CHICAGO — Children and teens from rural areas are nearly 40 percent more likely to land in the emergency room for self-harm than their big-city counterparts, according to a new study published in the Journal of Pediatrics.
And when it comes to self-inflicted firearm injuries, the difference is even more pronounced.
Rural youth in the study were three times more likely to be treated in the emergency room for self-inflicted gunshot wounds than their urban counterparts.
“More attention needs to be given to youth mental health, including earlier diagnosis, and more resources need to be invested in rural areas,” said study co-author Dr. Jennifer Hoffmann, a pediatric emergency medicine physician at Lurie Children’s Hospital.
“(And) it’s important that more messaging goes out about safe firearms storage.”
The study, based on a database containing 33 million emergency room visits in 37 states during 2016, didn’t examine the reasons for the higher rates of self-harm by firearms in rural America, but Hoffmann offered several potential explanations based on previous studies, among them that rural households are more likely to contain guns.
The study used a representative sample of ER visits by young people ages 5 to 19, to estimate that nearly 300,000 young people visited the emergency room due to suicidal thoughts and/or self-harm in 2016.
Overall, combined suicidal thoughts and self-harm rates were similar for rural and urban areas, but when self-harm alone was considered, rural areas fared worse.
The study estimated the rate of emergency room visits for self-harm in urban areas was 15 out of 10,000 young people, ages 5 to 19. That compared with 21 out of 10,000 in the most rural areas.
Looking for reasons
In the cases of self-inflicted firearm wounds, the numbers were relatively small, with a rate of .09 emergency room visits per 100,000 young people in urban areas, compared with .31 per 100,000 in rural areas.
Hoffmann said previous studies suggest a number of explanations for the differences in self-harm rates between rural and urban areas. Rural areas tend to have greater shortages of mental health professionals and lower household incomes. Privacy may also be a concern when people in small communities consider seeking mental health services.
Hoffmann called for more mental health training for pediatricians and school personnel. She also sees promise in telemedicine, which can allow families in rural emergency rooms to consult with psychiatrists from other regions.
Studies show that many children who die of suicide visit the emergency room in the months preceding their deaths. Hoffmann said she would like to see more emergency rooms embrace suicide screenings for young patients ages 10 and up.
“The emergency department is a critical space for identification of suicidal thoughts,” she said.
