[HN Gopher] Positive association between altitude and suicide in...
       ___________________________________________________________________
        
       Positive association between altitude and suicide in U.S. counties
        
       Author : KoftaBob
       Score  : 106 points
       Date   : 2023-08-14 13:23 UTC (9 hours ago)
        
 (HTM) web link (www.ncbi.nlm.nih.gov)
 (TXT) w3m dump (www.ncbi.nlm.nih.gov)
        
       | the_economist wrote:
       | High altitude is also associated with longevity, reduced heart
       | disease, and more efficient mitochondria.
        
         | adamgordonbell wrote:
         | Lower BMI as well.
         | 
         | https://slatestarcodex.com/2016/12/05/thin-air/
        
           | programmarchy wrote:
           | I'd wager a hidden factor is that slopes are more common in
           | higher altitudes i.e. there are simply more hills and stairs
           | one needs to navigate leading to incidental exercise.
        
             | PaulDavisThe1st wrote:
             | Most population centers in the US west are built on flat
             | land. Think Salt Lake City, Denver, Albuquerque. Even
             | relatively small (80k) Santa Fe, despite having a 5000'
             | elevation gain on its northern edge, is itself almost
             | entirely flat.
        
         | inpdx wrote:
         | They do say this:
         | 
         | "Despite a negative correlation (r = -0.31, p < 0.001) between
         | county altitude and the all-cause mortality rate, there was a
         | strong positive correlation (r = 0.50, p < 0.001) between
         | altitude and suicide rate at the county level (Fig. 1)."
        
           | [deleted]
        
         | copperx wrote:
         | There's also a lower incidence of cancer in the population
         | living in high altitudes despite being exposed to more
         | ultraviolet light.
         | 
         | I believe the leading hypothesis is that the higher oxygen at
         | lower altitudes causes more oxidation.
        
         | FollowingTheDao wrote:
         | This is why it is important to take genetics into account when
         | looking at these studies.
         | 
         | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460084/
         | 
         | Not all of us were meant to live at higher altitudes.
        
         | joadha wrote:
         | Yeah, and that made me wonder whether survivorship bias could
         | be at play. That is, populations at lower elevations see less
         | opportunities for suicide due to individuals dying of things
         | like heart disease, etc., before they have a chance to off
         | themselves at a later age.
         | 
         | But they do mention that they "[controlled] for percent of age
         | >50 yr." Does that imply that, per county, they excluded high-
         | elevation suicides that wouldn't have happened at lower
         | elevations, using known mortality rates for common causes-of-
         | death for age > 50 individuals?
         | 
         | I'm sure the answer is in the paper somewhere, but I need to
         | get back to work. :-)
        
       | feiss wrote:
       | [flagged]
        
         | ketanmaheshwari wrote:
         | HN, please shred my work to pieces while sipping coffee.
        
         | h2odragon wrote:
         | Thats _why_ there 's so few COBOL programmers left.
        
       | dist-epoch wrote:
       | They don't mention about temperature. Is it controlled for?
       | Winter months are know to be "sadder" than summer months.
        
         | sokoloff wrote:
         | I'd expect that difference to be driven by sunlight amount
         | rather than by temperature.
         | 
         | Cold is easier to deal with than dark and gloomy when I go to
         | work and dark and gloomy when I come home.
        
           | philote wrote:
           | I'm curious if they controlled for sunlight then. I'm in a
           | mountainous area and many areas (like where my house is) have
           | mountains blocking sunlight for multiple hours in a day.
           | Couple that with being in a wooded area and even some summer
           | days can feel dark and gloomy. But in my case, being
           | surrounded by nature far outweighs the lack of light in terms
           | of depression.
        
             | PaulDavisThe1st wrote:
             | People who live at altitude in the US western states,
             | particularly in cities, generally have high levels of
             | insolation.
        
       | hx8 wrote:
       | Is there a biological process that explains how high altitude
       | impacts suicide rates, or are there social variables that aren't
       | controlled for.
       | 
       | This paper gets a lot of scrutiny, but it's been out for over a
       | decade and hasn't been debunked or explained. I've been mulling
       | over this one for awhile, and have had several conversations with
       | reasonably informed individuals in related fields. There's a lot
       | of theories, many of which are explored in the comment section
       | here. If you strongly believe in a theory, I'd like to remind you
       | that this is a line of inquiry that could have life saving
       | implications.
        
         | DoreenMichele wrote:
         | There are a lot of biological processes that happen at
         | altitude, but HN is a great place to get pilloried for speaking
         | off the cuff about "hypotheses" of this sort.
        
       | brigadier132 wrote:
       | What's the correlation between altitude and the amount of
       | sunlight in a day?
        
         | mrosett wrote:
         | In the US, I would assume generally positive. The mountain west
         | gets more sun than the northeast or northwest.
        
           | brigadier132 wrote:
           | I would assume that higher altitudes would have more intense
           | winters that then result in people staying indoors and
           | isolated for longer periods of time?
           | 
           | I would guess that altitude and longitude are not correlated
           | globally (at least I don't know why they would be) but in the
           | US I generally associate altitude with snow.
        
             | [deleted]
        
             | misja111 wrote:
             | Countries like Finland and Iceland are consistently in the
             | top 5 of happiest countries in the world. Of course that
             | has many non-related reasons, but the effect of intense
             | winters can't be too bad.
        
               | giantg2 wrote:
               | The definition of "happy" can vary greatly between
               | countries. My understanding is that Finland's "happy" is
               | more similar to the US's "content".
        
               | crznp wrote:
               | Finland and Iceland also have some of the highest suicide
               | rates in Europe. It seems that the correlation between
               | happiness (or well-being) and suicide is complex.
               | 
               | Which makes sense: it can be isolating if everyone around
               | you seems to be thriving and you aren't.
        
           | pentamassiv wrote:
           | I would say it depends or is negative. I don't live in the US
           | but here in the german alps, most towns/cities are not on top
           | of the mountain. They are wedged between the mountains. In my
           | city that means the sun is setting at 1 pm in the winter
           | because it gets blocked by mountains. I had no idea about
           | this before moving here but I have to say it gets annoying.
           | There is also a city close by that has the highest suicide
           | rate in Germany. They get even less sun in the winter because
           | the surrounding mountains are higher.
        
             | PaulDavisThe1st wrote:
             | The US is generally at significantly lower latitude than
             | Germany and other mountainous areas in Europe. This means
             | that for large parts of the high altitude areas, seasonal
             | variation in day length is much less than in Europe.
             | 
             | Also, because urban environments in the US west are
             | relatively new, they tend not be found "between mountains"
             | in the same way that the centuries old cities across the
             | Alps etc. are. The large population centers (Denver, Salt
             | Lake City, Albuquerque) are built in large, open flat
             | areas, and many of the midsize cities are not really
             | surrounded by mountains in the way that equivalent European
             | or other non-American cities often are.
        
       | fulltimeloser wrote:
       | Related map of Italian data:
       | https://www.reddit.com/media?url=https%3A%2F%2Fi.redd.it%2Ff...
        
