Claude on Question 20, Sep 17

Wyoming has generally had the highest suicide rate in the US in recent years — roughly 30 per 100,000 people, more than double the national rate of about 14 per 100,000. Montana and Alaska trade places with it year to year, followed by New Mexico, Idaho, and the Dakotas. Because these states have small populations, their rates can swing noticeably from year to year, so the exact ranking shifts.

This cluster of high-rate states in the Intermountain West and Alaska is sometimes called the "suicide belt." Researchers point to several overlapping explanations:

Access to firearms. This is the factor most consistently emphasized in the literature. Wyoming, Montana, Alaska, and Idaho have among the highest household gun-ownership rates in the country, and few states in this region have secure-storage requirements or waiting periods. Firearms account for a majority of suicides in these states, and because they are far more lethal than most other methods, a higher share of attempts end in death.

Rurality and isolation. Low population density means long distances to emergency and psychiatric care, and many counties in these states are designated mental health professional shortage areas. Social isolation and limited crisis infrastructure both raise risk.

Demographics. Middle-aged and older white men — the highest-risk demographic group nationally — make up a large share of these states' populations. These states also have high per-capita veteran populations, another elevated-risk group.

Culture and help-seeking. Researchers often cite a regional ethos of self-reliance and stoicism that discourages seeking mental health treatment, alongside stigma that tends to be stronger in rural areas.

Occupation and economics. Employment concentrated in mining, oil and gas, agriculture, ranching, and construction brings boom-and-bust income volatility, workplace injury, chronic pain, and high rates of alcohol and opioid use — all documented risk factors.

Indigenous populations. American Indian and Alaska Native communities have the highest suicide rates of any racial or ethnic group in the US, which contributes substantially in Alaska, New Mexico, Montana, and the Dakotas. This is generally attributed to historical and intergenerational trauma, forced displacement, poverty, and underfunded health services.

Altitude. A more contested line of research, associated with work by Barry Brenner, Namkug Kim, Perry Renshaw, and others, finds that suicide rates correlate with mean elevation even after controlling for gun ownership, income, and population density. The proposed mechanism is that chronic mild hypoxia at altitude affects serotonin synthesis and brain bioenergetics, worsening mood disorders. Some researchers find this persuasive; others argue it's confounded by the fact that high-altitude states are also rural, gun-owning, and demographically distinctive.

Most epidemiologists treat these as interacting rather than competing causes — the combination of a high-risk population, high lethality of available means, and thin access to care is what produces rates two to three times the national average.

If this topic is personally relevant to you, the 988 Suicide & Crisis Lifeline (call or text 988 in the US) is available around the clock.