Country averages belie the fact that suicide rates often vary widely among socioeconomic and regional subgroups. That revelation comes from an expansive collection of articles, published yesterday in the Lancet, some of which dig into decades worth of data for a deeper understanding of what they call a badly understood, underreported problem.

In Australia, for example, as the nationwide suicide rate fell from 40 per 100,000 in 1997 and 1998, to 20 per 100,000 in 2003, it was rising among young men living in rural and isolated areas, Alexandra Pitman, a population health scientist at University College London, and her colleagues point out in their paper. “If you just looked at the national rates, you would be ignoring a big problem,” she says. “Such complexity in national and international patterns,” Pitman adds, means that “each country is forced to take a fine-grained approach to preventing [suicide].”

A similar urban-rural discrepancy occurred in India, according to a study lead by Prabhat Jha, a public health researcher at the University of Toronto, Canada. During 2010, the rate of suicide in rural areas was 20.4 per 100,000, nearly twice that seen in cities, a rate of 12.0 per 100,000. The paper suggests that the higher suicide rates seen in rural India than more urbanized parts of the country is in part due to greater access to pesticides, which are used in some suicide attempts. “Urgent research is needed to explore the reasons for suicide in young people and the large regional variations seen in this study,” the paper concludes.

The need for prevention may be particularly important given the dearth of psychiatric drugs and other treatments for suicide prevention, and the difficulty of arranging clinical drug trials for suicidal people, a topic explored in depth in a recent news feature in Nature Medicine.

Image courtesy of James Steidl via Shutterstock.