       | paxys wrote:
       | TL;DR - brain needs oxygen
        
         | FollowingTheDao wrote:
         | It is not about oxygen, it is about catecholamine depletion via
         | a decrease in BH4
         | 
         | https://www.liebertpub.com/doi/10.1089/ham.2015.29000.stg
        
       | vasco wrote:
       | It'd be funny if it turned out to be that somehow it's safer to
       | live at higher altitude meaning suicides rates would be
       | proportionally higher since you die less of other things. It's
       | something I've mused about in the past, if you extend
       | technological advances long enough into the future, suicide rates
       | would go up because there'd be less other things to die from due
       | to advances in medicine and so on.
        
         | frud wrote:
         | I think they kept those factors separate. From the abstract:
         | 
         | > Although there was a negative correlation between county
         | altitude and all-cause mortality (r = -0.31, p < 0.001), there
         | was a strong positive correlation between altitude and suicide
         | rate (r = 0.50, p < 0.001).
        
           | marcosdumay wrote:
           | That's not the GP's question. In fact, that reinforces the
           | question.
           | 
           | To paraphrase the question: since total mortality must be
           | exactly 100%, is the increase in suicides just an automatic
           | and meaningless numeric compensation for the decrease in
           | all-(health related)-cause mortality?
           | 
           | The answer to that is somewhere within their methodology on
           | controlling for age. But I was unable to grasp the jargon on
           | this one.
        
         | nabla9 wrote:
         | Suicide is not like cancer vs. heart disease where one replaces
         | another. Older people do slightly less suicides.
         | 
         | Suicide rates are up in absolute sense.
        
         | gonzo41 wrote:
         | Eh it's all just Lies and Statistics. It's like how 'non
         | drinkers' die earlier than those who lightly drink. But no one
         | who reports it writes the next sentence to explain that, non
         | drinkers include people who don't drink to manage chronic
         | health conditions and thus skew things with their ill health
         | making it seem like alcohol is required to be healthy.
         | 
         | I suspect in the future death by choice, in a palliative
         | setting may go up. Though with the current waves of
         | deregulation, maybe we're headed for more industrial accidents.
         | 
         | But as for the article. Places that are high up, are cold and
         | isolated and people are social beings.
        
           | joncrocks wrote:
           | Also includes people that are/were alcoholics and so _now_
           | don't drink.
        
             | itsoktocry wrote:
             | > _Also includes people that are /were alcoholics and so
             | _now_ don't drink._
             | 
             | Does it? Can you link to the study?
        
           | itsoktocry wrote:
           | > _But no one who reports it writes the next sentence to
           | explain that, non drinkers include people who don 't drink to
           | manage chronic health conditions and thus skew things with
           | their ill health making it seem like alcohol is required to
           | be healthy._
           | 
           | Can you point to the study that makes this claim without
           | controlling for other health issues? Otherwise, you're just
           | making stuff up, which is worse than what you accuse the
           | scientists of.
        
             | SpaceLawnmower wrote:
             | This study seems to be a pretty important one (cited by
             | Harvard in a blog post about alcohol's effects on health).
             | It doesn't necessarily go into preexisting health
             | conditions beyond broad markers like BMI, smoking, and
             | cancer history. It says one of the limitations of the study
             | is that it doesn't account for socioeconomic status, which
             | is probably correlated with general health (can't afford as
             | much alcohol if you're poor and you age less healthily).
             | 
             | https://journals.plos.org/plosmedicine/article?id=10.1371/j
             | o...
        
       | wryoak wrote:
       | Altitude as a proxy for isolation, perhaps
        
         | FollowingTheDao wrote:
         | It is so frustrating that people have such a hard time that our
         | mood can be effected by anything other than emotional inputs.
         | 
         | It has nothing to do with isolation, it has to to how living in
         | a place that does not match our genetics effects us as
         | biologically animals.
         | 
         | This effect is revealing the fact that people ho were
         | genetically adapted to live ate low altitudes should not live
         | at high altitudes.
        
         | scarmig wrote:
         | > Controlling for... population density of each county,
        
           | rhplus wrote:
           | Perhaps there's some economic FOMO too. You can find coastal
           | (sea level) town with the same population density and median
           | incomes as mountain towns, but the former _feels_ much more
           | connected and accessible than the later. Even a large city
           | like Denver has a remoteness about it... it's either an 8+
           | hour drive to the next big city or you have to fly. Compared
           | to west coast, east coast, gulf coast cities and counties, it
           | might as well be an island.
        
           | lm28469 wrote:
           | It's a very weak indicator, I'm living in the densest city I
           | ever lived in and I have less social life than ever.
           | 
           | Random 5 seconds search:
           | 
           | https://academic.oup.com/innovateage/article/2/suppl_1/19/51.
           | ..
           | 
           | > Follow-up analyses showed there was a significant (p =
           | .005) relationship between population density and isolation
           | in Whites, Hispanics, and others, in that higher population
           | density was associated with greater social isolation.
           | 
           | In any case it's much more complex than "many people = no one
           | feels alone"
           | 
           | Also if you compare the "suicide by county" and "distance to
           | nearest metro area" map there is a very nice overlap:
           | 
           | https://en.wikipedia.org/wiki/Suicide_in_the_United_States#/.
           | ..
           | 
           | https://www.washingtonpost.com/blogs/wonkblog/files/2018/02/.
           | ..
        
             | rcarr wrote:
             | I'd say it's not necessarily isolation, but lack of
             | opportunity. Presumably the higher up you are, the less
             | transport links and settlements there are, so
             | geographically you now have less opportunities within a
             | commutable distance. When I say "opportunity" I mean it in
             | a very general sense - it could be social opportunity,
             | dating opportunity, work opportunity, hobby opportunity
             | whatever. When you're deep in the hole of depression, by
             | definition you have lost hope of things improving, which
             | would indicate a dearth of opportunity or novel experiences
             | that could change your mindset.
             | 
             | I'd say that cities can feel extremely lonely, because you
             | can see all these people all around you but you can't
             | connect with any of them so you kind of feel disconnected
             | or unwanted which heightens the feeling of loneliness.
             | Wheres if you are in a rural location, you might be lonely
             | for lack of people but feel that if you were to find some
             | people that you would get on with them well. Tying this
             | back to the original point, I think if you can take
             | advantage of the huge variety of opportunities the city
             | offers you can easily overcome "city loneliness" whereas
             | "rural loneliness" is much harder to overcome - if you
             | don't get on with the small set of people nearby or don't
             | enjoy any of the small hobby groups available, you're shit
             | out of luck in terms of social interaction and will have to
             | either move, hope someone new moves nearby, attempt to
             | start your own hobby club or get used to your own company.
        
         | [deleted]
        
       | porkbeer wrote:
       | If you only look at gun deaths, and dont control for gun
       | ownership, wtf is this study for?
        
       | tetrep wrote:
       | > Using a different methodology, a similar, strong positive
       | correlation between altitude and suicide rates has recently been
       | reported by Kim and colleagues, (2011) using all counties in the
       | United States as well as all 233 counties in South Korea.
       | 
       | I assumed culture was a large component to this, but I don't know
       | enough about South Korea to compare its high altitude people to
       | those of the US. Maybe it is something environmental?
        
