Monday, February 13, 2017

Rural children and guns (Part II): Suicides

"A gun doesn't cause the suicidality, but a suicidal person with access to a gun is far more likely to die from an attempt than someone using another method...It's the combination of accessibility, familiarity, lethality, and really short time frame that's offered by a firearm." - Elaine Frank, director of Counseling on Access to Lethal Means. 

As I stated in my first post on this subject, guns kill rural children at a rate almost equal to urban youths. However, while most urban children die from gun homicides, rural youths tend to die from gun accidents and suicides. This post will focus on rural youths who use firearms to commit suicide. 

The Numbers
In 2011, suicide was the third leading cause of death among individuals aged 1-19 and the second leading cause of death among individuals ages 10-19, with 2,089 youths dying by suicide that year. Of these deaths, 41 percent (850 individuals) used a firearm.

Studies have shown that many teenage suicide attempts are impulsive, as can be seen by the fact that of teens who survived an attempt to kill themselves, one quarter of them said they had only thought of attempting suicide approximately five minutes before making the attempt. This impulsivity can be particularly lethal in cases in which the individual uses a firearm in their suicide attempt. According to a report by Madeline Drexler, the editor of Harvard Public Health, approximately 85 percent of suicide attempts that use a firearm end in death. This is in contrast to a drug overdose, the most widely used method for attempting suicide, which only proves to be fatal less than 3 percent of the time. 

According to a study by JAMA Pediatrics which looked at the "Widening Rural-Urban Disparities in Youth Suicides" from 1996 to 2010, rural suicides were almost double the rate in urban areas, regardless of the method used. Additionally, the study showed suicide by firearm and hanging/suffocation were "disproportionately higher in rural areas compared with urban areas." 

The (Potential) Reasons
One possible explanation for the higher rate of suicides in rural communities generally may be a lack of available and accessible mental health services in these areas.  Indeed, of the 1,669 areas that have been federally designated as having a shortage of mental health professionals, over 85 percent are in rural areas. Additionally, this lack of mental health care is even more pronounced in pediatric mental health services as, due to the shortage of specialized mental health care professionals, often primary care physicians are the ones providing mental health services to rural communities. Additionally, rural families often have lower incomes and are less likely to have mental health benefits included in their health insurance coverage.

This lack of easily accessible mental health care often means that rural individuals must travel longer distances to reach these services and/or face longer waiting times. Both of these factors may mean that individuals living in rural communities "may enter care later, with more serious symptoms, and require more expensive and intensive treatments than do their urban peers." Finally, there are the cultural barriers to consider in rural people receiving mental health care. There is often still a stigma surrounding mental health care in these communities that often pride themselves on their self-reliance, which compounded with the lack of anonymity in rural places, can lead to individuals not seeking mental health services when they may need them. 

Another explanation for the higher rates of suicides in rural communities may be due to geographic and social isolation, which may mean that rural individuals lack adequate support systems. Additionally, for younger people living in rural communities, their feelings of isolation may be heightened by the fact that many of their peers may have left the area for education and employment opportunities in more urban areas.
The final factor I will mention, though there are almost surely many more, in regards to the higher rates of suicides in rural communities is the often greater access to firearms in these areas. Gun ownership tends to be more common in rural areas (according to a 2014 study, 51 percent of rural people had guns in their home compared to 25 percent of people in urban areas and 36 percent in suburban areas). While drug overdose may be the most common form of attempted suicide in the US, guns are the most common mode of suicide in America, which is unsurprising given their lethality. Indeed, a "gun in the home raises the suicide risk for everyone: gun owner, spouse and children alike."

So, like the quote at the beginning of this post says, it does not appear as if owning a gun actually increasing the risk of attempting suicide. However, statistically it is much more likely that a person attempting suicide with a gun will succeed in their attempt. For rural children and youth that have easy access to guns and who often impulsively attempt to commit suicide with a firearm, this particularly lethal means can be devastating. 

