A new county-level study sheds further light on factors that increase risk for suicide. The study by The Ohio State University also shows that in many places in the U.S., the rate of suicides has gradually exceeded the national average over the past 16 years. This includes many parts of Kentucky, especially in rural areas.
The research shows counties that have higher rates of residents who are low income, are veterans or aren’t married all contribute to higher than average rates of suicide. Suicide rates also increased more rapidly in rural areas than in urban counties.
The study looked at suicide rates by county over three different periods of time between 2002 and 2016. It was published in the Journal of the American Medical Association Friday.
The three biggest factors that were associated with a county having a higher than average suicide rates were lower educational attainment, lower incomes, poverty, welfare assistance and employment; these factors made a bigger difference on suicide rates in rural counties than they did in urban counties.
The study also found what it called “social fragmentation” as the second biggest factor in these higher than average rates. That includes counties with residents who are single, unmarried, renters or are new to the area.
Western Kentucky A Dark Spot
In western Kentucky, the suicide rates were more than double the national average, outpacing the rest of the state. For instance, in Union County, suicide rates were about the national average between 2002 and 2004. But by the final time period studied — 2014-2016 — the rate was at least double the national average.
Across the state, a similar increase occurred in Grayson, Bullitt and Monroe counties.
Study authors aren’t sure why the suicide rate has increased so much in western Kentucky. But Patti Clark, program manager for prevention and promotion at the Kentucky Department Of Behavioral Health, said the state is well aware of the increase.
“We have been watching these increases in Western Kentucky for a bit,” Clark said. “There’s no one thing that we’ve been able to point at to say, ‘that’s what’s causing this kind of increase across that region.’”
The increase in rates is even higher than in eastern Kentucky, where suicides from economic depression are well documented. Clark said that the difference might be that western Kentucky’s economic downturn is relatively new.
“[In] Eastern Kentucky, it’s been a long time that it’s been a depressed region economically,” Clark said. “Where[as] Western Kentucky may be experiencing and seeing a shift as a result of some of the losses of industry and stuff that folks haven’t yet acclimated to, as well as they might have in Eastern Kentucky.”
Clark said the state has requested that the Centers for Disease Control and Prevention investigate the increase in suicides in western Kentucky. She said they were hoping to learn if there were any factors that could point the state toward more effective ways of preventing suicide there. But the CDC declined to investigate.
“They did not feel at that time that that they could identify from the data that there really was a contagion or anything that would require additional investigation,” Clark said. “ But the point is, we’ve been watching it for a while. There are things that are happening in and around our folks that are bigger than just depression, bigger than just the mental health, that sometimes we don’t necessarily recognize or don’t have the tools to make them better from a community standpoint.”
Rates also increased above the national average in almost every Kentucky county. Smaller increases were documented in Jefferson and Fayette counties.
Because one of the the biggest predictors of increased suicide rates were socioeconomic factors, University of Kentucky professor Julie Cerel said this finding might explain part of why suicide rates in western Kentucky are so much higher than the national average.
“Western Kentucky, in my experience seems to be hit hardest in terms of the economy, in terms of the opioid crisis and in terms of kind of those social disparities that they talked about,” Cerel, who has no affiliation with the study, said.
There were several other factors associated with higher suicide rates in counties, including:
Veterans have much higher suicide rates than people who have never served in the military. But among the study’s findings are that counties with high veteran populations also have higher overall suicide rates, too. Danielle Steelesmith is the lead study author from the Ohio State University.
“If we’re talking about 100 veterans, we’re saying two or three additional [people] will die by suicide,” Steelesmith said. “It’s small, but it’s significant.”
About 28 percent of veterans live in rural areas, compared to 14 percent of the overall population. Steelesmith also said rural areas have higher rates of military recruitment, which can disrupt families and lead to a greater community-wide risk of suicide.
Cerel at the University of Kentucky said there might be suicide prevention help coming to veterans. Earlier this year President Donald Trump’s administration launched a veteran’s suicide prevention taskforce. Cerel said the task force could open up avenues for funding community efforts. The study could be helpful in targeting specific programs that could reduce suicide rates for veterans.
