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Rural Youths Commit Suicide Almost Twice as Often as Urban Counterparts

Wallis, Laura

AJN The American Journal of Nursing: June 2015 - Volume 115 - Issue 6 - p 15
doi: 10.1097/01.NAJ.0000466301.39777.65
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Learning cognitive skills to deal with stress may help, but resources are scarce.

Laura Wallis

Figure.

Figure.

More young people in rural areas commit suicide than those in urban areas—by a factor of almost two, and a new study shows that the gap is widening. The researchers examined data files from 1996 to 2010 from the National Center for Health Statistics. They identified distinct groups by population size and urban or rural status and grouped decedents into four cause-of-death categories.

Despite an overall decline in firearm suicide, the most common method by far was firearms (51.1%), followed by hanging or suffocation (33.9%), poisoning (7.9%), and other means (7.1%). From 2008 to 2010, firearm suicides among both male and female youths (10 to 24 years old) were three times higher in the most-rural areas than in the most-urban areas. The overall rate of suicide in rural counties among male youths was nearly double that in urban counties; suicides among female youths, also higher in rural areas, were significantly less frequent than those among male youths. The differences persisted even after adjustment for an array of sociodemographic factors. “Although we endeavored to control for the number of health care clinicians, real differences in access to care between rural and urban environments remain one plausible explanation for observed rural–urban disparities,” the authors wrote.

An editorial in the same publication blames accessibility of guns in rural areas, citing the evidence indicating that many suicide attempts are impulsive acts and that access to firearms can turn an attempt into a fatality. Indeed, 86% of suicide attempts with firearms are successful, whereas attempts involving drugs or poison result in death less than 2% of the time.

Bernadette Mazurek Melnyk, dean of the College of Nursing at Ohio State University in Columbus and an expert in adolescent mental health, thinks the problem comes down to access to mental health care. Suicide is a problem nationwide, she says, but rural youths suffer from high rates of anxiety, depression, and social isolation and don't learn cognitive skills to deal with their stressors. “We know that cognitive behavioral therapy is best,” she says, “but with such a shortage of health care providers, kids aren't getting it.”—Laura Wallis

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Reference

Fontanella CA, et al. JAMA Pediatr 2015 Mar 9 [Epub ahead of print]; Rivara FP. JAMA Pediatr 2015 Mar 9 [Epub ahead of print].
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