Therefore, while factors like lack of mental health care and feelings of isolation may contribute to the higher rates of attempted and successful suicides in rural communities, guns (which don't not allow for a change of heart or mind) do have a large role in ensuring the "success" of a suicide attempt.  

4 comments:

Kyle said...

As a person who does not share many Americans' enthusiasm for guns, I would like to think that this post highlights a dimension of "the gun issue" that both sides could use to seek common ground. I assume that only the most ardent advocates of pervasive firearms would resist the notion that minors should not have ready access to guns without parental supervision. (And "should not" here could be a law, or it could just be a social norm.)

I doubt the data go into this level of detail, but I'd be curious to know about the types of firearms used in rural suicides. Given that the fatality rate is so high, I'm inclined to think that these are mostly handgun deaths. (My understanding is that the logistics of shooting one's self with a larger weapon like a rifle or shotgun are tricky, and I presume that such attempts have a higher "failure" rate.) If handguns are the implements of destruction in a significant number of rural suicides, I struggle to see how these weapons fit the "our way of life" justification for pervasive firearms in rural areas. And if the justification is instead "needed for self-defense," I wonder how many armed home invasions are happening in these rural communities.

Erin Gunter said...

I enjoyed reading your second post on rural children and guns and agree with Kyle that hopefully everyone, no matter which side of the gun debate they are on can find common ground with this issue. But I think this post would have benefited from a discussion on the reduced suicide rate produced by limiting access to lethal means, like guns (http://www.npr.org/sections/health-shots/2015/03/09/391830825/for-young-people-in-rural-areas-suicide-poses-a-growing-threat). According to a source you cited in your post, this can reduce suicide rates by 30 to 50 percent. I wonder if some of the increased access to firearms in rural areas is not only due to the sheer number of guns but also how they are stored. If improper gun storage contributes to both urban and rural children committing suicide, this is an issue that could be addressed through either legislation or education. It would be nice to see some discussion of both the problems that lead to suicides with guns and possible solutions to the problems.

Willie Stein said...

This is a great look at the connection between prevalence of guns and suicide in rural areas. I think your point about the difficulty of obtaining mental health services in rural areas is well taken. The stigma surrounding mental health issues in rural areas does more than impact rural people's rates of suicide. It prevents this very point about gun access and the impulsivity of minors from being well taken. I would argue that those who feel that seeking mental health services is a sign of weakness are also resistant to being psychologized or placed into a statistical framework. Drawing (supported) correlations between mental health issues and rurality might draw resentment from those whose framework for understanding why someone might commit suicide is more about individual weakness or individual volition. In other words, those rural people who resist seeking mental health help are also likely to resist explanations of mental health issues as generated by social factors, because both explanations presume that these are social problems that generate symptomatic outcomes for individuals. I don't have anything to support this contention on hand, but I suspect that this is connected to the isolation generated by the "rugged individualism" of the rural mindset.

dnlauber said...

Unlike Kyle, my family is incredibly enthusiastic about guns. My father has a small arsenal of firearms on his rural property in the foothills of Central California. Additionally, my dad has his CCW and almost always has a gun on his person or in his vehicle. That being said, as a child or as a teenager, if I would not have been able to obtain access to any of my father's weapons without his permission and participation. He stored all of his guns in either a vault (to which I did not know the code), or in cases with locks. If I wanted to commit suicide, his having not just one firearm, but (if I had to guess) more than 30 firearms, would not have increased my likelihood in "successfully" committing suicide. Granted, my dad is likely the exception to how most rural individuals store their weapons. However, I think it poses an interesting question about how gun safety plays into this issue.

According to this New York Times article (http://www.nytimes.com/2013/09/29/us/children-and-guns-the-hidden-toll.html?pagewanted=all&_r=0), as of 2013, less than 20 states had enacted laws to hold adults criminally liable if they fail to store guns safely, enabling children to access them. I agree with Erin and think that education and legislation could help address this problem and help reduce child suicide by firearm.