Suicide is the third leading cause of death for adolescents and young adults, and those who live in rural areas are especially at risk.
For young people between the ages of 10 and 24, the suicide rates in rural areas are nearly double those of urban areas, according to a study published Monday in JAMA Pediatrics. And that disparity is growing.
The study, which analyzed data from 1996-2010, also found over half of the young people who killed themselves during that time period themselves had used a gun. And the rates for suicide by firearm were especially high in rural areas — about three times the rates for urban areas.
The number of young people committing suicide by hanging or suffocation increased, the study found, and the number of people using firearms decreased slightly. But firearms still accounted for the majority of deaths, at 51 percent, followed by hanging or suffocation, 34; percent; poisoning 8 percent; and other means 7 percent.
Why? "For one, rural areas have poor access to mental health services," says Cynthia Fontanella, an associate professor of clinical psychiatry at Ohio State University who led the study. Around half of all counties in the U.S. don't have a practicing psychiatrist, psychologist or mental health professional – and all of these counties are rural.
There also tends to be more stigma around seeking mental health care in rural areas. "There's often this emphasis on self-reliance and this rugged individualism," Fontanella says. People hesitate to seek help with emotional issues.
"And even if someone wants to go to a mental health professional, in small towns there's a lack of anonymity in seeking care," she adds.
Those factors, combined with the fact that gun ownership is more common in rural areas, is likely what puts young adults who live in rural areas at particular risk for suicide, Fontanella says.
Safe gun storage is key to reducing suicide in rural areas, according to Dr. Frederick Rivara, a professor of pediatrics at the University of Washington who wrote an editorial accompanying Fontanella's study.
"So much of the tension around firearms has revolved around firearms and homicide," Rivara tells Shots. "But really what we need to be worrying about is guns and suicides."
Studies show that reducing access to lethal means can reduce suicides rates by 30 to 50 percent, Rivara notes. "Especially in rural areas, guns are here to stay," he says. "But what people can do is make sure that any guns at home are stored securely and kept away from those who are at risk."