       | squokko wrote:
       | I think mountain/hillbilly culture in the US is very much its own
       | thing and cannot be understood by lowland Americans. Maybe people
       | in Scotland / Afghanistan / etc. will understand it better.
        
       | nonameiguess wrote:
       | The figure 1 makes it look like an awful lot like there is no
       | pattern at all for the vast majority of counties, and then the
       | few with the very highest suicide rates are all very high
       | altitude. They also mention this, but I'm not sure country is a
       | great way to measure this. Death Valley and Mt Whitney, the
       | lowest and highest altitude points in the contiguous states, are
       | in the same county. Might also want to remove Vegas, which is
       | high altitude and high suicide, but obviously for unrelated
       | reasons.
        
         | PaulDavisThe1st wrote:
         | > They also mention this, but I'm not sure country is a great
         | way to measure this. Death Valley and Mt Whitney, the lowest
         | and highest altitude points in the contiguous states, are in
         | the same county.
         | 
         | Citing the exception to try to disprove the rule generally
         | doesn't work out so well.
         | 
         | Most high-elevation counties in the US are situated in
         | extremely large high elevation regions.
        
         | evancox100 wrote:
         | The appearance of figure 1 is due to the majority of counties
         | being at / near sea level. Suppose we take as true that there
         | is a direct link between altitude and some other phenomenon,
         | for example rates of altitude sickness. If 90% of the counties
         | are near sea level, with some variation, you would only see
         | increased altitude sickness in the 10% highest counties. The
         | graph would look similar to what you see here.
        
         | chongli wrote:
         | You could probably control for the Vegas issue by excluding
         | suicides of non-residents, though I don't know if that
         | information is tracked or not. If that information is not
         | tracked then it's really useless!
        
           | cozzyd wrote:
           | gambling addiction is a problem for locals as well (perhaps
           | more so).
        
       | slowmovintarget wrote:
       | Needs a [2011] tag.
        
       | bwanab wrote:
       | Mountains == isolation.
       | 
       | I grew up in a mountainous region where the ridges separate the
       | valleys. If your friend lived a mile away, it might take 20 miles
       | of driving to get there because of the separation.
       | 
       | I wonder if they've measured that people who are very isolated
       | have more suicide?
        
         | scoofy wrote:
         | The problem is that there are low altitude mountains. The
         | argument here is that the suicide rate of Denver or Park City
         | should be higher than folks living in the isolated mountains of
         | Maine or Oregon.
        
       | rmellow wrote:
       | Interesting correlation! This looks like variable omission.
       | 
       | What happens if we control for distance to a body of water? I
       | suspect that has a more direct impact on wellbeing.
        
       | frogger8 wrote:
       | I live in Utah and left the LDS / Mormon church in May. I am
       | dating woman that, like most modern American woman, are open to
       | having sex before marriage. It's not polite to kiss and tell but
       | turns out being touched starved IMHO is a really shi77y way to
       | live.
        
       | FollowingTheDao wrote:
       | Oh boy, this is a favorite topic of mine because I get psychosis
       | over 7000 feet.
       | 
       | And it is all about my genetics. I am a lowlander by heritage, a
       | Sami from Finland, and I carry genetic changes in NOS1AP that
       | lower my ability to make nitric oxide at altitude. But the other
       | factor is polymorphisms in GCH1, a gene linked to altitude
       | adaptation:
       | 
       | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460084/
       | 
       | See GCH1 is the enzyme critically needed to make something called
       | tetrahjydrobiopterin (BH4), and BH4 last at the center of the
       | creation of all the catecholamines, like dopamine and serotonin,
       | but also Nitric Oxide.
       | 
       | https://www.researchgate.net/figure/Fig-1-Tetrahydrobiopteri...
       | 
       | They make a drug called Kuvan which is a BH4 analogue but they
       | only sell it in the EU because they want those of use with mental
       | illness in the U.S. to suffer.
       | 
       | But zinc will increase the activity of GCH1 and alleviate many of
       | these issues for me.
       | 
       | https://www.sciencedirect.com/science/article/abs/pii/S00062...
       | 
       | It has nothing to do with low oxygen, but rather low
       | catecholamines.
        
         | selimthegrim wrote:
         | On a related note, how do you feel about the WaPo headliner
         | today about misappropriation of Sami remains for
         | (anthropological, not even medical) "research"
         | 
         | https://www.washingtonpost.com/history/interactive/2023/smit...
        
           | FollowingTheDao wrote:
           | Thanks for that. Makes me hate the how much humanity moved
           | away from nature even more than I already did. They took our
           | language and our spirituality so why not take our brains as
           | well.
           | 
           | Sometimes I wonder if my mental illness, and my utter disgust
           | of capitalism, is from the legacy of trauma in my lineage.
           | 
           | What is even more interesting is that my senior thesis paper
           | was on a man named John Collier who was the head of the
           | Indian Affairs Bureau in the early 1900's and really into
           | eugenics. He wanted to ship Indigenous Americans all over the
           | country so we could all get their genes and be more like
           | them. Funny that wikipedia called him an "advocate"!
           | 
           | https://en.wikipedia.org/wiki/John_Collier_(sociologist)
        
         | rednerrus wrote:
         | Is this related to being a slow metabolizer of catecholamines?
        
         | watersb wrote:
         | Wow!
         | 
         | Any correlation with blood pressure regulation?
        
           | FollowingTheDao wrote:
           | Oh yes, for sure. Also immune regulation via NOS2.
        
       | sigtstp wrote:
       | Just to nitpick
       | 
       | > strong positive correlation between altitude and suicide rate
       | (r = 0.50, p < 0.001).
       | 
       | That is _not_ strong. Put differently, altitude only explains 25%
       | of the suicide rate. I know some fields have lower thresholds for
       | what they consider strong, but still. An effect, sure, but I 'd
       | bet on this pointing to something else.
       | 
       | Not familiar with the demographics vs geography here, but how do
       | typical high-altitude places look like in terms of society? They
       | control for median household income and population density, but
       | what about social attitudes? (are these places more rural? more
       | traditionalist?), number of ways people can engage socially (say,
       | cultural events, clubs, and so on), does their diet differ? etc
       | etc.
       | 
       | Also, maybe putting the year (2011) in the title might be good.
       | There may be more recent work / reviews.
       | 
       | EDIT: I forgot to mention diet
        
         | itronitron wrote:
         | Here's another nitpick for you, Figure 1 is showing the
         | independent variable (elevation) on the y-axis instead of the
         | x-axis. And I don't know why they used a line plot instead of a
         | proper histogram.
        
           | victor106 wrote:
           | Why is elevation the independent variable?
        
             | selectodude wrote:
             | Because they're trying to see if the suicide rate _depends_
             | on the altitude.
        
       | cosmicvarion wrote:
       | I haven't dug into their controls, but it seems to me that higher
       | altitude may be associated with remoteness.
        
         | Waterluvian wrote:
         | Also altitude's correlation with climate.
        
           | rconti wrote:
           | I'd say Utah and Colorado probably have better climate due to
           | their elevation. If they were at sea-level they would
           | probably be insanely hot.
        
