Suicide Prevention Week: Suicide rates highest in rural America where guns and veterans are key factors
The availability of gun shops was also associated with increased suicide rates, highlighting the potential importance of access to lethal means of suicide
More Americans are killing themselves in rural areas where the rate of suicide is most pronounced, according to a study which found a jump of 41% in suicide rates between 1999 and 2016.
This is from a median of 15 per 100,000 county residents in the first part of the study (1999 to 2001) to 21.2 per 100,000 in the last three years of an analysis conducted by researchers at The Ohio State University, and Nationwide Children's Hospital.
In urban areas, however, counties with more gun shops tended to have higher suicide rates, shows the analysis. The cross-sectional study included all individuals — aged 25 to 64 years — who died by suicide from January 1, 1999, to December 31, 2016, in the US.
The analysis shows that during the study period, 453,577 people committed suicide in the US, and suicides were most common among men and those between ages 45 and 54.
Experts say that the suicide rates in the US are trending higher despite a national prevention effort that kicked off in 2015 with the goal of reducing suicide rates by 20% by 2025. The US is currently observing the National Suicide Prevention Week (September 8 to 14).
"The largest proportion of suicides occurred in the final three years of the study period (90,567). The majority of decedents were male (349,082 or 77%), with 101,312 (22.3%) aged 25 to 34 years, 120,157 (26.5%) aged 35 to 44 years, 136,377 (30.1%) aged 45 to 54 years, and 95,771 (21.1%) aged 55 to 64 years," states the study.
"Large metropolitan counties accounted for the greatest number of suicides (217,772), followed by small metropolitan counties (148,716 [32.8%]), micropolitan counties (77,424), and rural counties (9,665), despite higher suicide rates in rural counties," says the study published in JAMA Network Open.
"While our findings are disheartening, we are hopeful that they will help guide efforts to support Americans who are struggling, especially in rural areas where suicide has increased the most and the fastest," says lead researcher Danielle Steelesmith, a postdoctoral fellow at Ohio State's Wexner Medical Center.
Suicide rates were highest in less-populous counties and in areas where people have lower incomes and fewer resources as compared to large metropolitan counties. From 2014 through 2016, suicide rates were 17.6 per 100,000 in large metropolitan counties compared to 22 per 100,000 in rural counties.
"Suicide is so complex, and many factors contribute, but this research helps us understand the toll and some of the potential contributing influences based on geography, and that could drive better efforts to prevent these deaths," says Steelesmith.
According to the analysis, counties with the highest suicide rates were mostly in Western states, including Colorado, New Mexico, Utah, and Wyoming; in Appalachian states including Kentucky, Virginia and West Virginia; and in the Ozarks, including Arkansas and Missouri.
A critical aspect found to increase suicide rates, particularly in rural areas, was deprivation — a cluster of factors including underemployment, poverty, and low educational attainment.
The researchers explain that cities have better access to job assistance, food banks, and non-profits, which might all contribute to less desperation among residents.
"The highest observed suicide rates were noted in rural counties, especially those with high deprivation. Our study's findings suggest that individuals living in rural counties may be especially susceptible to the effects of deprivation, such as lower levels of education, employment, and household income," the findings state.
Researchers explain that long-term and persistent poverty appears to be more entrenched and economic opportunities more constrained in rural areas.
Greater social isolation, challenges related to transportation and interpersonal communication, associated difficulties accessing health and mental health services likely contribute to the disproportionate association of deprivation with suicide in rural counties, says the team.
"National and global trends associated with improvements in the economic outlook of larger cities and towns, such as advances in automation, information technology, and alternative energy, may bypass rural communities, particularly those focused on farming and extractive industries, such as coal mining," say researchers.
They add, "Rural counties may lack the flexibility and human capital necessary to adapt to meaningful changes in the broader economy, leading to greater susceptibility to deprivation than more urban or suburban communities."
Another important finding of the study is that suicides were higher in counties with more gun shops — specifically in urban areas.
This highlights the potential to reduce access to methods of suicide that can increase the chances an at-risk person will die, say researchers. Rural households were more likely to own firearms, and some evidence suggests that firearm suicides drive the increased risk of suicide noted in rural areas.
"Interestingly, an increase in the number of gun shops appeared to have a greater association with increasing suicide rates in large metropolitan counties than in more rural areas, perhaps suggesting some degree of saturation of access in rural counties relative to more urban areas," says the study.
The team says that consistent with previous studies, a larger percentage of veterans in a county was associated with increased suicide rates, as the rate of suicide among veterans is higher than the general population.
This may contribute to the higher rates of suicide in rural areas, where a greater proportion of veterans live — an estimated 28% of veterans live in rural areas compared to 14% of the general population.
"In addition, rural communities have had higher rates of recruitment into military service, which may disrupt family functions and routines and contribute to increased community-wide susceptibility to suicide, state the findings.
The study adds, "This finding highlights the importance of prevention efforts targeting veteran populations and suggests that additional services and supports may be especially relevant for veterans and their families living in rural communities."
According to study co-author Cynthia Fontanella, associate professor of psychiatry and behavioral health at Ohio State, suicide prevention can be bolstered with new information about trends and patterns of suicide.
"For example, all communities might benefit from strategies that enhance coping and problem-solving skills, strengthen economic support, and identify and support those who are at risk of suicide," says Fontanella.