The economic despair of middle-aged, rural Americans is reflected in rising suicide rates

The state of the US economy has a lot to answer for these days, including a pervasive feeling of hopelessness, the perception that crime is rampant (even if it’s at near record lows), and Donald Trump’s poll numbers.

But perhaps the most troubling trend is the toll the economy seems to be taking on Americans’ mental health. Suicide rates have been on the rise—especially in economically depressed regions of the country, and especially among the middle aged.

In 1999, 55- to 64-year-olds had one of the lowest rates of suicide among adults. Now they have one of the highest, trailing only the 45- to 54-year-old age bracket, which also has seen a substantial climb in suicides per 100,000 deaths.

Now let’s see what happens when we layer in the geographic data.

The figure below shows the percent change in suicide rates from 1999 to 2014, among men age 45 to 64, by area type. Suicide rates have increased everywhere, but the largest increase has come in rural areas.

It’s a fairly similar story for women, who, it is worth noting, have historically had much lower suicide rates. They still do—in 2014, middle-age men were more than three times as likely to die from suicide—but the gap is narrowing a bit. The suicide rate among rural, middle-age women has nearly doubled since 1999.

The disproportionate increase in suicides in rural areas could have something to do with economic sectors. Certain jobs normally found in rural areas traditionally have higher suicide rates, like farming, fishing, and logging. Some speculate that the chemicals farmers are exposed to contribute to depression. Suicide is more common in communities where people are more isolated, and where there’s less access to mental health services. Rural areas also have higher rates of drug addiction.

But the big, glaring reason for the uptick seems to be economics. Rural communities have faced a long economic decline alongside the surge in suicide rates.

The figure below is the employment-to-population ratio for urban and rural areas. Neither region type has seen a full recovery from pre-recession levels, but the gap between the two has widened.

But how much can a bad economy drive people to suicide? The National Violent Death Reporting System (NVDRS) kept track of data on why people kill themselves, examining records in 11 states between 2005 and 2010. It classifies three reasons for suicide: personal (including mental health issues and addiction), interpersonal (relationship trouble), and external (such as economic factors, or problems with the law).

Economic stress appears to be a growing factor in suicides. The figures below are from a study published in the American Journal of Preventative Medicine, which used NVDRS data in examining patterns in suicides by 40- to 64-year-olds. From 2005, when the economy was still growing at a fast clip, until the end of the recession in 2010, external factors, about 20% of which are job or economic related, were the only category to grow, while personal or interpersonal reasons stayed steady or declined slightly.

It’s important to note, these issues often are not mutually exclusive. Depression can impact your relationships and job, for example. And social isolation and mental health remain the primary risk factors. But economic stress may make people more vulnerable, especially if they don’t have an adequate support network.

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