Major Finding: Alaska, the state with the lowest population density (1.2 people/square mile), has the highest suicide rate (23.1 deaths/100,000 population. Conversely, the District of Columbia, which has the highest population density (9,316 people/square mile), has the lowest suicide rate (5.3 deaths/100,000 population).
Data Source: National Center for Health Statistics and Bureau of Census Data from 2004.
Disclosures: Dr. D'Mello disclosed that he is a member of the speakers' bureau for Pfizer, AstraZeneca, and Schering.
NEW ORLEANS — Suicides in the United States tend to occur more often in rural compared with urban locations, but findings from a new study suggest that the relative scarcity of mental health care providers in rural areas may factor in to the association.
“More than 600 counties in the United States don't have any health care provider, and 1,600 counties don't have a mental health care provider,” Dr. Dale D'Mello of the department of psychiatry at Michigan State University, Lansing, said during a press briefing held at the annual meeting of the American Psychiatric Association. “One recent study found that the distribution of health care providers is imbalanced in rural compared with urban areas. We also know that the prevalence of conditions like depression is equal in urban and rural areas.”
To examine the association between population density, the availability of mental health providers, and suicide rates in each state, Dr. D'Mello and his associates evaluated National Center for Health Statistics and Bureau of Census Data information from the year 2004. Suicide rates were defined as deaths per 100,000 population. They correlated these data with the population density (persons per square mile) and the number of mental health providers per 100,000 population.
Dr. D'Mello reported that a significant powerful negative correlation was observed between the rate of suicide and population density. For example, Alaska, the state with the lowest population density (1.2 people/sq mile), also has the highest suicide rate (23.1 deaths/100,000 population). On the other hand, the District of Columbia, which has the highest population density (9,316 people/sq mile), has the lowest suicide rate (5.3/100,000 population).
“The other states start off between these two extremes,” Dr. D'Mello said. “I work in Lansing, Michigan, but I do telepsychiatry in a county 200 miles away that's rural. I'm interested in this area, because the suicide rate in [that] population is twice that of people I see face-to-face in Lansing.”
Similar and striking significant negative correlations were observed between the distribution of psychiatrists, psychologists, and social workers and suicide rates.
Certain economic and cultural factors also may contribute to the higher rate of suicides in rural population, he said. “Economic causes include the recent change in the rural economy from agriculture to manufacturing, resulting in a disproportionate burden of rural poverty in most countries around the globe,” he said.
As for cultural factors, Dr. D'Mello continued, “there are a large number of books and papers written about the rural culture as being different from urban culture, focusing on the male farmer—the importance based on self-reliance and independence in forming the identity of the male farmer, and the fact that health is correlated with productivity. When productivity declines, a crisis occurs.”
One possible solution to improving mental health care for people in rural settings, he concluded, is to deliver mental health care in primary settings, “integrating the delivery of mental health and medical health. This has occurred in many cases around the country.”