A new study published Friday said suicide rates are on the rise, with a particularly stark increase in rural communities.

The suicide rate among Americans aged 25-64 rose by 41 percent from 1999 to 2016, researchers found. The rates were 25 percent higher among people living in rural counties as opposed to those living in major metropolitan areas.

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The study identified poverty, the presence of gun shops, poor access to health insurance, social fragmentation and high numbers of veterans as factors contributing to the higher rates among rural residents.

The study found that there were 453,577 suicides among Americans ages 25 to 64 in the 17-year span, with the largest number happening from 2014-2016. Most of the suicide victims were male and suicide was more common among middle-aged adults over younger and older Americans.

The counties with the highest rates of suicide were located in the West, Appalachia and the Ozarks.

“Study findings suggest that increasing social connectedness, civic opportunities, health insurance coverage, and limiting access to lethal means within communities have the potential to reduce suicide rates across the rural-urban continuum,” the researchers concluded.