By Lisa Rapaport

(Reuters Health) – Suicide rates are rising across the U.S., especially in rural communities and places with high poverty and a proliferation of gun shops, a new analysis suggests.

Researchers examined data on 453,577 U.S. residents aged 25 to 65 years who died by suicide from 1999 to 2016. Large urban areas accounted for almost half of the suicides during the study period, and only about 2% of the total happened in rural counties.

Nationally, half of counties had suicide rates at or above 15 deaths per 100,000 individuals in the period from 1999 to 2001, but this figure rose to 21.2 per 100,000 in the final three-year period from 2014 to 2016.

Suicide rates tended to be higher in counties with higher levels of deprivation – a measure of how many people live in poverty and have limited education, housing insecurity, or receive public benefits. This connection between deprivation and suicide was also strongest in rural communities, especially later in the study period, researchers report in JAMA Network Open.

“This finding highlights the struggle for rural communities to adapt to changing economic conditions and difficulties bringing in new industries and opportunities,” said Danielle Steelesmith, lead author of the study and a psychiatry and behavioral health researcher at The Ohio State University Wexner Medical Center in Columbus.

“It seems more urban areas may be better at adapting to these conditions since the association between deprivation and suicide in urban areas decreased with time,” Steelesmith said by email.

City residents might also have access to a broader range of services to help with housing, healthcare and job placement that could reduce risk factors for suicide like unemployment or housing insecurity and make it easier for people to get mental health care, said Dr. Alex Gertner, a researcher at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.

Rural communities in western states as well as in Appalachia and the Ozarks saw the largest increases in suicide rates overall, the authors note.

In most places, higher concentrations of gun shops were also associated with higher suicide rates. The connection may be partly explained by the fact that people who attempt suicide with firearms tend to die more often than those who try other methods.

“We can’t say with certainty from this study that having fewer gun shops would lower suicide rates, though there’s plenty of evidence from existing research that limiting access to guns leads to fewer gun deaths,” Gertner, who wasn’t involved in the study, said by email.

“Places with fewer gun shops may be places where guns are harder to buy, or they may be places where the local population is more averse to owning guns, or they may be places where local ordinances put limits on gun ownership – so there are different possible explanations for the findings.”

Regions with more uninsured residents also had higher suicide rates, which might partly reflect people being unable to access or afford mental health care.

Suicide rates were also lower in communities with higher levels of so-called social capital, where people had more opportunities to engage and connect with their neighbors, the study also found.

The study wasn’t designed to prove whether or how specific factors might directly impact suicide rates.

There are likely many interconnected factors involved, said Dr. Martin McKee, a researcher at the London School of Hygiene and Tropical Medicine in the UK, who wasn’t involved in the study.

“The past few decades in the U.S. have been extremely traumatic for many people,” McKee said by email.

“Real wages have barely increased for many people, life has become much more insecure, and traditional jobs are disappearing, mainly due to automation but to a smaller extent by being exported to low-wage economies,” McKee added. “Those with the least personal resources, which include education, skills, and assets that can be drawn on when times get tough, suffer most, hence, it is hardly surprising that poverty is associated with suicide.”

SOURCE: JAMA Network Open, online September 6, 2019.