Friday, November 10, 2017

Suicides drop in Summit County — Is Altitude a Factor in Suicide Rates?

Summit Daily reports that suicides in the mountain county are on the decline this year after a spike upward last year:

Four people have died of suicide this year in Summit County, a sobering statistic but still a welcome improvement from the double-digit numbers that have marked past years. If the trend continues, 2017 could have the lowest number of suicide deaths in a decade.The major reduction comes on the heels of a concerted push by advocacy groups and local officials to combat mental illness and break down barriers to care. And while it's difficult to draw a causal link with such a small sample size, the numbers indicate Summit is moving in the right direction. 
"I would say one suicide is too many, but any reduction in the number feels like a win," assistant Summit County manager and former Summit Community Care Clinic CEO Sarah Vaine said. 
There were 13 suicide deaths in 2016, the highest number on record, eight in 2015 and 10 in 2014. The most recent year with fewer than four deaths was 2007, according to coroner's office statistics.
This is good news to be sure, although when dealing with such a small population, huge swings can occur in events like suicides, without it indicating any sort of established trend. It may be that last year was the anomaly, and that there was never any growing trend of suicides to begin with. We'll need more time to know. 

Given that Summit County is a high-altitude county, this discussion is an interesting reminder that high altitude has been connected to suicides in at least one study. Writing in the journal High Altitude Medicine and Biology in 2011, Barry Brenner, David Cheng, Sunday Clark, and Carlos A. Camargo, Jr. concluded there really is a correlation: 
Recent preliminary studies have reported a positive correlation between mean altitude and the suicide rate of the 48 contiguous U.S.states. Because intrastate altitude may have large variation, we examined all 2584 U.S. counties to evaluate whether an independent relationship between altitude and suicide exists. We hypothesized that counties at higher elevation would have higher suicide rates. This retrospective study examines 20 yr of county-specific mortality data from 1979 to 1998... 
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. We conclude that altitude may be a novel risk factor for suicide in the contiguous United States.
In recent numbers for the state of Colorado overall (February 2017), Denver showed up with the lowest suicide rate among counties at 13.9, while mountain counties had some of the highest rates, including Gilpin (37.8), Clear Creek (37.8), Park (37.8) and Teller (37.8) counties. Among large counties, Pueblo county had the highest rate at 28.5. (All rates are total suicides per 100,000 people.)

Unfortunately, since these are such small counties, population-wise, the statewide report notes  "there is no significant statistical difference between the rate for this region and all other regions with the exception of Denver County."
Even if there is a clear correlation here, the implications for public policy are few, except that local healthcare workers ought to be aware of risk factors. The possible correlation here is interesting, nonetheless, and possibly of use when other alleged causes of suicide are put forward.