26 sudden-death controls from rural and 150 suicides and 108 sudden-deaths from urban regions.No significant differences were found between the urban and rural suicides and their sudden-death controls by gender, age, ethnicity or language.In both areas, suicides were more frequently separated, living alone and unemployed, compared to the sudden-deaths.There were no significant differences in marital status, living arrangements, education, and employment status between two suicide groups.Previous suicide attempt(s) and having any psychiatric disorder at the time of death were significant suicide predictors in both urban and rural regions.Compared to the urban suicides (70%), there was a significantly higher prevalence of psychiatric diagnoses in rural suicides (84%).In rural suicides, anxiety (40% vs.20%) and substance abuse disorders (38% vs.26.7%) were more prevalent.In sudden-deaths, visiting a GP in the previous three months was slightly higher, compared to suicides.Rural suicides showed slightly lower prevalence than urban suicides (77% vs.68.8%).Suicides had significantly higher neuroticism and lower agreeableness in both areas.Neuroticism was also higher in rural suicides compared to urban suicides.Aggression scores were significantly higher in suicides, compared to sudden-deaths; however, the general aggression score was significantly higher in rural suicides than in urban suicides.No remarkable differences in physical health were found between suicides and sudden-deaths.Conclusion: While geographical location alone may not be a risk factor, life events and living conditions that are more likely to be found in rural environments may increase vulnerability to suicide.In the present study, similarities in the predicting factors of suicide in rural and urban areas were found.However, some of the predictors were more prevalent in rural areas.For example, aggression, neuroticism and alcohol dependence were higher in rural suicides, though suicides in rural areas did not have a significantly higher prevalence of alcohol dependence when compared to sudden deaths.