         | irrational wrote:
         | Are Denver and SLC considered remote? My own city is about at
         | sea level, but by car the next closest cities are 3 hours to
         | the north, 6 hours to the east, and 9 hours to the south. I'd
         | say we are more remote, despite being at a much lower
         | elevation.
        
           | AnimalMuppet wrote:
           | Denver and SLC are reasonably big cities. If you need, for
           | example, a big-city childrens' hospital, they have them.
           | 
           | Then you start to drive out of town, and there is N O T H I N
           | G. I mean, from SLC, there's Ogden and Provo, maybe Park
           | City. From Denver, there's Colorado Springs and Fort Collins.
           | Once you get past those, it's a _long_ way to the next
           | anywhere.
           | 
           | So are they isolated? Depends on how you define isolation.
           | Does that particular kind of isolation affect depression
           | and/or suicide? No clue.
        
             | foogazi wrote:
             | Maybe isolation would be another variable that correlates
             | to extreme altitude regions
        
             | irrational wrote:
             | Then it would be interesting to compare those cities to my
             | own. If you leave the metro area, there is basically
             | nothing in any direction for many hundreds of miles. But
             | our elevation is at sea level instead of elevated.
        
             | dboreham wrote:
             | I live in that "long way to anywhere" zone (a day's drive
             | from both Salt Lake and Denver). Lots of suicide here
             | (annual 41 deaths by suicide per 100,000 people).
        
           | AtlasBarfed wrote:
           | I think he is equating remote and rural. Essentially, not as
           | much human contact, more separation from the world, and lack
           | of socialization.
        
         | jandrewrogers wrote:
         | The mountain West is the most highly urbanized part of the US.
        
         | CydeWeys wrote:
         | .
        
           | nabla9 wrote:
           | Nope.
        
           | andsoitis wrote:
           | From the article:
           | 
           |  _Increased altitude has recently been shown to have a
           | protective association with certain medical illnesses, with
           | apparent decreases in mortality among patients with end-stage
           | renal disease receiving dialysis (Winkelmayer et al., 2009),
           | coronary artery disease (Baibas et al., 2005; Faeh et al.,
           | 2009), and stroke (Faeh et al., 2009). By contrast, increased
           | altitude may enhance psychiatric disorders, such as panic
           | attacks (Roth et al., 2002)._
           | 
           | AND
           | 
           |  _Controlling for... population density of each county_
        
         | hinkley wrote:
         | Terrain also means more jumping opportunities, so you'd need to
         | break down by cause.
        
           | desertrider12 wrote:
           | They said there's a clear pattern both for suicides in
           | general and suicides by firearm.
        
         | londons_explore wrote:
         | They controlled for population density
        
           | hwillis wrote:
           | That's not the same thing. A town in the middle of nowhere
           | Appalachia is much more remote than sparse suburbs twenty
           | miles from a city. Hell, you might find _higher_ density in
           | some remote towns than eg Farmville Iowa.
           | 
           | Plus, depending how you measure it, "population density" can
           | be a nearly useless metric. County-level population density
           | is spread widely over 3 orders of magnitude. The smallest
           | county has 64 people and the largest has ten million.
        
             | SkyPuncher wrote:
             | My wife's job took us to a small rural city. By population
             | size and density, we weren't that small. The metro area was
             | 60k+ people. However, we were a 3 hours drive from any
             | major city.
             | 
             | To me this panned out in two ways:
             | 
             | * There really wasn't a lot to do outside a 10 mile radius.
             | Anything worth doing was 1 to 2+ hours drive (often more).
             | That meant nearly everything we did was in the small city
             | we lived in.
             | 
             | * Travel was frustrating. We essentially had to pay a 3
             | hour driving tax on every trip we took.
             | 
             | In other words, despite living in a "suburban" density city
             | (with some urban density areas), it was really how our city
             | was positioned relative to other cities that determined
             | it's feeling. It wasn't large enough to explore internally.
        
           | WindyLakeReturn wrote:
           | Controlling for population density doesn't control for the
           | impact of population density on the issue at hand, as these
           | are two different factors which are related and which are
           | named very similarly.
           | 
           | Consider this simplified example.
           | 
           | 11 areas. 10 of these are isolated and have 10 people living
           | in each area. The last area has 100,000 people living in it.
           | Of those 10 areas, 9 have 0 incidents, and 1 has 1 incident.
           | In the 100,000 area, there are 100 incidents.
           | 
           | Not controlling for the population: The populated area has
           | 100 incidents, the isolated areas have an average of 0.1
           | incidents. A 1,000 times difference. Populated area is much
           | more dangerous.
           | 
           | Well that's obviously the wrong way to look at the data, so
           | lets account for population:
           | 
           | Isolated areas have a rate of 1 per 100 population, populated
           | areas have a rate of 1 per 1,000 population. A 10 times
           | difference, in the opposite direction. So now we have
           | established a link between being isolated and have more
           | incidents, but we don't know why.
           | 
           | We still haven't controlled for the impact of population
           | density on incident rates. We need much more data to solve
           | this, as with the given information the result would be
           | "Isolated areas have 10 times the risk of incidents" and then
           | controlling for that factor we would see no more trends in
           | our data. If we added thousands of more areas with different
           | levels of population, calculate the per capita rate of
           | incidents in each population, and then create an analysis of
           | how populate density relates to incident rates, we could then
           | control for both factors. The catch is that this last step is
           | more difficult without enough data and often researchers
           | aren't able to isolate single individual items to control for
           | because they correlate too strongly with other issues.
        
         | onlyrealcuzzo wrote:
         | Did they do a study in Colombia or Mexico?
        
           | andsoitis wrote:
           | From the headline: _in 2584 U.S. Counties_
        
         | iraqmtpizza wrote:
         | It doesn't study suicide as a phenomenon. It studies firearm
         | suicide and does so without correcting for rates of firearm
         | ownership. But for some reason they decided they needed to
         | correct for race. Well, not race. Specifically percentage
         | white.
        
           | wlesieutre wrote:
           | _> Similar findings were observed for both firearm-related
           | suicides (59% of suicides) and nonfirearm-related suicides_
        
           | nabla9 wrote:
           | no.
           | 
           | >Similar findings were observed for both firearm-related
           | suicides (59% of suicides) and nonfirearm-related suicides.
        
       | exclusiv wrote:
       | Anecdotally, I've found mountain people to be much crazier than
       | normal. The desert has high drug use and has crazies, but even
       | desert people acknowledge the mountain people are more
       | unpredictable and unhinged.
       | 
       | This may or may not be fair, I don't know, but from my
       | experience, if I'm to theorize a generalization in conjunction
       | with this study:
       | 
       | Poor education. Lack of steady jobs. Low ambition. They consider
       | themselves self-reliant people even if they take government
       | subsidies. Don't need to work much to maintain their lifestyle.
       | Would prefer to get a higher hourly rate, not to extrapolate to
       | have a nice income, but to be able to work like 20% of the year,
       | be paid in cash and also take government benefits. Which is
       | likely also driven by the lack of steady jobs that provide
       | healthcare to be fair. Idle time and lack of structure in their
       | lives leading to higher drug and alcohol usage. Financial and
       | health stress. Leading to higher suicide rates.
       | 
       | Study mentions altitude itself and hypoxia and controlling for
       | income. But one could have the same income in a lower altitude
       | location and have MUCH better access to healthcare, quality of
       | healthcare, and steadier/structured employment than the higher
       | altitude people that take their life.
       | 
       | As with most things, I think it's a combination of factors. And
       | the altitude itself seems to be one of them. Not only from the
       | study's stated hypoxia, but it's a lot harder to work at altitude
       | just like it is in the desert with the heat. When people don't
       | have steady jobs and schedules, they have idle time, and along
       | with other pressures and stress, bad things happen.
        
