Youth suicide rates in rural areas are almost double those in urban areas, according to a recently released study, the latest to reveal a growing difference between rural and urban suicide rates.

Researchers at Ohio State University examined suicides in the U.S. from 1996 to 2010 in victims between ages 10 and 24. They found that suicide rates were almost twice as high in rural areas for both men and women, with males making up 81 percent of the suicide victims during that period. Higher suicide rates for other age groups are already a concern in rural areas, as discussed in a previous blog post.

The study, published in JAMA Pediatrics, offers several possible explanations for the disparity in youth suicide rates.

“More than half the counties in the United States – all rural – do not have a practicing psychiatrist, psychologist, or social worker,” said Dr. Cynthia Fontanella, one of the paper’s authors. “Many rural residents have to travel longer distances to seek health care and often wait longer for appointments.”

Mental illness may carry a more serious stigma in rural areas, Fontanella added, and it may be more difficult for rural residents to remain anonymous while seeking care.

Social and geographical isolation could also play a role. The open spaces and solitude that attract some people to the rural lifestyle can be detrimental for a person struggling with suicidal thoughts, and can lead to “less face-to face contact with family, friends, and other support networks”, according to the study.

Increased access to firearms may contribute to higher suicide rates in rural areas as well.

“The suicide rate by firearm was 2.7 times to 3.3 times higher in rural areas compared to urban areas,” Fontanella said, but added that the percentage of suicides by firearm have decreased in both urban and rural areas. “Safe storage of firearms can also help to reduce risk.”