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Gun access, rural residency are key risk factors in NC suicide crisis

CONTENT WARNING: This article references self-harm and suicide. Please take caution when reading. If you need mental health support, please consult our collection of resources. 

Suicide is the third leading cause of death among people ages 18 to 35 in North Carolina. It claims more lives than homicide, and its toll on young adults is surpassed only by motor vehicle accidents and unintentional drug overdoses.

The state recorded an average of 15.6 suicides per 100,000 residents from 2016 to 2020, higher than the national average over the same five-year span. Suicide also made up the vast majority of the state’s violent deaths that year, accounting for a larger share than homicides and unintentional violent deaths combined.

Those are just two of several troubling statistics shared with health care professionals during last week’s Rural Health Symposium in Greenville. Sue Anne Pilgreen, manager of the Eastern Carolina Injury Prevention Program, and Breanna Culler, the program’s suicide prevention coordinator, led a session focused on access to “lethal means”  — the objects or instruments used to carry out suicides.

Pilgreen said some of those means are “far more lethal than others.” A report released last year by the N.C. Department of Health and Human Services showed that 60 percent of the state’s suicides involve firearms — higher than the national rate.

“A firearm is, 90 to 95 percent of the time, going to be lethal,” she added. “We hear about a lot of [intentional] overdoses that are lethal, but overdoses in general are far less lethal than firearms are.”

Access to firearms  

The period of crisis that leads a person to suicide is usually “very, very brief,” Pilgreen said. 

“Almost half of the people that have a suicide attempt made the decision within 10 minutes. They made a decision — ‘I’m going to attempt suicide’ — and 10 minutes later, they have a firearm in their hand preparing to actually take their life.”

That’s borne out in the research. In one study, researchers interviewed 153 suicide-attempt survivors between the ages of 13 and 34 and asked how long it took between the decision to attempt suicide and the actual attempt. About a quarter said it was less than five minutes. Nearly three-quarters of the survivors said they deliberated for less than an hour before attempting to take their lives. 

The “prevalence of suicidal ideation and suicide attempt increased significantly” in the first two years of the COVID-19 pandemic, according to a 2022 study published by the International Journal of Environmental Research and Public Health. The spike coincided with a surge in gun sales across the United States. 

Despite this seemingly volatile combination of trends, researchers found that the “overall rate of death by suicide remained basically unchanged during the pandemic.” Indeed, Pilgreen said most suicides by firearm are carried out by people who already own guns.

“It was not necessarily somebody saying, ‘I want to kill myself, I think I'm gonna go to the store and buy a gun,’” she said. “It was a firearm that was already in their household.”

Delay saves lives

There are steps that gun owners who are experiencing thoughts of suicide can take to reduce their risk of self-harm. One of the most effective measures, Pilgreen said, is asking a friend or loved one to temporarily store their firearm in a secure place outside of the home.

“When you know you or somebody you care about is in a very vulnerable state, having somebody to take that firearm from them temporarily, just to keep them safe, is huge,” she said. 

Many suicides can be averted if there’s a delay between the decision and the act, according to the research. Having someone else minding the gun could be that delay. 

Culler acknowledged that some adults might be “unwilling to compromise on any aspect” of their access to firearms for home defense, hunting and other reasons. These people, she said, can still lower their risk of self-harm by creating “emotional distance” between themselves and their guns.

“That can be something like having photos of your kids in the lockbox or making the code a loved one's birthday,” she said. “Even if someone were to access the firearm, there's still that kind of emotional piece sitting there as a reminder of, ‘Hey, there are support networks out there. I should reach out for help instead of going through with this decision.’”

Just having gun locks or a firearm safe could be enough. One study published in JAMA Pediatrics in 2019 estimated that a “modest increase” in the number of homes that store firearms safely could prevent up to 32 percent of youth suicides. 

Rural risks

Pilgreen said North Carolina is “very rural” — something she sees as a contributing factor to the state’s relatively high rate of suicide. Seventy-eight of the state’s 100 counties are classified as rural by the N.C. Rural Center.

The suicide rate among rural North Carolinians was 1.2 times higher than their urban counterparts in 2020, according to the N.C. Violent Death Reporting System. DHHS reported that rural counties accounted for six of the 10 counties with the highest rates of emergency department visits for “suicidal ideation” in 2022.

That’s consistent with national findings from the Centers for Disease Control and Prevention, which has observed higher suicide rates in rural America than in urban communities over the past two decades. Some of the risk factors cited by the CDC include social isolation, limited access to mental health services and increased levels of poverty among rural populations.

Cullen said that “safety is the key thing” when talking to people who are having thoughts of suicide.

“We're not trying to be judgmental in any way,” she said. “It does not need to be a conversation about if you should or should not have a firearm. It just needs to be, ‘We're here to keep you safe and I care about you, and I want to support you in this time.’”

At the same time, she said, it is important for people at risk of suicide to know they are experiencing an “acute crisis.”

“It's not necessarily a forever thing,” she said. “You're not going to feel this way forever. And while it is a temporary state, it’s also very serious and we need to help keep folks safe.”

Look for additional coverage of the Rural Health Symposium coming soon on NC Health News.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.