       | [deleted]
        
       | nurumaik wrote:
       | Related interesting read:
       | https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...
       | 
       | TLDR: Author researches obesity epidemic in US, finds out
       | negative correlation between obesity and altitude and comes to a
       | hypothesis that it may be due to possible higher concentration of
       | lithium in the water in lower areas
       | 
       | Wonder if this is also the reason in this case since lithium is
       | an antidepressant
        
       | eminence32 wrote:
       | > This retrospective study examines 20 yr of county-specific
       | mortality data from 1979 to 1998.
       | 
       | I've only read the abstract (so I don't know if my question is
       | answered somewhere in the full report), but does anyone have any
       | insight about why newer data wasn't included in this study?
        
         | bannedbybros wrote:
         | [dead]
        
       | seltzered_ wrote:
       | I recall seeing this article from 2014 referring to suicides in
       | Utah ('utah paradox') and how neuroscientist Perry Renshaw was
       | trying to link it to altitude:
       | http://mic.com/articles/104096/there-s-a-suicide-epidemic-in...
       | which links to another study from 2011:
       | http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.201...
       | 
       | "Together, the stray statistics and stories about life out west
       | tipped off Renshaw to a common culprit: altitude-induced oxygen
       | depletion. [...] Renshaw believes that oxygen-poor air tampers
       | with brain chemistry, leading to a drop in serotonin and an
       | uptick in dopamine."
        
         | newsclues wrote:
         | This aligns with my similar theory (lack of O2 leads to
         | depression) that was born from observations of yoga, meditation
         | and walking all forced people to breath more air through breath
         | work, exercises or going outside, lead to better mental health
         | outcomes.
         | 
         | I am going to assume that in urban vs rural areas that is a
         | similar effect from air pollution.
         | 
         | But all my doctors have been inclined to give me pills for
         | depression, and aren't interesting in exploring the
         | relationship with O2.
        
           | marcosdumay wrote:
           | Your link from "yoga, meditation and walking" to oxygen
           | availability is... to put it mildly, in need of extra
           | support.
        
             | snakeyjake wrote:
             | Yoga and walking are both exercise. Any form of aerobic
             | exercise will increase oxygen availability.
             | 
             | Elite, and dedicated amateur, athletes will develop
             | specific breathing routines to increase O2 availability in
             | support of increasing their VO2 Max but even for sedentary
             | (so, typical) adults practically any form of mindful
             | breathing coupled with higher-than-typical physical
             | exertion will increase oxygen availability.
             | 
             | Their breathing routines not coincidentally almost always
             | mirror some kind of yogic breathing technique.
             | 
             | Yogic breathing in hypobaric environment: breathing
             | exercising and its effect on hypobaric hypoxemia and heart
             | rate at 3,650-m elevation
             | 
             | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413908/
             | 
             | Effects of Slow Deep Breathing at High Altitude on Oxygen
             | Saturation, Pulmonary and Systemic Hemodynamics
             | 
             | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495772/
             | 
             | When you meditate or do yoga asanas (poses) with a focus on
             | your pranayama (breathing) as a matter of routine for long
             | enough you subconsciously start performing yogic breathing
             | all of the time.
             | 
             | Walking is just irrefutably, no-citation-needed, good for
             | you.
        
           | jraby3 wrote:
           | I understood that rural air is significantly worse than urban
           | due to all the pesticides.
        
             | jskrablin wrote:
             | I live in a rural area and air here is significantly better
             | than smog filled and ozone enriched air in the city I used
             | to live in. Not to mention the lack of winter fog that can
             | linger around for weeks at times.
             | 
             | And that's excluding the light and noise pollution that are
             | inevitable in urban areas. Yeah, living in a rural area is
             | pure hell.
        
               | thephyber wrote:
               | What do you believe Ozone is?!?
        
               | jandrewrogers wrote:
               | A fairly toxic allotrope of oxygen?
        
               | callalex wrote:
               | Deeply toxic to human lungs.
        
               | thephyber wrote:
               | Today I learned that ozone is typically found in the
               | stratosphere (which I knew) but also at ground level due
               | to chemical reactions.
        
               | mrguyorama wrote:
               | And if you own an air purifier, likely in your room!
        
             | qwerasdf5 wrote:
             | Many rural areas do not have farming.
        
             | AnimalMuppet wrote:
             | Worse than urban air with auto pollution? I'd want to see a
             | source for that...
        
               | boesboes wrote:
               | Yeah, ppl on the ring road of Amsterdam live 10 years
               | shorter afaik, for instance
        
               | Scoundreller wrote:
               | Poor people live next to highways?
               | 
               | Or when we build the highway, we don't raze the homes of
               | the elite/wealthy/well-connected to do it, we do it in
               | "bad neighbourhoods"
               | 
               | Or indirect effects: factories move/build next to the new
               | highway (ease of moving materials+density of
               | employees+ease of commuting because of the highway),
               | contaminating the neighbourhood.
        
               | dgut wrote:
               | Source? As a counter anecdote: Madrid, where most people
               | live near traffic, has the highest life expectancy in the
               | EU at 85.4 years.
        
               | egman_ekki wrote:
               | maybe there are other factors at play here; who knows how
               | long would they live if they didn't live near traffic.
        
           | renewiltord wrote:
           | Urban/rural v suicide relationships are all over the place: h
           | ttps://www.sciencedirect.com/science/article/abs/pii/S01650..
           | . sees opposite relationship in China and Australia, e.g.
        
             | [deleted]
        
           | thephyber wrote:
           | I have lived in multiple cities and multiple exurbs, at sea
           | level and at a ski resort town (7000+ ft above sea level).
           | 
           | I would make these claims instead:                 - people
           | at altitude spend more time indoors avoiding extreme weather
           | caused by the altitude        - o2 levels to the brain are
           | not significantly different for people whose bodies have
           | adjusted to the altitude already       - people who live at
           | altitude are more likely to be more active       - cities in
           | modern western countries are largely clean of major sources
           | of air pollution (one of the few things NIMBYs are good at)
           | - cities in developing countries (eg. Pakistan, India, China)
           | are incredibly different       - rural areas are largely
           | clean of air pollution except in hotspots (eg. factories and
           | mines)       - your doctor likely doesn't do actual science
           | ("explore relationships"), but rather just disseminates the
           | evidence that others have already recorded       - your
           | doctor likely works in the USA where we pay fee for service.
           | Maybe you should look at how single payer systems align
           | healthy patient long term outcomes align with the single
           | payer total costs.
        
         | boringuser2 wrote:
         | Is depression and suicide significantly positively correlated
         | to asthma or other breathing disorders?
         | 
         | Preferably low-grade to rule out gross pathology.
        
