Rural America is facing an existential crisis. As cities continue to grow and prosper, small towns are shrinking.
The trend is clear: Rural America is literally fading away. It shouldn’t come as a surprise, therefore, that the opioid overdose epidemic has hit rural states, like Kentucky and West Virginia, especially hard. And the latest research from the CDC also shouldn’t come as a surprise: Suicides in rural America (labeled as non-core) have increased over 40% in 16 years.
From 1999 to 2015, suicide rates increased everywhere in America. On average, across the U.S., suicides increased from 12.2 per 100,000 to 15.7 per 100,000, an increase of just under 30%.
However, in rural America, the suicide rate surged over 40%, from just over 15 per 100,000 to roughly 22 per 100,000. Similarly, the suicide rate in micropolitan areas (defined as having a population between 10,000-49,999) went from 14 per 100,000 to 19 per 100,000, an increase of around 35%.
On the flip side, major cities saw much smaller increases in suicide rates, on the order of 10%.
The graph depicts a clear pattern: Suicide rates are highest in the most rural parts of the country, and they slowly decrease as urbanization increases.
What explains the difference?
The CDC suggests lack of proper mental healthcare, social isolation, the opioid crisis, and lingering effects of the Great Recession, all of which hit rural areas hardest. It appears fixing the suicide epidemic will require addressing very large societal trends and cultural problems.
Suicide rates are rising everywhere in this country and the opioid pain relief restrictions will undoubtedly lead to more.
Suicide is a major public health concern that causes immeasurable pain and suffering to individuals, families, and communities nationwide. Suicide is the tenth leading cause of death overall and the second leading cause among Americans aged 10-44 years.
In 2014, the suicide rate reached a 30-year high, accounting for nearly 43,000 deaths.
Suicide is preventable, however. Suicidal thoughts or actions are signs of extreme distress and require intervention.
If this is true, then many chronic pain patients are in “extreme distress” since the government decided to decrease access to effective pain relief in order to stop heroin overdoses. (Clearly not a logically reasoned policy)
Emergency departments (EDs) have been identified as an important site of care to identify individuals at risk, to provide timely support and intervention, and to facilitate entry into more intensive treatment, if appropriate.
This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents information on ED visits related to suicidal ideation among adults aged 18 years or older in 2006, 2010, and 2013
From 2006 to 2013, the population-based rate of ED visits related to suicidal ideation among adults increased by 12 percent on average annually, more than doubling over the 7-year period.
By 2013, these visits constituted nearly 1 percent of all adult ED visits.
From 2006 to 2013, the rate of ED visits related to suicidal ideation rose from 173.0 to 376.2 visits per 100,000 population aged 18 years or older, an increase of 11.7 percent on average annually—more than doubling over the 7-year period.
Regardless of time period, the population-based rate of ED visits varied by sex and age.
From 2006 to 2013, the population-based rate of ED visits related to suicidal ideation increased among all sex/age subgroups, with the largest increase among older adults.
In 2013, over 70 percent of ED visits related to suicidal ideation resulted in admission to the same hospital or transfer to another hospital or facility, whereas only 19 percent of all other ED visits resulted in admission or transfer.
Among suicidal ideation-related ED visits that resulted in inpatient admission, the aggregate cost of ED and inpatient care increased by 20 percent annually on average from 2006 to 2013.
Over one-half of all adult ED visits related to suicidal ideation were among males aged 18-64 years, compared with one-third of all other ED visits.
The vast majority of ED visits related to suicidal ideation resulted in either admission to the same hospital or transfer to another hospital or facility.
One-fourth of ED visits related to suicidal ideation resulted in routine discharge.
Among ED visits related to suicidal ideation, females were more likely than males to have an injury overall and to have a self-inflicted injury.
Mood disorders were the leading co-occurring mental and substance use disorder diagnoses across all adult age groups and were related to three-fourths of all ED visits related to suicidal ideation.
Among ED visits related to suicidal ideation, alcohol- and substance-related disorders were among the leading co-occurring mental and substance use disorder diagnoses for younger adults, whereas dementia was among the leading co-occurring diagnoses for older adults.
Among ED visits related to suicidal ideation, anxiety disorders were among the top five co-occurring mental and substance use disorder diagnoses for all age groups.