Sociologist Michael Staley, who now lives in Utah’s urban Wasatch Front, went to high school in a very different place: rural Dillon, Montana. With around 360 students, his tight-knit class all knew each other to some extent. So when classmates started dying — some in car accidents, some by suicide — the loss hit him hard and personally. The whole school would enter a period of mourning. Sports jerseys would be memorialized; students would meet with counselors; vigils would be lit with candles; teachers would cry in class.
Grief and loss, Staley said, were as integral to his teenage years as band trips and pop quizzes. But the suicides stood out. While Staley’s teachers could talk about safe driving and seatbelts, they didn’t really have much to say about suicide. Accordingly, Staley grew up seeing suicide as an unpredictable fact of life. He just had to accept its existence, and do so in silence. “No one really could talk about it, or no one did,” he said. “No one told us this wasn’t a random thing that happens.”
He held on to that perception until he attended Carroll College, in Helena. There, in Sociology 101, he read a nineteenth-century book by researcher Émile Durkheim called, simply, Suicide. Durkheim was among the first to examine suicide in a social context. The most violent act a person can commit against themselves, Durkheim surmised, wasn’t simply personal. It was intertwined with religion, sex, marital status, education, and even world politics.
“For the first time, I could see suicide through a different lens,” Staley said. “It wasn’t random.”
Finally, the fate of those who died at his high school, and how it affected the students who remained, could be parsed, sorted, understood. Order emerged from the data. Staley was amazed, and the course of his future was set. Since 2017, Staley has been investigating suicide cases in Utah, looking at them as Durkheim did more than 120 years earlier.
Nationally, 14 of 100,000 people died by suicide in 2017, according to the Centers for Disease Control and Prevention, and those rates are on the rise. Staley’s job — the country’s first state-sponsored position focused solely on suicide — exists because Utah’s suicide rate, 22.7 deaths per 100,000, is much higher than the national average, and no one knows exactly why.
The same is true in the West more broadly. Utah and five other Western states have the highest suicide rates in the country; Montana’s, at 28.9, tops the list. The geographical grouping is so pronounced that researchers sometimes refer to this region as the “Suicide Belt.” They’ve proposed and investigated various reasons for the Mountain West’s elevated rates: the density of middle-aged white men, socioeconomic depression, housing instability, lack of mental health services, rural life, and even altitude. The most lethal factor, though, seems to be gun ownership. More people out West own firearms, and guns represent the deadliest form of suicide attempt, according to research out of Harvard University and common sense. But guns don’t explain everything. Whatever the contributing factors may be, they are likely not singular or separate but multifaceted and entangled.
It’s Staley’s job as the suicide prevention research coordinator for Utah to try to understand what’s going on in his state, and so perhaps the rest of the West. He hopes to turn the trend around, to use and give others the knowledge he and his classmates didn’t have growing up.
After discussing Durkheim’s study in that college sociology class, Staley’s professor walked in front of her desk and talked straight to the students. They could, she said, look for suicidal behavior from their roommates, friends, and family members. “It gave me some tools,” Staley remembered. “Before that, I felt like, if people are thinking about suicide, there’s nothing we can do. And that’s false.”
Staley went on to study sociology — he finished his doctoral program this year— and moved to Utah in late 2013 to collect data on LGBTQ members of The Church of Jesus Christ of Latter-day Saints. He was learning about their experiences with sexually transmitted infections and HIV, and met a population struggling with mental health. Staley often met people who thought about suicide, and some had made plans to act on those thoughts. His focus began to shift.
“It doesn’t do much good to prevent gonorrhea when someone is suicidal,” he said, twisting the old doctor’s aphorism that a bleeding leg doesn’t matter if you don’t have a pulse.
His timing was fortuitous. Just as Staley was finishing up his dissertation, he saw a job posting from the Office of the Medical Examiner for a Suicide Prevention Research Coordinator. Staley saw a chance to dedicate himself to a philosophy exactly opposite the one he grew up with: Scientists can understand suicide; it doesn’t have to seem random; no one has to feel unequipped. Staley took the position in 2017.