         | bannedbybros wrote:
         | Too bad that the chemical theory of depression is pseudo-
         | science.
        
         | PaulDavisThe1st wrote:
         | For that to be true, you'd need to establish that _blood
         | oxygen_ levels differ significantly across altitude adapted
         | individuals, and I don 't believe that this is the case.
         | 
         | Also, when I first moved from Philadelphia to a village in New
         | Mexico at 6000', I remember reading that I should plan on a 3
         | phase adapative process that would take as much as 9 months to
         | complete. This makes me give less weight to things like the
         | 2005 Marines study that Renshaw cites, which only continued for
         | 90 days.
         | 
         | I should stress that I'm not doubting the statistics, just the
         | proposed mechanism ("low oxygen air"). On the other hand,
         | "varying ability to fully adapt to lower oxygen levels" seems
         | more plausible.
        
           | kulahan wrote:
           | Why would you need to show that? I don't see anything that
           | requires blood oxygen levels to be significantly different to
           | get from "people at high elevation have access to less
           | oxygen" to "living in lower-oxygen environments creates the
           | right conditions to see serotonin go down and dopamine go
           | up". Even if oxygen levels are identical once you get to the
           | blood stream, it can cause many changes further up the
           | process.
        
             | PaulDavisThe1st wrote:
             | You'd need to show it because for O2 levels to matter, it
             | would need to be the O2 levels _experienced by cells_ that
             | are different. But because of the body 's adaptive
             | mechanisms, it is possible for cellular O2 availability to
             | remain (relatively) constant despite living in a depleted
             | O2 environment.
             | 
             | Your cells cannot measure environmental O2 levels - only
             | what is available from the bloodstream. Ergo, if sufficient
             | adaptation has taken place - and it may not have - then as
             | far as the body is concerned, there is no depleted O2
             | environment.
        
               | kulahan wrote:
               | >Ergo, if sufficient adaptation has taken place - and it
               | may not have
               | 
               | This tiny little caveat is the entire point of my
               | comment. Happy to converse about other stuff, but it's a
               | tangential topic at best.
               | 
               | >You'd need to show it because for O2 levels to matter,
               | it would need to be the O2 levels experienced by cells
               | that are different.
               | 
               | Right, and some of your body's cells are experiencing it
               | differently. How... else would your body know to respond?
        
               | PaulDavisThe1st wrote:
               | > This tiny little caveat is the entire point of my
               | comment. Happy to converse about other stuff, but it's a
               | tangential topic at best.
               | 
               | Renshaw appears to be suggesting/hypothesizing that there
               | is some universal "low O2" effect that leads to higher
               | rates of suicide.
               | 
               | I'm saying that this seems unlikely, given that in fully
               | adapted individuals, the cellular environment does not
               | experience low O2.
               | 
               | Of course, in non-fully adapted individuals (either
               | because they are still adapting, or because
               | genetic/physiological factors prevent it), this would not
               | be the case.
               | 
               | But that still says that there's no "general" low-O2
               | mechanism that is affecting anyone who lives at altitude.
               | It only suggests that there maybe a low-O2 mechanism that
               | affects some individuals. Whether there is a correlation
               | between suicide rates and altitude adaptation doesn't
               | appear to be easily established.
        
               | PaulDavisThe1st wrote:
               | Suppose you had an internal combustion engine that
               | functions well in 20.9% O2, but very poorly in 19.2% O2.
               | 
               | Then a mechanic shows up a lever you can pull that alters
               | the way the engine intakes and processes O2. You move it
               | a bit, and all of a sudden, the engine now functions just
               | as well in 19.2% O2 as 20.9% O2.
               | 
               | Now imagine that the engine can measure its own
               | performance, and can move the lever itself ...
        
             | mrguyorama wrote:
             | You are missing the fact that the human lungs are something
             | like twice as effective and powerful as the "need" to be at
             | sea level, and have plenty of room to handle less oxygen in
             | the air. Second, the human body adapts quite well to living
             | at higher altitudes, because it will compensate for the
             | lower oxygen levels.
             | 
             | Same blood oxygen level as a sea level human means same
             | quantity of oxygen getting to the brain.
             | 
             | >Even if oxygen levels are identical once you get to the
             | blood stream, it can cause many changes further up the
             | process.
             | 
             | What mechanism could possibly cause this? The brain is
             | getting all the oxygen it needs.
        
               | kulahan wrote:
               | >What mechanism could possibly cause this? The brain is
               | getting all the oxygen it needs.
               | 
               | I have no idea, but I was unaware this could only be
               | caused by oxygen failing to reach the brain.
        
             | RobRivera wrote:
             | its called scientific rigor
        
           | lp251 wrote:
           | Did you ever fully acclimate? After 3 years at 6000 ft I
           | still had lower blood oxygen than at sea level. (per apple
           | watch, so take that with a grain of salt)
        
             | scoofy wrote:
             | Yea, we would only need a small percentage of folks unable
             | to acclimate to create a significant correlation.
        
             | Scoundreller wrote:
             | Isn't Apple Watch and other blood oxygenation just
             | measuring saturation (a relative measure)?
             | 
             | Among other things, Acclimatization involves producing more
             | blood-oxygen carrying capacity (or less if you go back to
             | sea level), which is an absolute measure, not a relative
             | one that the oximeters would pick up.
        
             | PaulDavisThe1st wrote:
             | I haven't measured my blood oxygen, alas.
             | 
             | I've been here 4+ years now, and other than being 4 years
             | older and just coming out of a sedentary 3 year period, I
             | notice zero effects of living (and running, cycling,
             | swimming, hiking) at altitude. Can't say any more than that
             | really.
        
               | refulgentis wrote:
               | Hmmm, given that...it does seem to me the initial claim
               | is likely to be true.
               | 
               | I know you said that it has to vary between multiple
               | individuals at altitude, but it's unclear to me why.
               | 
               | Don't we just have to show some individuals don't ever
               | get back up to the same blood oxygen levels?
        
               | PaulDavisThe1st wrote:
               | Well, another comment here from a guy of Sammi ancestry
               | notes potential polymorphism in GHC1 as possible (and
               | likely) partial explanation.
               | 
               | I would imagine that there are a variety of potential
               | genetic differences that could generate a wide range of
               | altitude-adaptation differences.
        
           | webdoodle wrote:
           | I agree. Low oxygen just doesn't make sense. It's more likely
           | the higher cosmic rays and other space weather, which are
           | already known to cause suicidal thoughts, as well as other
           | mental health problems.
        
             | jddj wrote:
             | I think that warrants a citation
        
               | JohnDeHope wrote:
               | This makes me think. What if there was a database of
               | conjectures. Each has an id number. The database could
               | link to all sorts of media, scientific studies, etc.
               | supporting or disputing each conjecture. Then you could
               | just give the id number and folks would also get all the
               | pro and con material they might like. Even things like
               | "the earth is a sphere" could link to educational videos
               | and whatnot. And even things like "political leaders who
               | I disapprove of are in fact lizard aliens" could link to
               | whatever material supports or disproves it. It'd be nice
               | too if we could categorize these things: disputed,
               | hypothetical, scientifically studied but not
               | independently verified, multiple independent validations,
               | technologies rely on the fact that this works, etc. I
               | dunno why your point made me think of that.
        
