A 2016 display of backpacks and other items on the University of Tennessee at Chattanooga campus was placed to draw attention to the subject of suicide among college students.
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People in rural areas are increasingly more likely to commit suicide than those in urban areas, according to a study by the federal Centers for Disease Control and Prevention.

The researchers studied all suicide cases in the U.S. from 1999-2015, the last year for which data was available. During that time, some 600,000 Americans died by suicide, with the highest annual rate occurring in 2015.

While suicides in large central metropolitan areas over the 15-year period increased about 5 percent, from 11 per 100,000 in 1999 to about 11.5 in 2015, suicides in rural areas rose from 15 per 100,000 in 1999 to 22 per 100,000 in 2015, or 32 percent.

Researchers said several factors probably were behind the higher rate in rural areas.

First, they said, troubled people in rural areas may have no access to mental health facilities. Psychiatrists tend to congregate in urban areas where they have more potential patients, and rural clinics generally do not offer mental health services.

Rural counties also have recovered more slowly from the Great Recession of 2008, the researchers said, noting that the suicide rate seemed to accelerate at that time. Rural areas also have been harder hit by opioid addiction, they said, which has been associated with a higher suicide rate. And rural residents may be more isolated, without the social contacts that can counteract depression.

"Because of funding and staffing issues, we don't see the mental health centers in every county like we used to even 10 years ago," said Scott Ridgway, executive director of the Tennessee Suicide Prevention Network.

In rural areas, "there is a disparity of health providers in general," said Mike La Bonte, director of the Memphis Crisis Center. "Not only are there fewer service providers, but in small areas, everybody knows everybody. People may be more reticent to share when they are having mental health issues, when they know the service provider in another context, as well."

He agreed that the lingering effects of the 2008 recession are an issue.

"Suicide is higher among white, middle-age males," he said, "and if you are looking at rural areas, the effects of the recession are longer lasting and more heavy-hitting for those folks."

The Suicide Prevention Network also is targeting gun owners, to urge them to follow some basic safety advice to reduce their chances of suicide.

"We're actually doing face-to-face outreach to a thousand gun shops," Ridgway said. "Instead of trying to take guns away, we're looking at getting people to follow gun safety at home."

"We stress things like making sure the gun is unloaded, keep the gun in one place and put the bullets in another, having the safety lock on," La Bonte said. "That decreases the risk. Instead of it being immediately there, when you put the safety precautions on, we find the time it takes to get the bullets and put the bullets in the gun can have a huge impact on people not following through, when they have more time to think about it."

While women are more likely to attempt suicide, men are four times more likely to kill themselves, in part because they use firearms while women are more likely to use pills, where there is a greater chance for them to survive the attempt. The CDC study reported that the suicide rate has gone up over the past 20 years for both men and women. For men, the numbers overall increased from 21.1 per 100,000 in 1999 to 23.3 in 2015, and for women, from 5.0 in 1999 to 6.2 in 2015.

The researchers concluded that no single approach would be effective in lowering the suicide rate. But they recommended finding incentives to lure mental health providers to rural areas, or to provide access via video or telephone conferencing, as well as encouraging community-wide activities that provide residents with the opportunity to interact with each other.

Contact staff writer Steve Johnson at 423-755-6673,, on Twitter @stevejohnsonTFP, and on Facebook,