Claude on Question 20, Sep 22

Wyoming generally ranks highest. In recent CDC data it has had an age-adjusted suicide rate around 30 per 100,000 — roughly double the national rate (~14). Montana, Alaska, New Mexico, and Idaho are consistently close behind, and Alaska held the top spot in many earlier years. These states form what researchers sometimes call the "suicide belt" across the Intermountain West and Alaska. One caveat: these states have small populations, so their rates swing noticeably year to year and the exact ranking shifts.

Factors researchers point to:

Firearm access. This is the most widely cited explanation. Wyoming, Montana, and Alaska have among the highest household gun ownership rates in the country, and firearms account for a larger share of suicides there (roughly 60–70%) than nationally (~55%). Because firearm attempts are lethal around 85–90% of the time versus a few percent for most other methods, easy access converts more impulsive crises into deaths. Storage practices matter too — unlocked, loaded firearms are associated with higher risk.

Rural isolation and thin health infrastructure. Low population density means social isolation, severe shortages of psychiatrists and counselors, long drives to care, and longer emergency response times, which reduces survival of attempts. Many counties in these states have no mental health provider at all.

Cultural norms. A frontier ethic of self-reliance and stoicism, plus stigma around seeking help, discourages treatment. This interacts with demographics: the population skews toward middle-aged and older white men, the group with the highest suicide rates nationally.

Occupation and economy. Agriculture, ranching, mining, oil and gas, and construction all have elevated suicide rates, and boom-bust extractive economies create financial instability. These states also have large veteran populations.

Substance use. High rates of heavy and binge drinking in the region are an independent risk factor.

Indigenous populations. American Indian and Alaska Native communities have the highest suicide rates of any US racial/ethnic group, driven by historical trauma, displacement, and poverty. This weighs heavily in Alaska, New Mexico, Montana, and the Dakotas.

The altitude hypothesis. A genuinely interesting and partly contested line of research (notably by Perry Renshaw and colleagues at the University of Utah, and Brent and Kim) finds that county-level altitude predicts suicide rates even after controlling for gun ownership, poverty, and population density. The proposed mechanism is that chronic mild hypoxia impairs brain serotonin synthesis and cellular energy metabolism, worsening mood disorders. Notably, altitude correlates with higher suicide but lower all-cause mortality, which argues against it being just a proxy for rural disadvantage. It remains an active area of debate rather than settled science.

Most epidemiologists treat this as multiplicative rather than attributable to any single cause: the West combines elevated rates of depression and distress with unusually lethal means and unusually poor access to intervention.

If this touches you personally, the 988 Suicide & Crisis Lifeline (call or text 988) is available 24/7 in the US.