Carrie Henning-Smith As rural suicide rates increase in America, studies show risk is not randomly distributed

New research suggests that suicide prevention efforts must include structural policy responses to strengthen the communities that bear the greatest burden.
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By Carrie Henning-Smith, deputy director of the University of Minnesota Rural Health Research Center

Suicide is more than a personal tragedy; it is both a source and a symptom of collective pain. Despite laudable efforts to prevent suicide, rates are going in the wrong direction. In the past two decades, suicide rates increased in all but one state, and half of all states saw an increase of more than 30 percent. Rural areas have felt this most acutely, as suicide rates are higher and increasing more quickly in rural areas than in urban ones. Together, we can reverse rising trends, but only if we focus on changing the systems and structures that shape suicide risks.

Suicide claims the lives of almost 50,000 people in the United States each year, making it the 10th leading cause of death. An additional 10 million adults consider suicide each year, with almost 1.5 million of those making a nonfatal attempt. Underlying those statistics are the countless other lives that are touched by suicide, as people mourn the loss of loved ones and wonder what else could have been done.

Rural areas have felt this most acutely, as suicide rates are higher and increasing more quickly in rural areas than in urban ones.

Today is the last day of National Suicide Prevention Awareness Month, and new research adds evidence to what we already know: Suicide risk is not randomly distributed, and some people are at greater risk than others. The study, which investigated the almost half a million suicides in the U.S. between 1999 and 2016, found that the majority of people who died by suicide were men between the ages of 35 and 54. Other research has shown disparities in suicide rates by race and ethnicity; American Indian and Alaska Native people have the highest rates of suicide of any racial group.

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Perhaps most startling are the differences in suicide rates by geographical location. Rural areas have higher suicide rates than urban areas, and indeed have suffered faster increases in recent years. Counties with more social fragmentation (e.g., people living alone, living unmarried, renting their homes, or moving recently) and less social capital (e.g., the number of associations, organizations and participation in civic and community life) both have higher rates of suicide, as do counties with more veterans, more gun shops and more people who are uninsured. Altogether, these statistics make clear that suicide prevention efforts need to support more than individuals at risk, but also include structural policy responses to strengthen communities that bear the greatest burden.

Put another way, rural suicide prevention efforts, and public health policy, should tackle the immediate risk factors related to suicide in the forms of public education, harm reduction and access to mental health services. But, efforts should also tackle broader, systemic issues, such as structural racism, chronic poverty and social fragmentation.

In fact, forward motion on many of today’s most contentious political issues would help to reduce suicides, including health reform, climate change and access to firearms. Rural areas have higher rates of the uninsured than urban areas, especially in states that have not expanded Medicaid. The lower the rate of insurance in the county, the higher the suicide rate.

Sometimes, the factors leading to higher suicide rates are widely known — but are not generally connected to suicide. Changes to the climate, for example, can be devastating to rural areas, which cover more than 95 percent of all U.S. land, and are home to many of the natural resources that we all depend on, including food, water and energy. Increases in temperature have been linked to increases in suicide, and have a direct effect on the mental health of rural populations who depend on the land for their livelihood.

Sometimes, the factors leading to higher suicide rates are widely known — but are not generally connected to suicide.

Meanwhile, rural residents are also more likely than urban ones to own firearms, the most common means of suicide. Divisive debates over gun policy in the U.S. often gloss over the fact that the majority of firearm deaths are suicides. Any action on gun regulation should incorporate the voices of rural residents who are disproportionately impacted by suicide.

Policy and programmatic efforts to reduce suicides need to account for the unique and heterogeneous landscape of rural America and its diverse residents. Rural areas differ in important ways from urban areas. For example, many rural areas face considerable challenges related to transportation infrastructure. Others lack access to broadband internet and cellular connectivity. Health care access is a perennial problem in rural communities, related to workforce shortages, hospital closures, long distances, and financial constraints. Each of these may hamper traditional suicide prevention efforts, if the resources to connect with and serve people are not first in place.

Of course, rural assets and strengths should not be overlooked. At the University of Minnesota Rural Health Research Center, we found that older adults in rural areas had more close relatives and friends than their peers in urban areas. And yet, they were more likely to report feeling lonely. Just having people in your life is not enough; each of us needs regular and meaningful interactions. In rural areas with barriers to travel and connecting, more effort may be required to ensure a sense of community connectedness for all residents.

Given its many overlapping and complex risk factors, preventing suicide — especially in rural areas — may seem overwhelming. But, there are many successful examples of rural efforts already in place that provide inspiration. Continuing to support those efforts is essential, but not sufficient. Meaningful structural and policy change is also needed to support the rural people and places that bear disproportionate risks of suicide in order to truly turn the tide from personal pain to collective healing.

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.