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Widening rural-urban disparities in youth suicides

The JAMA Network Journals

Rural suicide rates were nearly double those of urban areas for both males and females in a study of suicide deaths in young people ages 10 to 24, according to an article published online by JAMA Pediatrics.

Suicide is a public health problem and in 2010 suicide was the third leading cause of death in young people behind only unintentional injuries and homicides, according to the study background.

Cynthia A. Fontanella, Ph.D., of Ohio State University Wexner Medical Center, Columbus, and coauthors provide an updated comparison of rural and urban youth suicides by analyzing national mortality data from 1996 through 2010 focusing on young people between the ages of 10 and 24.

Study results show that 66,595 young people died by suicide during the study period and that rural suicide rates were nearly twice those of urban areas for males (19.93 and 10.31 per 100,000, respectively) and females (4.40 and 2.39 per 100,000, respectively). The most common method was death by firearm (51.1 percent), followed by hanging/suffocation (33.9 percent), poisoning (7.9 percent) and other means (7.1 percent).

Rates of suicide by firearm declined for both males and females but rates of suicide by hanging/suffocation increased. However, rates of suicide by firearm and hanging/suffocation were disproportionately higher in rural areas, according to the study. For example, in the most recent time period (2008-2010), the rates for suicide by firearm were between 2.7 and 3.3 times higher for males and females, respectively, in rural areas compared with urban areas.

The authors speculate on several reasons for these trends, including a limited availability of mental health services in rural areas, geographic and social isolation in rural areas, more common ownership and use of firearms in rural areas, and changing sociodemographic and economic factors.

"Rural-urban differences are robust and persistent across the study period regardless of sex and suicide method, but the mechanisms whereby rural residence might increase suicide risk in youth remain elusive. Although low population density per se may be operative, efforts to improve access to mental health services and offer social support at the local level could narrow the gap in risk for youths in rural as opposed to urban settings. Additional study is warranted and of potentially great public health significance," the study concludes.

(JAMA Pediatr. Published online March 9, 2015. doi:10.1001/jamapediatrics.2014.3561. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The project described was supported by an award from the National Center for Research Resources. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Editorial: Youth Suicide and Access to Guns

In a related editorial, JAMA Pediatrics Editor-in-Chief Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, writes: "Suicide is in many ways the oft-ignored part of gun tragedy in America, the part that few talk about, especially those who resist any efforts to decrease access to guns."

"The prospects for resolution of the ideological struggle in the United States regarding firearm ownership remain remote. However, safe storage of firearms in the homes of children or others at risk for suicide is a pragmatic rather than ideological issue that should not be contentious. ... The problem of suicide and the issue of firearms are very complex public health concerns. But, in the United States, they also appear to be integrally linked and demand our attention," Rivara concludes.

(JAMA Pediatr. Published online March 9, 2015. doi:10.1001/jamapediatrics.2015.104. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: The author reported receiving funding for research on firearm violence from the Centers for Disease Control and Prevention and the city of Seattle. Please see article for additional information, including other authors, author contributions and affiliations, etc.

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Media Advisory: To contact author Cynthia A. Fontanella, Ph.D., call Eileen Scahill at 614-293-3737 or email Eileen.Scahill@osumc.edu. To contact editorial author Frederick P. Rivara, M.D., M.P.H., email mediarelations@jamanetwork.org

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