Whether they are densely populated or deeply rural, few communities in the United States have escaped a shocking increase in suicides over the last two decades. From 1999 to 2016, suicide claimed the lives of 453,577 adults between the ages of 25 and 64 — enough to fill more than 1,000 jumbo jets.
Suicides reached a 50-year peak in 2017, the latest year for which reliable statistics are available. The vast majority of those suicides happened in the country’s cities and suburbs, where 80% of Americans live.
But a new study shows that the nation’s most rural counties have seen the toll of suicide rise furthest and fastest during those 18 years.
The new research ties high suicide rates everywhere to the unraveling of the social fabric that happens when local sports teams disband, beauty and barbershops close, and churches and civic groups dwindle. But in rural counties, especially, it finds a powerful link between suicide and economic deprivation — a measure that captures poverty, unemployment, low levels of education and reliance on government assistance.
The study also finds that in counties where health insurance is lacking, and in those where military veterans represent a larger proportion of the population, suicide rates were higher over the 18-year period studied.
And in all but the most rural counties, the more stores there are selling firearms, the higher the suicide rate — a finding that underscores the risk that goes hand-in-hand with having easy access to guns.
At a time when surging suicide rates have contributed to a sustained decline in life expectancy in the United States, the study results suggest that efforts to rescue Americans from self-destructive despair must focus on combating loneliness, revitalizing downtrodden communities, broadening access to healthcare and narrowing access to guns.
And it suggests that economic decline in the nation’s rural outposts has generated a hopelessness that must not be overlooked.
“Suicide rates in rural counties are especially susceptible to deprivation,” a team led by researchers from Ohio State University wrote in Friday’s edition of the journal JAMA Network Open. “Rural counties present special challenges and deserve targeted suicide-prevention efforts.”
The Centers for Disease Control and Prevention has reported that the age-adjusted suicide rate rose from 10.5 deaths per 100,000 people in 1999 to 14.0 per 100,000 in 2017 — a 33% increase. Suicide is now the 10th-leading cause of death for people of all ages in the United States. While rural counties have long led urban ones in suicide rates, the gap became even wider during those years.
Across the country, the new study found that counties whose suicide rates exceeded the national average by the greatest amount tended to be in Western states (particularly Colorado, New Mexico, Utah and Wyoming), in Appalachia (including Kentucky, Virginia and West Virginia), and in the Ozarks (Arkansas and Missouri).
A time-lapsed series of snapshots of suicide rates since the turn of this century reveals a spreading geography of despondency that’s broken up by just a few islands — virtually all of them urban — where suicide rates have risen only moderately.
In a series of maps, elevated suicide rates first appear from 2002 to 2004 in pockets scattered across the American Southwest, the inter-mountain West, Appalachia and the farthest reaches of Alaska.
By 2008 to 2010, above-average suicide rates darkened much of the mountainous West and extended across Oregon and Northern California to the Pacific Coast. And they gained a solid foothold in the Midwestern heartland and in counties of the industrial Upper Midwest.
By 2014 to 2016, increased suicide rates spread across the vast expanse of the American West, sparing only most of the counties hugging the California coast from Sonoma County to San Diego. They also covered the industrial Midwest and appeared in rural counties in southern Mississippi and Louisiana, the mid-Atlantic states and New England.
Danielle L. Steelesmith, the study’s lead author, said the findings on guns warrant further scrutiny. But she noted that this isn’t the first time researchers have seen that where access to firearms is greater, so too is the number of suicides committed with a gun.
The exception was in the 20% of counties classified as rural — those lacking a town with a population greater than 2,500. Steelesmith said the fact that the density of gun shops there was not linked with an increase in suicide risk may reflect a central fact of rural life: Most homes already have a gun, so the availability of a gun retailer may not necessarily increase gun access.
But in counties that include towns larger than 2,500, the added access that comes with more gun shops may make a difference.
“It’s relatively small as an association,” Steelesmith said. “In a large metropolitan county, one additional gun shop would increase suicides by one to two people. But at the national level, that’s potentially a lot of people.”
The new analysis helps explain why suicides, drug overdoses and other so-called deaths of despair have ravaged rural white populations while touching more lightly upon African Americans and Latinos, said Brookings Institution research analyst Carol Graham.
In more metropolitan counties, the long-entrenched poor — including communities of color — appear able to fend off despair by accessing shared resources like city parks, neighborhood barbershops and community churches, and by tapping into the social networks that have sustained them through generations of hardship, Graham said. Plus, they are closer to a wider range of employment opportunities.
Even in rural counties dominated by minorities, such shared institutions have long existed, helping blacks and Latinos to weather long-standing poverty, she said.
In rural counties hollowed out by more recent economic decline, the shared communities of religious congregations, Grange meetings and even high school football games have dwindled. And as residents fled, those left behind have become increasingly isolated from one another, said Graham, who studies the geography of happiness and despair as well as the social, economic and political factors that contribute to population health.
“These are the places that used to be thriving rural places, near enough to cities and manufacturing hubs,” she said. “They’re places that accord with a stereotypical picture of stable blue-collar existence — and a quite nice existence — for whites in the heartland.”
With the collapse of extractive industries such as coal mining, the departure of manufacturing jobs, and a strapped agricultural economy, “these communities just got flipped on their head,” Graham observed. “And the people in those places became unhinged. You’d have a sense of places where everything has left. And among those who stay, you see no optimism for the future.”
Steelesmith said that one of the study’s findings — that “social capital” in the form of clubs, churches, schools and group activities was associated with lower rates of suicide — offers hope to rural populations reeling from economic deprivation.
Maintaining friendships and building connections with others “are something that residents can do themselves,” she said.