A distressing new report from the journal JAMA Pediatrics finds that adolescents and young adults in rural communities take their own lives twice as often as those in cities, sparking an “urgent” need to ensure mental health help and access in large swaths of the country. And the gap between remote and urban populations is growing, the study says. The lack of mental health care outside of urban areas isn’t news, but the severity of that shortage is alarming, the study says: Of 1,669 areas in the nation that the federal government has flagged for lack of mental health care, 85 percent fall in rural regions. More than half of the counties in the U.S., all of them rural, lack a single psychiatrist, social worker or psychologist. Coupled with a rural sensibility that sometimes stigmatizes mental health care as dubious, a waste of money or a sign of weakness, researchers theorized, the paucity of providers worsens the odds that young people will get help before their illness grows dire.
No Help for Miles Around
A team from Ohio State University’s (OSU) Wexner Medical Center looked at national mortality records of young people between the ages of 10 and 24 between 1996 and 2010. Suicide was the third leading cause of death among young people in 2010 after accidental death and homicide. Of the 66,600 suicides that occurred in that decade and a half, 90 percent of victims suffered at least one major mental health problem, such as depression or bipolar disorder, and many of them were substance abusers, putting them at higher risk for impulsive behavior and destabilizing mood swings, the study’s authors said. What’s more, the gap between suicides of young people in remote communities versus cities has widened, according to Cynthia Fontanella, PhD, clinical assistant professor of psychiatry and behavioral health at OSU’s Wexner Medical Center and the study’s lead author. “Even when they do have services, they still have to travel longer to get services,” Dr. Fontanella said in an interview. “So by the time they get to an appointment they have more severe symptoms and they also require more services. This, combined with a disproportionate stigma of mental illness, means there is reluctance to seek out care.”
Youth Suicide in Numbers
Here’s some of the data behind the recent JAMA Pediatrics report:
- Between 1996 and 2010, 66,595 youths between age 10 and 24 died by suicide in the United States, according to the National Center for Health Statistics National Vital Statistics System.
- Among males, the rural versus urban suicide rate was 19.93 and 10.31 per 100,000, respectively, and for females, 4.40 and 2.39 per 100,000, respectively.
- When the researchers controlled for a number of other potential factors such as demographic, socioeconomic or geographic (lack of access), the rural and urban suicide rate disparity increased over time for males.
- The suicide rate for young males is four times higher than for young females.
- More than half of this age group who took their own lives (51.1 percent) did so with a firearm, while 33.9 percent died by hanging.
“These kinds of surveillance studies can really help us identify areas to target our prevention efforts, and it’s clear we need to target rural areas for primary prevention of suicide,” Fontanella said.
Youth Suicide: What Can Be Done?
For some time, the federal government has offered incentives, such as student loan repayment or forgiveness, for mental health providers to locate in more remote locations. According to Fontanella, the Affordable Care Act (ACA) provides additional incentives for mental health providers to move to rural areas, and the ACA simply provides more care overall. Other remedies suggested by the research team include tapping primary care providers to include mental health help, having schools step up intervention by catching early warning signs, and using technology to try and fill the gap through telemedicine, video conferencing and other means.
Other Factors in Rural Youth Suicide
Fontanella says lifestyle in remote areas, or at least rural ones, tend to include more firearms. Be it self-defense or hunting, guns are more accessible to young people in rural communities, and this is reflected in the study findings, she says. Suicide among rural young people is more commonly by gun or hanging than in urban environments. There’s also pride about being able to take care of one’s own problems without asking outsiders, even if they’re professionals, Fontanella said. No studies have been done to try to pinpoint specific causes of this disparity in suicides based on residency of young people, but the study authors cited the social and geographic factors. They said that one thing’s clear: “If a rural child is depressed, it’s much harder to get state-of-the-art care. And it’s especially difficult to receive psychotherapy in a rural area.”