Editorial roundup

April 9

The Tennessean Rural areas need suicide lifelines

The federal Centers for Disease Control and Prevention released a study in March that showed suicides on the rise between 1999-2015, with 600,000 Americans taking their lives.

The highest annual rate was in 2015, the last year for which data was available. The authors found suicides increased across all levels of urbanization but noted a widening gap between urban and rural areas. In other words, they saw a trend where people were more likely to commit suicide in rural areas than in urban.

Preliminary numbers and the trend are similar for Tennessee. Some 1,065 Tennesseans committed suicide in 2015, up from 945 recorded in 2014, according to Scott Ridgway, executive director of the Tennessee Suicide Prevention Network.

The federal researchers found that suicides increased during the study period from 11 per

100,000 population in 1999 to about 11.5 in

2015 or about 5 percent in large central metropolitan areas. In rural areas, the numbers increased from 15 per 100,000 population in 1999 to 22 per 100,000 in 2015 or about 32 percent.

Researchers attribute the increase and the trend in rise of rural suicides to a number of issues.

Those include limited access to mental health care, social isolation, the opioid overdose epidemic — because opioid misuse is associated with increased risk for suicide — and the economic recession.

Rural areas by nature are isolating, and people don’t like to talk about mental health issues or suicide for fear of being stigmatized.

“Because we live in the Bible belt, we never have those conversations,” he said.

That could be solved, Ridgway says, with training at clinics, emergency rooms and family practices and the use of a routine screening question: Have you thought about suicide in the past two months?

“If we ask the questions, people will answer us correctly,” he said. “They will feel their anxiety lowered and may begin to feel comfortable about discussing suicide.”

Rural areas have been hard hit by the opioid epidemic, and the researchers suggested opioid misuse as increasing the risk of suicide. Ridgway says that because Tennessee doesn’t do toxicology tests on every suicide or every overdose death, it’s hard to determine how many were because of opiates.

The economic recession of 2007-2009 also affected rural areas greater than urban areas and involved a longer recovery time. Factories closing, folks losing jobs. Even if they had access to mental health services, how would they pay for them?

The effect of a single suicide impacts family, friends, neighbors and co-workers. In rural communities, the CDC report suggests it is a growing public health threat that needs a comprehensive preventive approach. Resources targeted toward rural communities, enhanced training for front-line health providers and relocation incentives for mental health professionals are ways we can begin to prevent suicides.