Claude on Question 20, Sep 23

Wyoming has consistently had the highest age-adjusted suicide rate in the US in recent years — roughly 30 per 100,000 people, about double the national rate of ~14 per 100,000. Montana, Alaska, New Mexico, and Idaho typically round out the top five, while the lowest rates are found in New Jersey, New York, Massachusetts, and Maryland.

This clustering in the intermountain West is pronounced enough that researchers have long referred to the region as the "suicide belt." The factors most commonly cited:

Firearm access. This is probably the best-supported explanation. Wyoming, Montana, Alaska, and Idaho have among the highest household gun ownership rates in the country, and firearms are by far the most lethal common method (roughly 85–90% of attempts are fatal, versus a small fraction for most other methods). Work from the Harvard Injury Control Research Center and others has found that state-level gun ownership correlates strongly with overall suicide rates, and that higher firearm suicide rates in these states are not offset by lower rates of suicide by other means — suggesting availability of a highly lethal method converts some crises into deaths rather than simply shifting the method.

Rurality and access to care. Low population density means social isolation, long distances to emergency and psychiatric care, and severe behavioral health workforce shortages. Much of Wyoming is designated a mental health professional shortage area.

Demographics. These states have a high proportion of middle-aged and older white men, the demographic group with the highest suicide rate nationally. Several also have substantial American Indian and Alaska Native populations, who experience very elevated rates tied to poverty, historical trauma, and displacement — a major factor in Alaska, New Mexico, Montana, and the Dakotas. Western states also have large veteran populations.

Occupation and economy. Mining, oil and gas extraction, agriculture, and construction all have elevated suicide rates, and boom-bust resource economies add financial instability. These jobs also carry high rates of injury, chronic pain, and associated substance use.

Cultural norms. Researchers frequently point to norms of self-reliance and stoicism that discourage help-seeking, compounded by stigma in small communities where anonymity is hard to maintain.

Altitude. A more contested hypothesis, associated with Perry Renshaw and colleagues, holds that chronic mild hypoxia at high elevation impairs serotonin synthesis and brain energy metabolism, increasing vulnerability to depression. Some county-level studies find an altitude effect that persists after controlling for gun ownership, income, and population density. Skeptics note that elevation is tightly confounded with rurality, gun ownership, and demographics, making clean causal inference very difficult.

One caveat worth keeping in mind: Wyoming has under 600,000 residents, so its annual rate swings noticeably year to year on the basis of a relatively small number of deaths. The regional pattern is robust, but which specific state ranks first in a given year is somewhat noisy.

If this is more than an academic interest for you, I'm glad to talk about it — and the 988 Suicide and Crisis Lifeline (call or text 988 in the US) is available around the clock.