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Suicide rates in rural areas of Maryland are 35 percent higher than in urban settings — a disparity that could stem from access to firearms, according to a study conducted by the Johns Hopkins Bloomberg School of Public Health.

The study examined 6,200 suicides that took place in the state between 2003 and 2015 and found that the suicide rate in rural counties was more than 24 deaths per 100,000 people. In the state's most urban areas, the rate was 16 deaths per 100,000 people.

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Roughly half of those Maryland suicides were committed using guns — but suicides involving firearms were 66 percent more common in rural areas than urban settings, said Dr. Paul Sasha Nestadt, a post-doctoral fellow in the Bloomberg School's Psychiatric Epidemiology Training Program.

Published this month in the American Journal of Public Health, the study was written by Nestadt and other Hopkins researchers as well as Dr. David Fowler, the state's chief medical examiner.

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Nestadt said it's widely known that people who live in rural areas are more likely to own a gun than those in urban areas.

Removing suicides by gun from the data, suicide rates in the state's rural and urban areas were comparable, he said.

Nestadt said this is because a suicide is an impulsive act, and research shows that those who want to commit suicide typically reach for whatever is most accessible to them — whether it's a gun, medication or other means.

Having a gun in the home also greatly increases the likelihood of a successful suicide attempt compared to other methods, he said.

"When there's a gun in the bedside drawer, there's an 85 percent fatality rate," said Nestadt, citing a 2001 study by the Centers for Disease Control.

Fatality rates from suicide attempts through cutting or poisoning oneself are less than 10 percent.

More stringent gun control policies in rural areas could curb suicide rates, Nestadt said. Preventing people from accessing firearms easily, perhaps by implementing permit requirements to purchase a handgun, could help, he added.

It's also imperative to keep people contemplating suicide away from firearms, Nestadt said. He suggested Maryland develop clear protocol for the legal transfer of a gun to a spouse, family member or neighbor if someone feels an urge to commit suicide.

"If a physician learns a suicidal person has a gun in the home, the best thing they can do is determine what to do to make it less accessible during this period of crisis," he said.

Dr. Thomas E. Gift, a child and adolescent psychiatrist in Rochester, N.Y., published a critique of the Hopkins study on the Doctors for Responsible Gun Ownership website.

He said it failed to take into account other risk factors such as age, mischaracterized suburban counties as rural and reflected the anti-gun bias of the researchers and the Bloomberg School, which has a long track record of producing research calling for increased gun control.

"For a long time it's been said that a bad tree can't produce good fruit, and it's noteworthy that the 'Bloomberg' in the 'Johns Hopkins Bloomberg School of Public Health' is the same billionaire who has given financial support to a number of highly visible groups that seek to restrict Second Amendment rights," Gift wrote.

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