Kentucky has the 19th-highest suicide rate in the country, with an average of one person dying every 12 hours and nearly 50 people attempting suicide every day, according to the American Foundation for Suicide Prevention.
Over a 10-year period, from 2006 to 2015, records show more than 6,000 Kentuckians committed suicide, and 396 of those deaths occurred in the Purchase area.
"The Purchase region has the highest suicide rate in the state, and that's where we've been for a while now," said Ellen Walsh, director of the Regional Prevention and Education Center with Four Rivers Behavioral Health.
The Purchase region is made up of nine counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, McCracken and Marshall.
Over the past 10 years, McCracken County saw the most suicides with 116 deaths, and Marshall saw the second most with 78. Graves had the third-highest number with 67 deaths, and Calloway the fourth with 48. The remaining counties averaged about 15 suicides each.
And those numbers, Walsh said, count only the suicides that are reported.
"There are a lot of deaths that maybe aren't reported as suicides, so the rate could be higher than that," she said. "A lot of times families don't want the death certificate to say it was a suicide."
McCracken Coroner Dan Sims said his office has investigated about 10 suicides each year since 2014.
"The numbers we see fluctuate," he said. "One month, or one year they're up, one year they're down, but I think we're seeing a little more now compared to 10 or 20 years ago."
In 2014, the coroner's office investigated 10 suicides, six by self-inflicted gunshots and four by ligature asphyxiation (strangulation). In 2015 that number rose to 11, with five self-inflicted gunshot deaths and six ligature asphyxiations.
Last year, the county saw a slight decline with nine suicide deaths. Four were ligature asphyxiations, four were self-inflicted gunshots and one was what Sims determined to be from helium asphyxiation.
So far this year, Sims said his office has investigated two suicides, one from a self-inflicted gunshot and one from ligature asphyxiation.
Sims said a majority of the suicides he's investigated range in age from 15 to 35.
"Every now and then you'll see someone who is elderly and has a terminal illness, but over the last few years we're seeing more suicides among the younger generations, " he said. "Over the past four years, we've seen an increase in teenage suicides -- young people making permanent decisions for temporary problems."
Data from the AAS indicates suicide is the second-leading cause of death for Kentuckians ages 15 to 24. Research shows 6.3 percent of high school students self-reported having attempted suicide one or more times in 2015, 10.9 percent reported making a plan for a suicide attempt and 13.8 percent reported seriously considering a suicide attempt.
In investigating suicide deaths, Sims said there are common threads in what may have driven these people to decide to end their lives.
"Nine times out of 10 suicides are driven by financial problems, marital and/or relationship problems, some by health but not that many, and of course depression or metal illness," he said. "With younger kids, it's typically driven by relationship woes, stress or pressure, low self-esteem or depression."
Sims said young people also could be driven to suicide as a result of sexual, physical or mental abuse. However, he said he has not seen many during his career that could be directly tied to abuse.
When concerned that a loved one may be contemplating suicide, changes in behavior or the presence of entirely new behaviors -- especially if related to a painful event, loss or change -- can be warning signs.
Increased use of alcohol or drugs, researching suicide methodology, acting recklessly, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions and aggressive behavior also can be warning signs.
If a loved one exhibits these behaviors, it is important to talk with that person and ask directly if he or she is contemplating suicide.
"We cannot stress enough how important it is that you ask the question, 'Are you suicidal?'" said Samantha Powell, a prevention specialist with Four Rivers Behavioral Health.
"People feel like that will scare somebody or shut them down â ¦ but that's absolutely not the case. It is shown in studies that once that question is asked, that person actually feels a sense of relief because they now know they have someone they can go to when they're feeling suicidal."
Powell also recommended helping to find the person the appropriate help, whether that be counseling, therapy or referring them to a support group.
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