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DES MOINES — Ryan Nesbit was a 15-year-old boy in small-town Iowa when he found his best friend dead by suicide.

Nesbit was with his friend’s mother when they discovered him.

For the next 15 years, Nesbit often had suicidal thoughts.

“Highly suicidal at times. Hopeless. Alone. Angry. Guilty,” is how Nesbit described himself.

It was not until Nesbit started his own family that he began to shake those feelings. He decided to dedicate his life to helping people who suffer from depression and suicidal thoughts. He now works with the Iowa chapter of the American Foundation for Suicide Prevention.

“That’s why I do all this,” Nesbit said this week, shortly after having spent much of his morning talking to someone who sought help.

Suicide rates increased by more than 30 percent in half of U.S. states between 1999 and 2016. In Iowa, suicide rates increased 36 percent over that period, according to a report by the federal Centers for Disease Control and Prevention.

The report was published amid a national dialogue on the topic after the recent, high-profile suicides of designer Kate Spade and TV personality Anthony Bourdain.

It is difficult to discern why suicide rates are increasing, said Pat McGovern, a suicide-prevention coordinator in the Iowa Department of Public Health. The numbers are increasing across demographics, so the increase is not being driven by one segment of the population.

“Suicide is a complex issue,” McGovern said. “There are so many factors that do play a role, so it’s really hard to tease out what’s going on.”

Experts say mental health problems, relationship problems, a recent or upcoming crisis, problematic substance use, a physical health problem or a job or financial problem are leading factors.

Suicide rates are highest among those in farming, fishing and forestry, a 2016 federal report concluded. Suicide rates are higher in rural areas across the country, the new report showed.

One expert in farming and psychology said farmers may be more susceptible to suicide because of the deep emotional ties they feel to their profession, their livestock, their crops and their land.

“This is a calling that they feel is noble,” said Mike Rosmann, an Iowa farmer and psychologist who specializes in agricultural behavioral health. “Farmers feel when their livelihood is threatened, in terms of owning their land, that they end up often thinking they did something wrong and they take it out on themselves.”

A lack of access to mental health care may be another root cause for the higher rates of suicide in rural areas, Rosmann said.

“There is less access to treatments, and there are not very many places or states that have farmer-friendly telephone hotlines,” he said. “Like the national suicide hotline, most farmers don’t call that hotline because they know that the person answering won’t really understand what’s going on about agriculture. ...

“I think there’s a picture that emerges of insufficient ways of maybe responding in our country to agricultural stress.”

Peggy Huppert has been tracking mental health care resources in Iowa for years. The executive director of the Iowa chapter of the National Alliance on Mental Illness, Huppert praised recent steps taken by the state to bolster services in Iowa after years of falling behind.

“We need to make sure we have adequate resources across the board for wherever people are at and needing, whether it’s in crisis or stabilization or the ongoing help and treatment,” Huppert said. “I think we’re making a lot of progress, but it’s going to take a while. I guess we had to come to a crisis point. We reached that tipping point where people came to this overwhelming consensus that we have to do something. Now it’s going to take a while to get to where we are addressing all these needs effectively.”

These days, Nesbit frequently gives speeches on suicide. He also pointed to a lack of access to mental health care as a possible driver of the increasing suicide rate in Iowa.

“Whether that means there are not enough beds, not enough psychiatrists, (people are) waiting six weeks to see a counselor. Those are realities,” Nesbit said.

But societal changes, including social media use, may also be at play, Nesbit said.

“This is kind of a community problem, I would call it. We really need a connection, and we don’t have it,” Nesbit said. “Our connection is text, Facebook, Snapchat. What we need is face-to-face, touching each other, human interaction, not social media interaction.”

Nesbit challenges people to go 48 hours without physical contact with another person.

“You’ll be miserable,” he said. “Then try to realize for thousands of people, that’s their life. There’s not physical love or touch because everything is technology now.”

Experts implore anyone who may be concerned about a loved one, friend or colleague to reach out to that person.

“Be direct. Straight out ask them if they’re suicidal. That’s 100 percent the first thing to do face-to-face,” Nesbit said. “... Be 100 percent open and honest, and that will show them your level of care. And that usually gets them to respond with, ‘Wow, someone actually cares enough to ask questions.’”

McGovern said concerned people should not be worried their questions will upset the potentially suicidal individual.

“It’s OK to ask. ... It doesn’t plant a seed, doesn’t suddenly make them want to do that,” McGovern said. “It makes them notice that someone notices and cares enough to ask.”

And experts encourage anyone having suicidal thoughts to reach out to the various resources available, including national and state hotlines.

“We have so many options now with help numbers, websites, chat lines. So many more options than 25 years ago to get help,” Nesbit said. “Suicide can never be an option. It often feels like it’s the only option, and I’ve been there myself. But that season will pass, and you can come out of it and be better than ever.”

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State house reporter for The Courier/Lee Enterprises.

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