> 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:
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.
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.
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
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.
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.
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.
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.
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.
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).
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.
> 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?
"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."
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.
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
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.
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.
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.
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.
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."
[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.
>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.
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.
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/
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.
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.
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.
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.
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)
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.
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.
I can only speak anecdotally about my experience when I was young and now that I am much older. When I was young I went from about 69' MSL to about 6780' MSL when doing a job at the Air Force Academy and we dared each other to run up some stairs. We made it about half way up and fell over laughing and gasping for air. Our team chief that smoked about a half a carton of cigarettes a day walked right past us shaking his head. For about a week or so I had some pressure in my leg near the hip but it cleared up.
I am much older now and a couple years ago I retired/moved from about 600' MSL to 6300' MSL and it took about a half of a year for my body to adjust including some pain in my legs with some associated popping and other weird pressure like feeling similar to what I had when younger but it took longer to go away. Probably too many decades behind a computer and not enough walking. I've had no feelings of self defenestration.
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.
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.
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 ...
This implies that it has some type of sensor which determines if it's at 20.9% or 19.2% in some manner. Those are analogous to whichever cells are experiencing the world differently, so that the lever knows to move.
> 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.
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.
> missing the fact that the human lungs are something like twice as effective and powerful as the "need" to be at sea level
on average, but you can get a population effect from "some small portion of the population has smaller or disease compromised lungs or just sleep apnea, and THOSE people commit suicide at a higher rate at high altitude".
The "our lungs are big enough" only works if you control for the cases where they aren't.
I'd hoped that things like genetic screening would uncover that some cases where studies showing that eating/avoiding Foo has a small positive or negative effect turns out to actually be an enormous effect in a small sub-population... but so far we don't appear to have identified too many of those.
> 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.
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.
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
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.
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.
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.
> 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.
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.
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.
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?
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.
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?
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"
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?
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.
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.
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.
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.
"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)."
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.
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.
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. :-)
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
>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.
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).
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.
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.
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!
> 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.
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:
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.
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.
On a related note, how do you feel about the WaPo headliner today about misappropriation of Sami remains for (anthropological, not even medical) "research"
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"!
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.
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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/...
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.
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.
What happens if we control for distance to a body of water? I suspect that has a more direct impact on wellbeing.
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
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.
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.
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.
>Similar findings were observed for both firearm-related suicides (59% of suicides) and nonfirearm-related suicides.
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.
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?
"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."
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.
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.
Source, in dutch: https://www.hln.be/milieu/omwonenden-a10-snelweg-leven-79-da...
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.
And that's excluding the light and noise pollution that are inevitable in urban areas. Yeah, living in a rural area is pure hell.
I would make these claims instead:
"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...
[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.
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.
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.
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/
Serotonin theory being debunked does not mean “chemical imbalance” is totally cleared from blame
Seems clear enough to me, but noted for the future!
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.
I think there are a few other similar sites.
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.
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?
I would imagine that there are a variety of potential genetic differences that could generate a wide range of altitude-adaptation differences.
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.
I am much older now and a couple years ago I retired/moved from about 600' MSL to 6300' MSL and it took about a half of a year for my body to adjust including some pain in my legs with some associated popping and other weird pressure like feeling similar to what I had when younger but it took longer to go away. Probably too many decades behind a computer and not enough walking. I've had no feelings of self defenestration.
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.
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?
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 ...
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.
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.
I have no idea, but I was unaware this could only be caused by oxygen failing to reach the brain.
on average, but you can get a population effect from "some small portion of the population has smaller or disease compromised lungs or just sleep apnea, and THOSE people commit suicide at a higher rate at high altitude".
The "our lungs are big enough" only works if you control for the cases where they aren't.
I'd hoped that things like genetic screening would uncover that some cases where studies showing that eating/avoiding Foo has a small positive or negative effect turns out to actually be an enormous effect in a small sub-population... but so far we don't appear to have identified too many of those.
Preferably low-grade to rule out gross pathology.
> 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.
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
You'll always have to augment statistical associations with further knowledge of the world, so you can get to causes.
Bogus science can move us forward, but also backwards.
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.
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.
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...
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.
also, why isn't the headline "low altitude people more likely to die"
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.
High rises have their own associations with mental illness. I don’t know if anyone has ever looked at pure altitude as possible effect.
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.
"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)."
https://slatestarcodex.com/2016/12/05/thin-air/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460084/
Not all of us were meant to live at higher altitudes.
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. :-)
I believe the leading hypothesis is that the higher oxygen at lower altitudes causes more oxidation.
Cold is easier to deal with than dark and gloomy when I go to work and dark and gloomy when I come home.
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.
Which makes sense: it can be isolating if everyone around you seems to be thriving and you aren't.
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.
https://www.liebertpub.com/doi/10.1089/ham.2015.29000.stg
> 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).
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.
Suicide rates are up in absolute sense.
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.
Does it? Can you link to the study?
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.
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
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.
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.
https://www.washingtonpost.com/history/interactive/2023/smit...
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)
Any correlation with blood pressure regulation?