It's been clear for some time now that suicide rates are higher in rural than urban areas, at least in the United States, and the gap is widening. A report last year by the Centers for Disease Control and Prevention speculated that "limited access to mental health care, social isolation, and the opioid overdose epidemic" may play a role in this disturbing trend.
New research points to what may be the most important factor of all: People in rural areas are more likely to own firearms.
"The reason that rural suicide rates are higher is because people in these areas are killing themselves with guns," lead author Paul Nestadt of the Johns Hopkins Bloomberg School of Public Health said in announcing the findings. "The media focuses on homicides with guns, but only one in three deaths by firearms are homicides. The other two are suicides. Most of the other leading causes of death are going down. Suicides are going up—and firearms are a big reason why."
In the American Journal of Public Health, Nestadt and his colleagues examined suicide rates in Maryland to attempt to explain the urban/rural divide. They gathered data on 6,196 Maryland residents who took their lives between 2003 and 2015, and noted the county where they had lived and the method they used to kill themselves.
Guns don't kill people; people kill themselves with guns.
"We found that, although there is a higher suicide rate in rural Maryland counties than urban ones, the rate difference is limited to firearm suicides," they report.
Specifically, "among men, suicide by firearm was more common in the rural counties than in most urban counties," the researchers write, "whereas there were no significant differences in the non-firearm suicide rate across counties."
This pattern was limited to men, who made up 89 percent of suicide victims.
"It has been suggested that increased suicide rates in rural areas may be the result of increased isolation, economic disparities, or decreased access to care," the researchers write. "However, the findings from this study suggest that the impact of these contextual factors may be overshadowed by the differences in access to means of suicide, as the rural-urban rate difference was limited to firearm suicides."
Indeed, the researchers found "no significant differences in mental-health care provider availability" between the state's urban and rural counties. That suggests counseling for depression was available to residents living outside of big cities.
As Nestadt and his colleagues note, suicide is the tenth-leading cause of death in the U.S., and the suicide rate in 2015 was the highest in 30 years. They conclude that investing in "more robust rural firearm safety and control initiatives" could help address this "pressing public health problem."
True enough, but so long as the rural gun culture remains—and there's no sign of it abating—rural men with suicidal thoughts will have a sadly effective way to act on that impulse. To tweak the famous slogan, guns don't kill people; people kill themselves with guns.