TThis is the third in a series of articles about variations in suicide rates in Iowa. The first article dealt with gender differences in youth, and the second between younger and older persons.

This column will look at the differences in suicide between urban and rural populations.

Urban Vs. Rural

In Iowa and in the United States, suicide in rural areas occurs at a greater rate than in urban areas. There are several reasons presented for this.

First, people in rural areas are often more isolated from one another. With the consolidation of farms based on the need for greater acreage, rural areas have lost population and those remaining are increasingly isolated.

Second, mental health services are less accessible in rural areas. In addition, people in rural areas often have an attitude of “rugged individualism” arising in part from a real need to depend upon themselves. This, combined with a stigma that one has to be “crazy” to seek mental health help, and that it may lead to institutionalization, contributes to the inaccessibility.

Third, with the greater percentage of farm families possessing guns, means that are more lethal are more easily available in rural homes than in urban homes.

Finally, as younger people leave rural areas for education or work in more urban areas, older people are left behind. Older people are more likely to use guns to kill themselves, and have the highest rates of suicide.

How does this work in Iowa?

Iowa’s US Congressional District Five along the western border of the state includes nearly one-third of all counties in Iowa, most with populations under 20,000. Indeed ten of them, nearly a third, have populations under 10,000. This very rural part of the state has two metropolitan centers, Sioux City and Council Bluffs/Omaha.

Over recent years (2001-2003), the number of suicides in this Congressional District has increased from 55 to 86, an increase of 31. This increase represents 65% of the increase in suicide for the whole state of Iowa, which during the same time period went from 304 to 350 total suicides.

In addition, this part of the state must also claim the highest rate of suicide by young males, 20-24. The rate for all suicides in this age group in this District was 57.75 (per 100,000) and the rate for suicides by gun was 34.65. This is double the state average for this age group, and six times the average for all ages, both sexes.

In contrast, Districts 1 & 2, in the northeastern (Waterloo) and southeastern (Cedar Rapids) parts of the state, each had only 2 male suicides in this age group. Only 1 of which was with a gun.

The difference between the eighteen rural counties (less than 10,000 in population) and the nine urban counties (70,000 or more) in terms of gun suicides for both sexes and all ages, is quite dramatic. The rate per hundred thousand in the 18 counties with the smallest populations is 8.17, while the rate in the 9 counties with the largest populations is 4.52. The rate in the small counties is 180% that of the large counties.

The difference in the rate of suicide for all means is not so great. The rate per hundred thousand in the small population counties is 13.01 while in the large population counties it is 10.44. The rate in small counties is 124% of the large ones.

Guns are a much more frequently used means of suicide in small counties than in large ones, contributing disproportionately to the higher rate of suicide.