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West Virginia psychiatrist weighs in on reasons why rural adolescent suicide rates nearly twice that of urban areas


The Register-Herald

BECKLEY, W.Va. — Recently released data show the suicide rate among adolescents in rural counties is nearly twice that of their urban counterparts.

In 2015, the suicide rate among adolescents age 15 to 19 was 7.4 per 100,000 in large central counties. The rate was 14.3 in rural counties.

“There are so many factors involved in this,” said Dr. Shilpa Sammeta, a child psychiatrist at Beckley ARH Hospital and Southern West Virginia Clinic.

Perhaps the biggest reason for the disparity, she said, is lack of access to mental health providers.

While practicing in Charleston, Sammeta said many of her patients would drive up to three hours to see her. As Beckley practitioner, she said many of her patients were previously being managed by a primary care doctor or an adult psychiatrist.

Many hurdles must be overcome before accessing care in rural areas, she said. The first obstacle is the stigma associated with mental health care. And when patients do agree to treatment, there’s oftentimes a delay in receiving care.

“Transportation is a major issue if you’re traveling from an isolated place, and as treatment is delayed, symptoms can become more severe,” Sammeta said.

When symptoms escalate, in-patient treatment is sometimes necessary. But when the patient is released, few options are available for follow-up care.

“Sometimes they just fall through the cracks, and it’s hard to watch.”

Higher rural adolescent suicide rates could also be associated with hunting culture and the easy access to guns, she suggested.

“With guns in the house, you want to make sure they’re not accessible when an adolescent is alone, depressed and not thinking straight.”

Insurance coverage and financial constraints, too, can cause issues regarding mental health treatment. Sometimes a particular medication isn’t the best fit, but Sammeta has to prescribe it because it’s the only option covered by the patient’s insurance.

“It gets really frustrating,” she said. “We also have to be frugal with how many tests we’re doing to make sure the patients don’t feel overwhelmed with co-pays.”

• • •

The data comes from the National Center for Health Statistics publication “Health, United States,” which reported an increase in all four urbanization categories in adolescent suicide rates between 2005 and 2015.

“The rural-urban disparities have been persistently widening,” Sammeta said. “It’s increased over the years.”

Rates have increased 24.9 percent in large central counties; 26.2 percent in suburban counties; 33.8 percent in medium/small counties; and 39.2 percent in rural counties.

For ages 15 to 19, suicide was the second leading cause of death in 2015. Unintentional injury was the leading cause.

Sammeta said there is a shortage of child psychiatrists, which could be alleviated, in part, by the use of telepsychiatry.

“There are still some hiccups, but I think, for the most part, (telepsychiatry) works. It’s a good way to reach out, and there should be more of it.”

Another possible solution is additional screening from primary care physicians to make sure mental health diagnoses aren’t missed.

“They already do that, but just being more routine about it,” Sammeta suggested. “Sometimes patients may not volunteer the information, but if you put it into the questionnaire, it gives the child a way to express themselves.”

Dr. Sammeta is currently accepting new patients at her practice at Southern West Virginia Clinic.

“We’re here to help,” she said.

For more information, call 304-254-2600.

Email: [email protected]; follow on Twitter @WendyHoldren

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