Suicide is the third-leading cause of death for people ages 10 to 24, and rates are nearly twice as high for young adults in rural communities than in urban areas, a new study found.
The actual overall death rates for young people may likely be even higher, suggested the authors. The stigma of suicide may lead to underreporting of the events, they suggested.
Mental health services should be expanded to address “robust and persistent” differences in rural areas, the authors recommended. An accompanying editorial suggests tangible steps physicians can take to help.
A total of 66,595 young people died by suicide between Jan. 1, 1996, and Dec. 31, 2010, found the study published Monday in JAMA Pediatrics.
The rate of suicide in rural counties among both sexes was nearly double what it was in urban counties. Specifically, among males, the rates per 100,000 were 19.93 in rural counties and 10.31 in urban counties; for females, the rates were 4.40 and 2.39 respectively.
Access to mental health services is a long-standing problem in rural areas, the researchers noted. That issue is compounded by other factors, they wrote, such as the lack of availability and accessibility to health benefits, the social isolation of rural geographies and greater access to firearms.
Just over half the suicide deaths resulted from use of a gun, while 33% used hanging or suffocation and nearly 8% turned to poison, the researchers reported. For both sexes, suicide rates involving guns were disproportionately higher in rural areas than suicides in urban ones. Between 2008 and 2010, for example, the rate for males was 4.42 per 100,000 in the most urban counties and 11.87 per 100 000 in the most rural counties.
“Suicide is in many ways the oft-ignored part of gun tragedy in America, the part few people talk about,” wrote Dr. Frederick Rivara of the Child Health Institute at the University of Washington, Seattle, in an accompanying editorial.
Given the shortage of child psychiatrists, social workers and other mental health specialists, he suggested that primary-care physicians can play a role in prevention by asking about whether or not firearms are present in the home, especially if a patient has signs of mental illness.
The problem of suicide and the issue of firearms are complex public health issues, said Rivara, editor for JAMA Pediatrics. “But, in the United States, they also appear to be integrally linked and demand our attention.”
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