Suicide rates have been climbing across the U.S., and the problem is most pronounced in rural America.
Not only has research found that suicide rates are higher in these less populated areas — even as urban areas are also seeing an uptick in suicide — but rural suicide rates are rising faster as well. “Interventions to prevent suicides should be ongoing, particularly in rural areas,” wrote researchers in a report released in October by the Centers for Disease Control and Prevention that drilled down further into those trends — looking at factors ranging from sex, race and age to the means most commonly used for suicide. “Comprehensive suicide prevention efforts might include leveraging protective factors and providing innovative prevention strategies that increase access to health care and mental health care in rural communities,” the researchers suggested.
Among factors that experts believe contribute to higher rates of suicide in rural areas are economic downturn (as many residents have more limited employment prospects) and poverty; use of alcohol and drugs, like opioids; less access to mental health care; and greater availability of guns. “Lots of survey studies have shown that there’s just more guns per household in rural areas,” says Dr. Paul Nestadt, postdoctoral fellow in Johns Hopkins Bloomberg School of Public Health Psychiatric Epidemiology Training Program, and supervising psychiatrist for the Johns Hopkins Hospital Anxiety Clinic in Baltimore. While he emphasizes that multiple factors contribute to suicide and variation in rates, he’s found increased access to firearms is a significant factor in the disparity between rural and urban suicide rates. A recent study Nestadt led evaluating urban-rural differences in suicide in Maryland found that, in fact, non-firearm suicide rates in the state weren’t significantly higher in rural counties. That research was published in the American Journal of Public Health in October.
In particular, men — who research finds are much more likely to die by suicide than women, despite women being more likely to attempt suicide — commonly use firearms. While the majority of deaths by suicide involve adults, experts stress the importance of gun safety for children as well.
[See: 11 Ways Rural Life Is Hazardous to Your Health.]
The CDC report found: “Across all urbanization levels, firearms were the most often used mechanism of death, with rates in nonmetropolitan/rural counties almost double those in large metropolitan and medium/small metropolitan counties.”
Looking at the bigger picture, Asha Ivey-Stephenson, a behavioral scientist at the CDC who led the research, notes, “one of the general overall findings is that suicide rates over the course of the entire study period, which was 2001 to 2015, were consistently higher in rural areas than metropolitan areas.” That reflects previous research. “Suicide is a public health problem and one of the top 10 leading causes of death in the United States,” the researchers wrote. “Substantial geographic variations in suicide rates exist, with suicides in rural areas occurring at much higher rates than those occurring in more urban areas.”
During the study period, the CDC report counted well over half a million suicides total. That included more than 114,500 deaths by suicide in rural counties. Suicide rates climbed from 15.5 per 100,000 in the three-year period from 2001 to 2003 to nearly 20 per 100,000 for 2013 to 2015 in rural counties. By comparison, the rate increased from 11 to nearly 13 per 100,000 in large metropolitan counties and 13 to nearly 17 per 100,000 in small to medium metro counties during that period.
Experts stress that suicide is a growing problem everywhere — not just in rural areas. However, as part of tailoring prevention efforts to make them more effective, researchers and mental health practitioners say it’s important to consider factors specific to life in rural America to best serve those who live there.
“Depression, which is present in about 80 to 90 percent of suicide cases, is eminently treatable,” Nestadt says. Yet many don’t seek treatment because of the stigma that still often surrounds mental illness, and experts say that tends to be more of a concern in rural areas.
“It’s also important to normalize talking about feelings,” says K. Bryant Smalley, executive director of the Rural Health Research Institute and a professor of psychology at Georgia Southern University. “A common feature of rural culture is an avoidance of vulnerability, an increased sense of self-reliance, which can affect people’s willingness to talk with someone when they are having problems.” While that kind of rugged independent streak may have its place and purpose, Smalley says it can impede a person from seeking services even when they are available.
[See: Am I Just Sad — or Actually Depressed?]
Individuals and families who aren’t sure where to turn during a time of crisis are advised to pick up the phone and call the National Suicide Prevention Lifeline at 1-800-273-8255. “You can call that from anywhere in the country, and you will get connected to the nearest crisis center in the network,” says Elly Stout, director of the federally funded Suicide Prevention Resource Center, which is located at the Education Development Center in Waltham, Massachusetts. “That is a service that’s available for people not just who may be in crisis themselves, but for family members or loved ones who might be concerned about someone.”
Particularly for those in rural areas who have limited access to mental health care, Stout recommends sharing concerns with a primary care provider. “We’ve developed a few resources to support primary care practices in identifying people who may be at risk of suicide and getting them the support they need,” she notes. The clinician may make a referral, if needed, to a mental health professional. Efforts are also being made — despite obstacles, like less internet connectivity in more remote areas — to increase the role of telebehavioral health to connect people virtually with mental health professionals when they aren’t easily able to access those services in their community face-to-face.
Staying connected to family, friends, community — and health providers — has been shown to be a critical component of well-being, where isolation can undermine a person’s health, from increasing risk for depression to being a predictor of heart disease. “Focusing on interconnectedness with family members, friends and the community is really important,” Smalley says. Feeling a part of something bigger than oneself can be especially important where there are less opportunities to make those connections. “There can be increased levels of isolation in rural communities, including personal isolation, as well as isolation from health care,” he says.
That combination of limited social support and limited access to mental and physical health services can be particularly troublesome. “When you factor in higher chronic disease burden in rural areas, plus an established link between chronic disease and depression and anxiety, plus less ability to manage the conditions in rural areas, because of access to care issues, that can lead to worse mental health outcomes,” he says. And of course higher rates of depression can raise the risk for suicide.
Taking immediate steps when a person is suicidal is also key for prevention. “Keeping someone who’s having these suicidal thoughts temporarily away from dangerous ways to end their life, will save their life,” Nestadt says. Experts urge trying to make sure lethal means, from prescription drugs to firearms, are safely secured away from individuals in crisis.
Regardless of where a person stands on gun control — and beyond checks at the point when a person purchases a gun — health practitioners say there are steps gun owners can take to protect a loved one in crisis. That may include, for example, removing a gun from a home temporarily — when possible, and in a manner that complies with state law — or locking it away for a time, so a person isn’t able to access it.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
“It’s worth knowing that there are a lot of good studies that show people who are prevented from making a real suicide attempt, or make a very serious attempt but don’t die, tend to get treatment and get better, as opposed to trying and trying and trying again until they die,” Nestadt says. In the vast majority of cases, such life-saving efforts don’t simply forestall the inevitable but give a person the ability to turn a corner, and ensure that person still has the rest of their life in front of them.
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Combating Suicide in Rural America originally appeared on usnews.com
