The gap in suicide risk between young people in rural U.S. communities and those in more urban areas is widening, a new study suggests.
Possibly due to differences in mental health services, isolation, firearm access and economic factors, suicide is twice as common among young Americans in rural communities as in urban areas, the researchers write in JAMA Pediatrics.
Previous studies found rural and urban difference, but what's new here is that the differences are growing, said study leader Cynthia Fontanella, from the Ohio State University Wexner Medical Center in Columbus.
Fontanella and her colleagues say suicide is the third most common cause of death among people ages 10 to 24. It was listed as the cause of death for 66,595 people in that age group from 1996 through 2010.
For the new study, they looked suicides data for U.S. youths from 1996 through 2010.
Overall, for every 100,000 males ages 10 to 24, about 20 in rural areas committed suicide every year, compared to about 10 per year in urban areas.
And for every 100,000 females in that age group, about 4 died by suicide each year in rural communities, compared to about 2 each year in more urban areas.
The researchers estimate that the rural-urban gap in suicide risk increased about 59 percent among males and 93 percent among females between 1996 - 1998 and 2008 - 2010.
The widening gap appears to be due to falling suicide rates in urban areas coupled with relatively stable suicide rates in rural communities, Fontanella said.
The gap in suicide risk persisted even after the researchers accounted for differences in healthcare access and social and economic traits.
Still, Fontanella said there may be residual problems in accessing mental health services in rural areas that could contribute to the gap, including lack of specialists and facilities. Also, stigma against metal health services is greater in rural areas, she said.
Other possible contributors to the increased suicide risk are economic hardship and isolation, the researchers write, adding that increased access to lethal methods of suicide may be a factor.
They say that while gun ownership is reportedly falling in urban communities, it remains relatively stable in rural areas.
They also found that in rural areas, suicide by firearm was about three times as common as in urban areas, and suicide by suffocation and hanging was about twice as common as in urban areas.
In an editorial, Dr. Frederick Rivara wrote that recent research suggests that trigger locks, gun lockboxes or safes can reduce the risk of suicide and unintentional injury by up to 70 percent.
Still, about 41 percent of U.S. adolescents report easy access to firearms, wrote Rivara, an editor of JAMA Pediatrics from the University of Washington in Seattle.
“Most concerning is that adolescents with a history of mental illness and those with a history of suicidality were as likely to report access to guns kept in the home as were those without such histories,” he added.
Fontanella and her colleagues suggest that integrating mental health services into primary care visits may improve access. Additionally, access to so-called telemedicine may allow people in rural areas to access mental health services through technology.
School education programs and the education of key community members about suicide may also help reduce suicide risk in rural areas, the researchers write.
They say safe storage campaigns or policies to reduce firearm access among young people in rural areas may be particularly effective in reducing suicides.