Suicide rates for young people are almost twice as high in rural areas as they are in urban areas, and the gap among males is widening, a team of researchers reported Monday. While the use of firearms in suicides declined, the rate of hangings and suffocations rose for both males and females.

Writing in JAMA Pediatrics, a team of researchers from Ohio State University found suicide rates of 19.93 per 100,000 for males and 4.4 per 100,00 for females in rural areas, compared to 10.31 per 100,000 for males and 2.39 per 100,000 for  females in urban areas. The study examined 66,595 suicides by people ages 10 to 24 between 1996 and 2010.

Completed suicides are much more common among males than females, even among this age group. Men commit four out of every five suicides, the new study shows. For this age group, it was the third-leading cause of death, behind only accidental injuries and homicides. Sixty percent of the suicides were committed by people between 20 and 24.

[Robin Williams was part of a group facing high suicide risk: Older white men with depression.]

Suicide rates for boys and men declined in most urban areas but remained largely unchanged in rural areas, widening the already substantial gap in those rates, the researchers, led by Cynthia A. Fontanella, an assistant professor of clinical psychiatry at Ohio State, reported.

The report offered several explanations for the findings, emphasizing the relative shortage of mental health care in rural settings "owing to chronic shortages of clinicians." It also suggests social isolation from friends and family, the economic impact of the Great Recession and easier access to firearms in rural areas as other possible explanations.

"Suicide is a major cause of gun deaths in rural areas, and evidence suggests that firearm ownership is associated with suicide," the researchers wrote.

In the midst of such limitations, having primary care physicians do more mental health work, employing more telemedicine and intervening in school are three of the more promising solutions, they wrote.