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 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.
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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.
SOURCE: http://bit.ly/1GjUX0J
and http://bit.ly/1GjV24n JAMA
Pediatrics, online March 9, 2015.
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