In March, JAMA Pediatrics posted the findings of a recent study on rural suicide that examined morality data for young people between age 10 and 24, between 1996 and 2010. It found that suicide rates in rural areas compared to urban areas have almost doubled during these years, for children, teens, and young adults. Keep in mind that suicide remains the third leading cause of death for all young people according to JAMA.
As parents, grandparents, family members, community members, educators, clergy, and medical professionals in our area, it is important to be aware of this phenomenon and take action to fight this tragedy. A closer look at the study is warranted.
Lead author of the study, Cynthia Fontanella of Ohio State University, shared the following findings: From 2008 to 2010, almost 67,000 young people died from suicide. Broken down by gender, the rate of suicide during these years among rural males 10 to 24, was 19.93 per 100,000, almost double that of 10.31 per 100,000 for urban boys and young men. Data for this same demographic from 1996 to 1998 found that the ratio used to be 18.98 per 100,00 for rural youth and 11.95 per 100,00 for urban youth. For females from 2008 to 2010, the rural suicide rate was 4.4 per 100,000 while the urban rate was 2.39 per 100,000 for the same age range. Data from 1996 to 1998 showed a suicide rate of 3.19 per 100,00 for rural females of this demographic, versus 2.18 per 100,00 for urban females of this same demographic. All of the numbers illustrate the rise in this sad trend.
Analysis of national mortality statistics for young people during this time period found the leading cause of death by suicide was firearms (51.1 percent). The second leading cause of death was hanging and suffocation (33.9), followed by poisoning (7.9), and all other methods accounting for (7.1), according to the Ohio State study. The study speculates that rural youth have greater access to firearms — being more likely to grow up with guns and have guns in their homes — thus lending itself to easy accessibility for suicidal acts.
The study looked at what factors contribute to the high suicide rates in rural areas. Pinpointing a direct cause remains elusive. Fontanella speculated about specific cultural, economic, and geographic ones within the study. In terms of cultural reasons, there remains a greater belief in self sufficiency and strength. There may be greater stigma for a rural person to seek help when it comes to mental health needs. In terms of economic variables, the study discusses how the Great Recession hit rural areas the hardest. Residents in rural areas are of lower income strata and less likely to have health insurance that covers mental health services. Additionally, less opportunity has meant that young people have left rural areas for more urban environments. The thought is that undiagnosed or untreated mental health needs, combined with greater isolation than in more urban areas, have contributed to greater suicide rates. As far as geography is concerned, there is a greater disparity between mental health needs and accessibility of services. The study discusses the degree to which more than 85 percent of federally designated areas experiencing mental health shortages are rural.
According to the study, more than half of all rural counties in the United States do not have a psychiatrist, psychologist, or social worker in residence. As a result, patient care is farther away, leading to greater obstacles with appointments and seeking timely care. Lastly, distance can equate to greater social isolation for rural members of society. Strong social networks and social support greatly contribute to mental health and well being.
To counter these risk factors and barriers, Fontanella recommends several steps, strategies, and policy ideas. She states that more needs to be done to educate the public about the need for proper firearm storage and locks. The study looks at adding mental health professional to physicians’ offices to improve access and care needs for the mentally ill. It also looks at training primary physicians to ask about mental health needs, placing more mental health professionals in schools, using technology like Skype to facilitate mental health therapy for young people who live far from mental health services. It also recommends simple mental health education for parents, that teaches them the signs of depression in their children and teens.