The study found that the more gun shops, the more suicides there are in metropolitan counties. Steelesmith said one could expect one or two people per every 100 people to die by suicide with each additional gun store.
That finding applied to large metropolitan counties, but didn’t have the same effect in rural counties.
Clark with the Kentucky Department Of Behavioral Health speculated about why this might be: more rural households might already have guns at home, whereas urban residents may not.
“I grew up in Eastern Kentucky, and we had guns in our house all the time — It was just part of what was there,” Clark said. “Whereas in the urban area, it may be more that, if I’m going to have a plan I need to go purchase it.”
The study authors say the finding provides backing for gun sale restrictions, which could include so-called “red flag” laws. These laws allow law enforcement, mental health professionals or a family member to petition a court to remove any firearms temporarily from a person who is going through mental distress or has talked about suicide.
In Kentucky, lawmakers have moved in the opposite direction. In June, a law went into effect that allows residents to carry a concealed weapon without a permit.
“What we’ve seen in other states that have loosened laws about firearms is that their suicide rates have indeed gone up when people have more access,” Cerel said. “And I fear that in Kentucky, we’re going to see an increased rate.”
A lack of health insurance was also associated with higher suicide rates. As the uninsured population increases by just one percent, study author Steelesmith said that an additional suicide can be expected for every 200 residents.
“Access to mental health care in particular can be limited — it’s probably even more so when you don’t have health insurance,” Steelesmith said.
Clark with the state said having health insurance can both allow for people to be screened for potential suicidal thoughts, and also make people feel that they’re able to get help if they need it.
“I can feel like I’ve got the ability to take care of myself — whether that’s a physical issue or a mental issue — I think it’s really just that kind of a protective factor,” Clark said.
Having more psychiatrists, however, didn’t make a statistical difference in if a county rate was higher or lower than the national average.
“A lot of what people have talked about in recent years [on suicide factors] in rural areas [is that] we think that is an access issue…but in fact that wasn’t really it at all,” Cerel said. “It was things like social fragmentation, lack of social capital, lack of health insurance.”
There are some factors that were associated with lowering suicides rates, however. Steelesmith and her team created a way to measure social capital, or the connections within a community that a resident might have. Those included the number of beauty shops, parks, charities, businesses, civic groups and churches.
“If you live in a county with the most connectedness between individuals, the suicide rate is lower than in the low-social capital counties,” Steelesmith said.
This finding, paired with the others, could create a plan for states or counties to prevent suicide.
“It does indicate that there are some things that can be done policy-wise to improve economic situations or to encourage connectedness even at the grassroots level,” Steelesmith said.
Clark with the Department of Behavioral Health said Kentucky is currently working on a project that will allow first responders to more easily report if they’re responding to a person who’s in a suicide crisis. Clark said they hope this will allow the state to target specific communities better with prevention efforts.
Clark also said there are many federal resources that go toward preventing youth suicide, which is also increasing. She said the training that community providers and stakeholders receive in preventing a kid from killing themselves can also help these providers recognize the signs in adults.
“So that’s why a lot of the work that we do, starts there — but a lot of it continues and carries over [to adults],” Clark said.
People between the ages of 25 and 64 who died by suicide between 1999 and 2016 were included in the study using data from National Center for Health Statistics National Vital Statistics System. Suicides were grouped into three-year ranges to make sure suicide rates for a timeframe were an average and representative. Counties were broken into four categories: large metropolitan, small metropolitan, micropolitan and rural.
If you or someone you know are having thoughts of suicide and want help, here are some resources:
The National Suicide Prevention Lifeline
The National Suicide Prevention Lifeline provides free and confidential emotional support to individuals experiencing a suicidal crisis or emotional distress via telephone or chat 24 hours a day, 7 days a week.
Text HOME to 741741 from anywhere in the United States, anytime, about any type of crisis.