               | PaulDavisThe1st wrote:
               | It's not particularly good, but you could look at
               | procon.org
               | 
               | I think there are a few other similar sites.
        
               | aorloff wrote:
               | Its called reddit
        
               | gregw134 wrote:
               | Sounds like Snopes.com
        
               | mrguyorama wrote:
               | In the age of the internet, lack of knowledge about
               | something is a choice. People who believe Obama is a
               | lizard alien don't do so because they haven't seen the
               | appropriate "educational" video, but because that's what
               | confirms what they want to believe.
        
               | PaulDavisThe1st wrote:
               | What about people who do (or do not) believe that
               | socialism is the future of America?
        
         | imperio59 wrote:
         | Except that whole chemical imbalance theory was thoroughly
         | debunked earlier this year as not being the cause of
         | depression, just a marketing gimmick used to sell more anti
         | depressants by pharma companies...
         | 
         | "The serotonin theory of depression has been one of the most
         | influential and extensively researched biological theories of
         | the origins of depression. Our study shows that this view is
         | not supported by scientific evidence. It also calls into
         | question the basis for the use of antidepressants."
         | 
         | https://www.ucl.ac.uk/news/2022/jul/analysis-depression-prob...
        
           | what-no-tests wrote:
           | THIS needs to be spread around much more broadly.
           | 
           | [UPDATE]: Looks like I'm getting downvoted by people who
           | cling to their meds. Try physical activity and adjusting your
           | self-talk. Try having goals and making steady progress toward
           | them. What you need doesn't come from a pill, it comes from
           | living life.
        
             | mrguyorama wrote:
             | >What you need doesn't come from a pill, it comes from
             | living life.
             | 
             | Fuck off. Imagine telling someone with astigmatism that
             | they don't need a physical modification and augmentation to
             | their bodies, but rather "to live life", whatever that
             | means.
             | 
             | Meanwhile, after decades of swearing I didn't need a pill,
             | I didn't want a pill to "change" me, etc, I got on pills,
             | and my life actually works. I rode a rollercoaster for the
             | first time in decades the other day, zero butterflies in my
             | stomach, zero panic or anxiety, zero inappropriate fear.
             | I'm likely only alive today BECAUSE of medication.
             | 
             | The whole point behind how new medications are tested are
             | that we often don't have a great understanding of HOW a
             | medication works, but that doesn't matter, because it
             | demonstrably works in some percentage of people, and for
             | those that it doesn't work for, often another medication
             | might.
             | 
             | So, with zero respect because you are actively harming
             | people, Fuck right off.
        
               | copperx wrote:
               | Thanks for saying that.
               | 
               | Although I've resigned myself because I know that people
               | will often not acknowledge and have empathy and
               | understanding towards a condition if they haven't
               | experienced it in their own skin.
               | 
               | It's depressing, but it seems to be part of the human
               | condition.
        
           | ethanbond wrote:
           | 1. A countervailing meta-analysis does not mean it's
           | "debunked"
           | 
           | 2. A theory being debunked does not mean it's "just a
           | marketing gimmick"
           | 
           | 3. The serotonin theory being debunked does not mean
           | "chemical imbalance" is totally exonerated
           | 
           | Great article though, thank you for sharing. Here's the paper
           | itself for anyone interested (AFAICT it is oddly _not_ linked
           | in the UCL article?):
           | https://pubmed.ncbi.nlm.nih.gov/35854107/
        
       | user_7832 wrote:
       | From the abstract:
       | 
       | > Controlling for percent of age >50 yr, percent male, percent
       | white, median household income, and population density of each
       | county, the higher-altitude counties had significantly higher
       | suicide rates than the lower-altitude counties. Similar findings
       | were observed for both firearm-related suicides (59% of suicides)
       | and nonfirearm-related suicides.
       | 
       | So (median) income has been considered, in case anyone is
       | wondering.
        
         | lm28469 wrote:
         | Which is dumb, what matters is the income of the person who
         | commits suicide, not the median income of their county
        
           | JimtheCoder wrote:
           | Getting income data from specific people can be hard...
        
             | lm28469 wrote:
             | Harder than publishing bogus studies for sure
        
               | cykotic wrote:
               | We live in a world of imperfect knowledge. We look for
               | patterns to try to determine cause/effect. The beginning
               | process for this is to point out correlations and then
               | further investigate. It's not possible to account for all
               | variables when it comes to things like suicide. It is
               | possible and worthwhile to try to study the phenomenon as
               | best we can.
        
               | lm28469 wrote:
               | These thing end up on wikipedia and in dubious news sites
               | as "Suicide is caused by high altitude", so yes it does
               | matter a lot actually.
               | 
               | It's poor science at best, if you can't control variables
               | then the whole thing is next to useless, which happens a
               | lot these days. At the end you have correlations, not
               | causations
        
               | cykotic wrote:
               | If we did science as you seem to think it should be done
               | then very little progress will be made. You should read
               | up on the history of progress in neuroscience.
               | Metaphorically speaking; when you walk into a dark room
               | one has to reach out and try to make sense of things
               | before stumbling upon where the lamp is.
        
               | foxyv wrote:
               | You may want to consider, how much that bogus science has
               | set us back. How long have we removed tonsils, ate the
               | food pyramid into Type 2 Diabetes, measured people's
               | skulls for criminality, and convicted people on the
               | results of polygraph tests?
               | 
               | Bogus science can move us forward, but also backwards.
        
               | cykotic wrote:
               | On the whole though you would agree progress has been
               | made, right? In a world with imperfect knowledge you do
               | the best you can with the information you have.
               | 
               | The response to a paper ought not be, "This paper is
               | bogus because they didn't control for all variables.". If
               | the paper is bogus then give reasons for why this is the
               | case. Was the statistical analysis wrong? Are there
               | reasons why this can't be true? Is this new information
               | worthy of further investigation?
               | 
               | It's sloppy thinking to say it's a bad paper without
               | having studied the issue and the data.
        
               | foxyv wrote:
               | > This retrospective study used mortality data assembled
               | by the U.S. Centers for Disease Control and Prevention
               | (CDC).
               | 
               | Retrospective studies are fairly rife with poor science.
               | They are heavily limited by the data collected and can be
               | easily manipulated by changing different controlling
               | factors. While I wouldn't describe the paper itself as
               | bogus. The title certainly takes a lot of liberties.
        
               | Tomte wrote:
               | You never get causation from statistical procedures,
               | regardless how well you control for variables.
               | 
               | You'll always have to augment statistical _associations_
               | with further knowledge of the world, so you can get to
               | causes.
        
           | foxyv wrote:
           | This isn't too far off base. High levels of inequality lead
           | to depression and anxiety. It isn't a great feeling to almost
           | get hit by Maseratis every other day walking to the grocery
           | store when you can barely afford the rice and beans you eat
           | because your rent is 75% of your income.
        