His position came into being after a legislative push from Utah state representative Steve Eliason, who has had three family members die by suicide. Eliason is committed to the state’s goal of reducing suicides by 20 percent by 2025. He sponsors suicide-prevention bills, speaks publicly about the topic that left Staley’s teachers so silent, and supports research like Harvard’s and Staley’s.
Eliason also introduces pathos into the equation. On February 21, 2017, Eliason and the Utah chapter of the American Foundation for Suicide Prevention set up more than 600 pairs of shoes on the steps of the state Capitol, each representing a person who died by suicide the previous year. There they sat — empty — representing all those lives lived, all those lives lost. High heels perched on marble stairs near combat boots, each pair a silent and grounded witness to a real person.
Since Staley joined the Medical Examiner’s Office, his research hasn’t focused on the population most affected by suicide — white men between 25 and 45 — but on younger people between 10 and 18. That agenda aims to get at the truth behind a persistent narrative in the Beehive State: that Utah has a high suicide rate because of LGBTQ young people plagued by the Mormon church’s policies and positions.
It’s not an unreasonable assumption. Throughout history, and especially in recent years, the LDS church has come out swinging against the queer community. The religion teaches that “same-sex attraction” is a challenge to be overcome, a desire never to be acted upon, and an ailment that will be cured in heaven. From the church’s proclamation on the family, which reinforces strict gender roles and puts forth a traditional home life as the only righteous option, to the November 2015 policy (now rescinded) that placed same-sex marriage on par, ecclesiastically, with murder, to the tendency of some Mormon families to disavow their queer children, the LDS church undoubtedly hurts LGBTQ Utahns. But can that animus explain the state’s suicide rate? Perhaps, say the Huffington Post, Ellen Degeneres’s talk show, and a documentary from the formerly Mormon members of the band Imagine Dragons.
There’s a problem, though: “That narrative doesn’t have any evidence to support it,” Staley said. “It doesn’t mean there isn’t evidence that will support it in the future,” he added, but right now, the verdict hasn’t come in. That kind of thing is, of course, exactly what Staley was hired to investigate. To find out which narrative — or narratives — actually apply here, Staley set his research agenda around that LGBTQ-LDS claim.
Staley and a small team use the centralized medical examiner system to inform a “psychological autopsy” of people who have died by suicide. They look then into juvenile court, medical, child and family services, disability, and educational records. Going beyond the page, though, his team also sits down with family and friends for extended interviews.
Staley’s team is also conducting broader “epidemiological surveillance” on other suicides, which entails calling relatives within a month of a death and asking questions about the person who died. “Were they employed? Were they registered with a Native American tribe? Did they identify as LGBTQ? Did they go to church? What church? How often?” Staley said.
None of this, of course, is easy. If your child or brother or mother just died, revisiting the details can rip open wounds that never had time to close. Staley and his team are surrounded by grief and loss all day — the necessary cost of understanding who and why, not just what and when.
“To date, [death investigation] has largely been a forensic exercise, where the goal is to explain why this person is dead, and that’s it,” said Staley. “That doesn’t necessarily give us the information to prevent death.” In other words, if someone died from the flu, sure, knowing exactly what kind of flu helps. But if someone died of an intentional overdose, knowing which specific pills they took doesn’t give investigators much of a clue as to why that person died.
Why? It remains an open, complicated question when it comes to suicide. But a recent report from the Harvard T.H. Chan School of Public Health provides some conclusions for Utah. In 2016, as part of a bill instructing the state’s Department of Human Services “to collect and analyze data for a Suicide Prevention and Gun Study,” Harvard researchers “linked data from Utah’s Violent Death Reporting System to criminal background checks, concealed carry permit status, and hospital data,” in addition to looking at gun ownership and storage statewide.
When Staley read the report, he was struck that one-third of the people who used a firearm to kill themselves were intoxicated when they died. And more than half had a conflict with family, friends, or a partner before they killed themselves.
