Rural Youth Suicide Incidents Close to Double Urban Rate
Suicide is the third leading cause of death for adolescents aged 10 to 24 and results in approximately 4,600 lives lost every year, according to the Centers for Disease Control and Prevention. The rate of suicides for youth living in rural areas is almost double the rate for youth living in urban areas. That’s what a new study by researchers at the Wexner Medical Center in Ohio found. The study, titled “Widening Rural-Urban Disparities in Youth Suicides,’’ was published online in the Journal of the American Medical Association of Pediatrics on March 9.
“It’s scary,’’ said Cynthia Fontanella, lead author of the study and clinical assistant professor of psychology at the Ohio State University Wexner Medical Center.
“We undertook this study, because these kinds of surveillance studies can really help us identify areas to target our primary prevention efforts,’’ said Fontanella. “It’s clear that we really need to target rural areas for primary prevention of suicide, and the study results really confirm that.’’
Fontanella said her team analyzed National Center for Health Statistics mortality data for adolescents aged 10 to 24, from 1996 through 2010. The study found that 66,596 youth (male and female) died from suicide during that time, and that the rate of suicide among rural residents was almost twice the rate of young people who lived in urban areas.
“What we found was that suicide rates, even though gun use has decreased and hanging has become the more common method of suicide rates for males and females, we found that suicide rates by firearm and hanging are disproportionately higher in rural areas than in urban areas for both sexes,’’ said Fontanella.
“I think that these findings are really disheartening, and unfortunately, not surprising,’’ said Dr. Randy Auerbach, director of clinical research for the division of child and adolescent psychiatry at McLean Hospital in Belmont and an associate professor at Harvard Medical School. “The one thing that we do know in the mental health field is that suicide rates are on the rise, in particular among youth.’’
In the study, Fontanella said she and her colleagues speculated why there may be higher suicide rate in rural areas, including barriers, or limited access, to mental health care, social and geographical isolation, socio-economic factors, and a disproportionate stigma associated with mental illness in rural areas. Firearm ownership may be another consideration.
“Rural residents, particularly males, also grow up around guns, have guns in their homes and use guns for hunting, agricultural needs, or recreational,’’ said Fontanella. “It’s part of the rural culture.’’
Auerbach echoed Fontanella’s speculation that barriers to care, access to firearms, and greater stigma around mental health in rural areas might be a contributing factor for the study results.
But the difference between studying suicide and studying illness, he said, is that the pathway to suicide is very heterogeneous, making it difficult to isolate why suicide rates are on the rise.
“People who end their life struggle with a number of different disorders, have a variety of different influences in the context of their life’’ he said. “Genetic influences, familial influences, psycho-social-environmental influences. And so it really becomes difficult to find the one pathway that ends in suicide.’’
Auerbach emphasized the importance of identifying patients at risk and intervening earlier.
“No community, unfortunately, is immune to this tragic event,’’ he said. “I think what differentiates Boston, and potentially other cities, is that we have by comparison a lot of youth-based services.’’
The study took about a year to conduct, according to Fontanella.
“Prior research has shown that rural areas tend to have higher rates of suicide, but the fact that these disparities are widening over time is a novel finding,’’ she said.
Fontanella said she hopes further research will be done around the reasons why young people in rural areas have a higher rate of suicide, and she said she hopes the question will be raised, “What can we do?’’
“It is shocking when you think 67,000 youth have died by suicide, and in many ways it appears that if you live in a rural area the cards are stacked against you in terms of some of these access barriers,’’ said Fontanella.
The study does make some suggestions for intervention: integrated care, use of health practitioners within a primary care setting, telemedicine, and school-based intervention.
“The findings suggest that there’s an urgent need to improve access to, and availability of, mental health care in rural areas,’’ she said.
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