People living in rural areas of the United States are at greater risk of suicide than those living in urban areas, according to a new study from researchers at the Centers for Disease Control and Prevention (CDC).

Specifically, the study found that the suicide rate in rural counties is almost a third higher than the rate in large metropolitan areas.

This finding supports another CDC study published earlier this year that reported a widening gap in suicide rates between rural and urban areas over the past two decades. The new study, however, takes a more in-depth look at this trend by analyzing it by gender, race, ethnicity, age and method of suicide.

Suicide research has taken on an even greater sense of urgency in recent years. The national suicide rate has climbed by more than 20 percent during the past two decades. Suicide is now the 10th leading cause of death in the United States. More than 44,000 Americans take their lives each year. 

Although those numbers are tragically high, they probably don’t reflect the true scope of the problem. Experts believe the increase in the U.S. suicide rate since 2000 is much greater than reported because of an underreporting of opioid-related suicides.

Fifteen years of data

For the current study, the CDC researchers used county-level death certificate data collected from 50 states and the District of Columbia from 2001 through 2015.

A total of 524,115 suicides were reported during that period — 256,511 in large metropolitan counties, 173,045 in small to medium metropolitan counties and 114,559 in rural counties.

The highest annual rate of suicide was in the rural counties, however — 17.32 per 100,000 people, which compared to 14.86 per 100,000 in small/medium metropolitan counties and 11.92 per 100,000 in large metropolitan counties.

The data also revealed that while large cities started seeing substantial increases in their annual suicide rates after 2005, such increases began in rural areas in 2007 — in the aftermath of the Great Recession. The CDC researchers point out that the kind of economic consequences triggered by recessions — housing foreclosures, unemployment and poverty — tend to have “greater prevalence” in rural areas and, therefore, were likely a contributor to the rural/urban differences in suicide rates.

CDC

Suicide rates among persons aged ≥10 years, by county urbanization level — United States, 2001–2015

Other revelations

Here are some additional findings from the study:

• The suicide rate increased for all age groups between 2001 and 2015, with the highest increases in rural counties. Working-age people aged 35 to 64 were at greatest risk of suicide, however, no matter where they lived.
• In all three types of counties, the suicide rates were four to five times higher for men than for women.
• Whites have the highest rate of suicide in large metropolitan areas, while American Indian/Alaska Natives have the highest rate in rural areas.
• Blacks living in rural counties have consistently lower suicide rates than blacks living in urban counties.
• Guns were the most common method of suicide in all three types of counties. The highest rates and greatest increases in gun-related suicides occurred, however, in rural counties. People who live in rural areas are twice as likely to kill themselves with a gun than people living in large metropolitan areas. The CDC researchers say this finding is likely related to the fact that gun ownership is more common in rural areas.

“The trends in suicide rates by sex, race, ethnicity, age and mechanism that we see in the general population are magnified in rural areas,” said James Mercy, director of the CDC’s Division of Violence Prevention, in a released statement.

“The report underscores the need for suicide prevention strategies that are tailored specifically for these communities,” he adds.

FMI: The study was published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), where it can be read in full. If you know someone in crisis, call the toll-free National Suicide Prevention Lifeline (NSPL)  at 1-800-273-TALK (8255), 24 hours a day, 7 days a week. The deaf and hard of hearing can reach the lifeline via TTY at 1-800-799-4889. If it’s an emergency, dial 911.