That’s different from the common perception, he said. If you ask most people to guess the top reason people die by suicide, they’ll often list financial woes, but only 13 percent had economic struggles at all. Similarly, just 14 percent had criminal or legal problems. Nearly 40 percent, meanwhile, had a crisis of some sort within two weeks of their death, which suggests that shooting oneself is often a response to the acute, not the chronic. If a person in pain can just get through the initial impulses intact, they may have a greater chance of staying alive long-term.
Those surprising findings show why suicidology is important: It can inform prevention. If the motivation for suicide comes from a crisis, leaders can educate the community on how to handle thoughts of harming oneself. Lawmakers can take action, too. In January, Eliason told the Deseret News that a recent bill on trigger locks and firearm safety is meant to create “space and time and distance,” especially for young people who, he said, typically have only 15 minutes between when they think about suicide and when they act. The law, which passed, could give people considering suicide a life-saving pause.
Staley wants to similarly interrogate the alleged connection between Mormonism, queerness, and suicide. While it might be true, as Staley said, all the evidence isn’t yet in. “We exist within context,” he said. “Colorado has a high rate of suicide. So do Nevada, Montana, Idaho, New Mexico. It’s a Rocky Mountain West issue.” If Utah’s Mormon population far outweighs the other states’, and the primary factor driving suicide increase is LGBTQ-LDS antagonism, its rate should stand apart. And it doesn’t. “If we just, without evidence, go along with the popular narrative … and we’re wrong, where are we?” he said. “We will have done an injustice to the people who actually need help.”
The goal is to understand who needs help, and how. If a relatively homogenous population is vulnerable for particular reasons, prevention still isn’t easy, but it’s straightforward: Find people in that group; talk to them. But if the population is heterogeneous, “we have to then look at our prevention approach,” Staley said. “We have to not look at any targeted population, but we have to go up the river.”
“Up the river” or “upriver” is a West-appropriate term suicidologists use to mean long before suicidal plans come to pass — ideally, during childhood, when our brains are more receptive to rewiring, more apt to burn coping mechanisms into their circuits. Staley cites the “Good Behavior Game” as an example. The team-based behavior management classroom program helps kids not only create a more positive, less disruptive learning environment, but also to grow up more resilient. “People carry those skills forward with them into adulthood, and that saves their lives when they break up with their first girlfriend who they thought they would be with forever,” said Staley.
Another successful youth program, called Sources of Strength, started in North Dakota in collaboration with tribes. The program focuses, said executive director Scott LoMurray, on training influential students to recognize signs of distress in their peers — signs like those Staley’s sociology professor taught him. Those “peer leaders” help create schoolwide mental-health programs, and pinpoint their and their peers’ personal coping strategies and strengths.
Scientists have validated the team’s approach with a major study, published in 2010. Among other things, the research showed that peer leaders were more connected to adults, more engaged in school, and better at using coping strategies four months into the program. Students in general more strongly felt that adults were around to help, and that it was acceptable to seek help. That change was most pronounced in students who’d struggled with suicidal thoughts. A six-year randomized trial funded by the National Institute of Mental Health started that same year. Before Sources of Strength, LoMurray said the previous attempts were fruitless. “There was a lot of teen suicide prevention without teenagers involved,” he said. A tactic that seems as ill-advised as asking people who don’t read to start a book club.
With actual adolescents involved, though, skills spread through social and cultural teenage spheres like mono and smoking. “Positive things can spread through a network in the same way — things like hope and resiliency,” LoMurray said. “We’re not training students to be junior psychologists or counselors. [But] they can become patient zero in an epidemic of health.”
One thing participants in Sources of Strength often do is create an “I am Stronger” video, not unlike the It Gets Better Project videos that queer adults made to tell young LGBTQ kids how their lives will improve as time goes on. The Sources of Strength website has examples: a girl with braces describes finding mentors who helped her through problems at home, a boy in a Muse T-shirt talks about finding close friends, a curly-haired redhead talks about working through an eating disorder by bringing it up in conversation. Normally, that might all sound kind of lame and overly sincere to a teenager. But LoMurray said that, for the most part, the students are happy to participate.