           | cykotic wrote:
           | Higher median income places tend to have a fewer percentage
           | of poor people. Probably some people assume poverty
           | correlates to suicide rate. The authors did the best they
           | could at making sense of the data they had.
           | 
           | Here's a map of suicide rate in Italy. Note the north has
           | higher rate of suicide than the south. The north of Italy is
           | much richer than the south.
           | 
           | https://www.reddit.com/media?url=https%3A%2F%2Fi.redd.it%2Ff.
           | ..
        
             | mjhay wrote:
             | As someone else said, it's the inequality that matters.
             | People don't die by suicide from being poor, they do it
             | because of the low self-esteem poverty causes when you're
             | around many people doing better than you. Many very poor
             | countries have suicide rates much lower than the US.
             | 
             | Mountain towns have about the biggest class dichotomy that
             | I've seen anywhere between the wealthy and the "help."
             | Unlike many other places, they're all in close proximity.
        
               | hunter2_ wrote:
               | I assume that mainly comes down to attractions like ski
               | resorts (an activity that thrives on altitude and money)
               | pulling in rich tourists and, more recently than this
               | study, remote employees. Curious to hear other
               | contributing factors for mountain town issues. And on the
               | flip side: what types of locations tend to have the most
               | socioeconomic equality?
        
               | cykotic wrote:
               | That is certainly plausible and worth looking into.
        
       | throwaway154 wrote:
       | Completely tangental: Higher air pressure makes me feel happier.
        
       | iraqmtpizza wrote:
       | [flagged]
        
         | whimsicalism wrote:
         | Well it is a good thing you don't have your name on this
         | comment.
        
           | iraqmtpizza wrote:
           | Good thing I didn't waste six months of my life writing a
           | paper about "what if mountainous areas and lowland areas were
           | equally white, how would the firearm suicide rates compare?
           | we'll throw in some laughable speculation about sleep apnea
           | and mood disturbances to spice it up"
           | 
           | also, why isn't the headline "low altitude people more likely
           | to die"
        
         | andsoitis wrote:
         | From the article: _Similar findings were observed for both
         | firearm-related suicides (59% of suicides) and nonfirearm-
         | related suicides._
        
           | iraqmtpizza wrote:
           | They literally corrected for whiteness. So we don't even know
           | what the actual rate would be. Also, studying firearm and
           | nonfirearm separately just screams bias. Why not
           | pharmaceutical vs nonpharmaceutical?
        
       | [deleted]
        
       | [deleted]
        
       | oldstrangers wrote:
       | Wonder if they've looked at Vitamin D considering there's an
       | association with living at high-altitude and Vitamin D
       | deficiency.
        
         | kilroy123 wrote:
         | That was my first thought as well.
        
         | hinkley wrote:
         | Latitude or altitude?
        
       | forgetfreeman wrote:
       | Median household income seems like a pretty bullshit metric when
       | talking about parts of the country where it's not uncommon for
       | multi-million dollar ridgetop mansions to coexist with gross
       | poverty. All of the high elevation country I've visited
       | (disregarding obvious outliers like Denver and the front range)
       | had a few things in common: very wealthy people enjoyed having
       | homes there and the rest of the locals were dirt poor with no
       | obvious opportunities for social or economic advancement.
        
         | CaptainNegative wrote:
         | Why is this a bad case for using the median, which is normally
         | pretty resilient to influence from outliers?
        
           | wnoise wrote:
           | Because the variance (or any other measure of spread) is a
           | useful explanatory variable that is ignored and left on the
           | floor. Switching from mean to median, while more "robust"
           | doesn't actually capture something new, just something old
           | slightly better.
        
           | [deleted]
        
       | danesparza wrote:
       | I don't want to come of as flippant, but I'm genuinely curious:
       | Is there a correlation to how many stories the person's residence
       | has as well? If they live on a 3rd story of an apartment, is
       | there a higher suicide rate than the first floor of an apartment?
        
         | rmellow wrote:
         | Surely the rate of successful defenestration is lower at the
         | 3rd vs the 13th floor.
        
         | smeej wrote:
         | The percentage of time spent at home would vary too much from
         | person to person anyway, whereas percentage of time spent in
         | the _county_ of one 's home is much more homogenous.
        
         | JimtheCoder wrote:
         | Getting granular data like this on a large scale can be rather
         | difficult.
         | 
         | Even knowing things like where the final act was committed (at
         | home, not at home, etc) would be super useful, but that data is
         | hard to come by i'm sure, especially at scale.
        
         | Symmetry wrote:
         | Given that even a 1000 meter change in height above sea level
         | only leads to a large but not huge change in suicide rates, I'd
         | be very surprised if a 6 meter change in where you spend half
         | the day would be statistically detectable.
        
         | twobitshifter wrote:
         | That's actually a really interesting field of study
         | https://buildingtheskyline.org/highrise-living/
         | 
         | High rises have their own associations with mental illness. I
         | don't know if anyone has ever looked at pure altitude as
         | possible effect.
        
           | CrimsonCape wrote:
           | High-rise depression is caused by the architectural design.
           | Rental apartments in a high rise are for-profit, and 99.9% of
           | the time a developer is maximizing the rentable amount of
           | square footage and minimizing the amount of non-rentable
           | square footage. This eliminates all common spaces that might
           | foster inter-personal interaction and relationships with your
           | neighbors.
           | 
           | Anecdotally, a 1:5 relationship is about ideal, for every x5
           | 700 square foot apartments, there should be 700 square feet
           | of common space. Think 5 doors attached to one courtyard that
           | itself is about the size of an apartment.
           | 
           | From a for-profit point of view, this is a waste of
           | construction cost.
        
       | plamic wrote:
       | ME: Current resident of Asheville NC (elevation 2,134'). current
       | mood: depressed/agitated. suicide risk: low/medium-low.
        
       | josu wrote:
       | I'm completely detached from the world of academia. If I want to
       | look at the raw data how can I obtain it?
        
         | ForgottenPwd wrote:
         | You contact the study author(s).
        
       | knice wrote:
       | Would higher altitude not correlate with colder, gray, gloomier
       | (highly scientific term) winters?
        
         | hx8 wrote:
         | Colder, sure. If by gray/gloomier you mean cloud cover then I
         | don't think so.
         | 
         | Regardless, high altitude cities like Denver, Salt Lake City,
         | Reno or Boise are neither particularly cold or cloudy when
         | compared to other US cities.
        
           | giantg2 wrote:
           | We also have to consider that temperatures feel different at
           | altitude (and the mountain west is generally very dry). A dry
           | 20F at 10k' feels more like 40F at sea level on the East
           | coast.
        
           | twobitshifter wrote:
           | Might be associated with worse air quality however. Denver is
           | particularly bad in terms of ozone.
           | 
           | "at high altitudes, atmospheric pressure is reduced, and
           | oxygen is less available (commonly referred to as the air
           | being "thinner"). This has a couple of effects on air quality
           | for the people in the area. First, combustion engines perform
           | less efficiently than they do at lower altitudes, causing an
           | increase in emissions. Second, UV rays from the sun have a
           | greater impact at high elevations, leading to an increase in
           | photochemical smog, the result of airborne pollutants
           | reacting with sunlight."
           | https://www.aprilaire.com/blog/altitude-and-healthy-air-
           | air-...
        
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