"Rural suicide arises from all the circumstances Ms. Barrasso noted and more. Despite a sleepy “Mayberry” sort of image, the realities of small-town life can take an outsize toll on the vulnerable. A combination of lower incomes, greater isolation, family issues and health problems can lead people to be consumed by day-to-day struggles, said Emily Selby-Nelson, a psychologist at Cabin Creek Health Systems, which provides health care in the rural hills of West Virginia.
“Rather than say, ‘I need help,’ they keep working and they get overwhelmed. They can start to think they are a burden on their family and lose hope.”"
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