Overall suicide rates in the most rural U.S. counties defined by population size and proximity to a metropolitan area were 19.93 per 100,000 for males and 4.40 per 100,000 for females, compared with 10.31 and 2.39 per 100,000 for males and females, respectively, in the most urban areas, according to a report in JAMA Pediatrics. In general, the rates trended higher as counties became more rural. The period under study was January 1, 1996, through December 31, 2010.
Firearms and hanging/suffocation were the two most common methods of suicide among youth (51 percent and 34 percent, respectively), though for both males and females the rates of suicide by firearm declined while rates of suicide by hanging/suffocation increased over time between 1996 and 2010.
Firearm suicide deaths showed some of the most striking rural-urban contrast; in the most recent period analyzed (2008-2010), the rates of suicide by firearm were about 3 times higher in rural areas compared with urban areas.
The study authors proposed that several factors may account for these trends, including geographic and social isolation, less availability of mental health services in rural areas, and more common ownership and use of firearms in such regions.
To read about suicide prevention among youth, see the book Helping Kids in Crisis: Managing Psychiatric Emergencies in Children and Adolescents from American Psychiatric Publishing.