Study shows rural residency, gun shop prevalence, lack of insurance associated with higher suicide rates.
A higher density of gun shops, lack of health insurance and larger populations of veterans are all associated with higher adult suicide rates across the United States, according to a new Ohio State University study that reviewed county-level data.
Deprivation and social fragmentation also are possible explanations for increased suicide rates, which are higher and have risen more rapidly in rural counties, said the study, published online Friday in the journal JAMA Network Open.
Researchers hope the findings will be used to target specific suicide prevention efforts, said Cynthia Fontanella, co-author and associate professor of psychiatry and behavioral health at Ohio State.
“Findings suggest that increasing social connectedness, civic opportunities, health insurance coverage, and limiting access to lethal means within communities have the potential to reduce suicide rates across the rural-urban continuum,” the study says. “Suicide rates in rural counties are especially susceptible to deprivation, suggesting that rural counties present special challenges and deserve targeted suicide prevention efforts.”
The study looked at the 453,577 suicides between 1999 and 2016 among people ages 25-64, and it compared the rates in three-year periods.
The first period, between 1999 and 2001, saw a median suicide rate of 15 per 100,000 people on the county level. The last period, between 2014 and 2016, saw a rate of 21.2 per 100,000 — a jump of 41%.
Men accounted for more than three-fourths of the suicides.
Counties with the highest suicide rates were mostly in Western states, Appalachia and the Ozarks.
Researchers also calculated a “standardized mortality ratio” for each U.S. county, or county equivalent, to compare the actual number of suicides with the expected number of suicides. Counties with a ratio of more than 1 are considered as having an excess risk of suicide.
Nationwide, the highest risk in the three-year period from 2014 to 2016 was found in the Wade Hampton (now Kusilvak) Census area in Alaska. It had a 4.2 ratio. The lowest ratio, 0.56, was in Kings County, New York.
The states with the highest average county-level mortality ratios were Montana, Utah, New Mexico, Nevada and Wyoming. Those with the lowest were New Jersey, Massachusetts, New York, Connecticut and Maryland.
In Missouri, the average county mortality ratio was 2, which is 11.1 percent higher than the national average of counties.
The gun shop association was most substantial in urban areas and present in all county types except the most rural, the study says.
Guns were used in about half of all suicides in 2017, according to the Suicide Prevention Resource Center.
Study researchers found no association between gun shops and suicides by methods other than firearms.
Jim Irvine is board president of the Buckeye Firearms Association, which also is involved in suicide prevention efforts. He said he hadn't seen the report's data, and noted that suicides with firearms often result in death, but they are not necessarily used in the most attempts.
"Suicide is a massive problem in our country, and we need to deal with it, and I welcome any study on it that helps us understand what's going on better and make some progress to reverse these trends and save lives," Irvine said.
Along with reducing access to lethal means among people at risk, Fontanella said, communities may benefit from enhancing coping and problem-solving skills and strengthening economic development, education and training, incentivizing mental health clinicians to work in underserved areas and using web-based telemedicine.
“Rural areas might also benefit from suicide prevention strategies that support social connection through community organizations and community engagement activities,” she said.
The study also showed that higher social capital — measured by the number of several groups, such as charities, business, political, civic and religious organizations, and opportunities to engage in art and recreation — was associated with reduced suicide rates.
Factors that showed no association with suicide rates were the ratios of physicians to residents and psychiatrists to residents and the number of drinking establishments.
"We know we can prevent suicide,” said Terry Russell, executive director of the Ohio affiliate of the National Alliance on Mental Illness. “But it takes gatekeepers to identify people early and make sure they know what services are available.”
If you or someone you know has thoughts of suicide, reach the national Suicide Prevention Lifeline at 1-800-273-8255/TALK (or 1-888-628-9454 for Spanish speakers).