“Teenagers, young people, they care. They care about their world; they care about their friends.” They want them to live long enough to grow up.
But what of the many kids who have already grown up empty-handed? “You’ve got all of these adults without resilience, without coping mechanisms,” LoMurray said. “How then do we teach those skills to adults?”
It’s a good and unanswered question. But, at least out West, there may be another way to help adults work through suicidal ideation — one that doesn’t involve undoing years of mental habits. At the University of Utah, researchers are looking into the biology of suicidal impulses. Sure, rurality, isolation, economics, substance abuse, and housing insecurity probably play into suicide risk. “But a lot of these are not really something a person can change very easily,” said neuroscientist Shami Kanekar, who works in the School of Medicine’s psychiatry department. “Biological risk factors are something that can be changed with effective treatment. That’s why we’re pushing so strongly.”
She has been seeing how one such risk factor might come into play: where, exactly, a body lives. In other words, its altitude. The correlation is strong — the Suicide Belt states are also the highest. The air is different up here.
At sea level, you breathe around 21 percent oxygen. Climb to Salt Lake City, at 4,200 feet, you take in around 18 percent oxygen. In 7,000-foot Flagstaff, Arizona? Sixteen percent oxygen. That may not sound like much difference, but if you’ve ever lived at the beach and tried to run in the mountains, you know those small numbers can make a big difference to breathing. And, maybe, to your mood.
Depression rates increase with altitude, and more people with breathing-related illnesses — like chronic obstructive pulmonary disease and asthma — are depressed. “That implies that chronic hypoxia” — an oxygen deficiency — “might mess up our brains,” Kanekar said.
If you’re sucking in less oxygen, the thinking goes, maybe your brain can’t make as much serotonin — the neurotransmitter that, among other things, regulates mood. While the link between low serotonin levels and depression isn’t clean or clear, the molecule does seem to be involved in happiness, and many antidepressants work by keeping serotonin in the brain, blocking the body from absorbing it. If there’s less to start with, Kanekar thought, maybe the medicines wouldn’t be as effective.
To start this line of research, Kanekar’s team put rats into conditions that simulated sea level, 4,500 feet, and 10,000 feet. After the rats lived there for a week, the scientists looked for signs of anxiety and depression — like not being psyched to eat sugar, not exploring their environment, and not fighting through a swim test. The findings surprised Kanekar: Female rats showed more behavior associated with depression and anxiety at high altitude than males did. In later research, the team found that neither sex, at altitude, responded to most of the anti-depressants that rely on blocking serotonin. If elevated doctors want to use medicines to treat depression, Kanekar believes, they may need pills that don’t rely on this particular neurotransmitter. And women may have a harder mental time living high up.
Of course, rats aren’t humans, and not everyone buys these results. Researchers at the University of Colorado School of Medicine found that the sociological factors — like age, unemployment, substance abuse, gun ownership, and psychiatric history — may play a much larger role than hypoxia. Besides, the authors pointed out, the direct measurements of serotonin in rats come from way high altitudes, around 20,000 feet, not the 7,000 or 8,000 feet realm Western ski towns occupy. And, importantly, no studies have measured serotonin in high-elevation human brains.
Obviously, the lab science is far from settled. Same goes for Staley’s messier real-world work. But he is not laboring under the impression that he will understand all of Utah’s suicides or the science of this complex topic that is still in its early stages. Ultimately, Staley plans to write scholarly papers and an official report, based on his team’s work, which he will send to the Department of Health to disseminate. Out of that report will come even more questions that he hopes state, federal, and university researchers will investigate. “I will never be able to really do [the data] justice and fully understand every research question that comes out of this study,” he said. Instead, others will mine them for years to come.
Maybe, years from now, a sociology teacher will assign Staley’s report as reading. Maybe students, like Staley did, will look for answers to seemingly unanswerable questions, answers that make sense out of sadness.
And, with Staley’s work inspiring future research, maybe Suicide Belt will become a moniker of the past.
If you or someone you know is having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
