(Reuters Health) - Suicides rates may be higher in rural America than in cities at least in part because gun ownership is more common outside of urban areas, a recent study suggests.

For the study, researchers examined data on 6,196 adult suicides from 2003 to 2015 in the state of Maryland. Overall, suicide rates were 35 percent higher in rural counties than in urban counties, the study found.

Firearm suicide rates were 66 percent higher in rural counties than in urban counties, the study also found. But there wasn’t a meaningful difference in suicide rates for cases that didn’t involve guns.

“For patients and physicians, this study further illustrates the life-or-death importance of discussing firearm ownership as a healthcare issue,” said lead study author Dr. Paul Nestadt of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“Doctors need to be asking their patients about firearm access, right alongside asking about diet choices, seatbelt use, and other behavioral contributors to mortality risk,” Nestadt said by email. “This is especially true for patients at any risk for suicide.”

In particular, doctors need to pay close attention to gun use and mental health for men, the study results suggest.

That’s because 89 percent of the gun-related suicides occurred among men, and because the higher rural suicide rate was only true for men.

Firearm suicide rates were 36 percent higher for rural men than urban men. But rural women were 37 percent less likely to commit suicide than urban women, regardless of the method.

This may be explained at least in part by men tending to prefer guns as their method of suicide, researchers note in the American Journal of Public Health.

Most of the suicides in the study happened where the majority of people in Maryland live – in metropolitan areas with at least 1 million residents.

Just 218 suicides, or 3.5 percent, occurred in rural communities.

One limitation of the study is that researchers relied on data from medical examiner reports to identify people who died by suicide, the authors note.

Results from Maryland also might not reflect what would happen elsewhere in the U.S., particularly because the state has enacted permit laws that can make it more difficult to purchase a new gun, the authors also point out.

Rural communities in Maryland are also much more densely populated than remote areas of many other U.S. states, noted Dr. Eliot Nelson, a researcher at the University of Vermont Larner College of Medicine in Burlington who wasn’t involved in the study.

Still, the study results underscore the importance of safe gun and ammunition storage as one tool to help prevent suicide attempts involving firearms, Nelson said by email.

“Access to guns in the home creates a higher risk of suicide for family members whether or not there are known mental health concerns,” Nelson said. “Secure gun storage - locked, preferably in a storage cabinet, and unloaded with ammunition locked up separately - should be routine in gun-owning homes.”

When a household member does have mental health problems or is coping with a serious life crisis, then the best way to protect them is by removing guns from the home altogether, Nelson added.

“Store them temporarily with other relatives, close friends, local resources or local police until the crisis has passed,” Nelson advised.

SOURCE: bit.ly/2flvGSd American Journal of Public Health, online September 13, 2017.