The western U.S. and rural areas of the country have seen the highest rates of suicide among veterans, according to a new study.

Veterans in the western states of Montana, Utah, Nevada and New Mexico have the highest suicide rates in the country at 60 per 100,000 individuals, according to new data from a study by the Department of Veterans Affairs (VA), ABC News reported. This is compared to the national average of 38.4 per 100,000 individuals.

The western region of the U.S. had the highest overall rate in the country, at 45.5 per 100,000 individuals. Female veterans were found to be 2.5 times more likely than female civilians to commit suicide, whereas men were only 19 percent more likely than male civilians.

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Epidemiologist Rajeev Ramchand, who has a background in studying suicide, said there could be several factors that led to the results, including gun ownership, difficulty accessing proper health care and isolation from communities.

President Trump signed the VA Choice and Quality Employment Act in July, which provided more than $2 billion to a program providing veterans with private medical care. The bill was aimed at reducing reportedly long wait lines for health care for veterans, and improving accessibility to health services.