Discussions of Book of Mormon issues and evidences, plus other topics related to The Church of Jesus Christ of Latter-day Saints.

Thursday, January 10, 2019

If Utah Were an Island

What if Utah were an island? OK, I know what you're thinking, but I mean the kind of island that is near sea level, surrounding by lovely beaches and not towering mountains. Given the growing evidence that altitude is one of the strongest factors related to suicide rates, not just in the US but around the world, what would Utah's statistics look like? Right now they are pretty bad. Utah is #5 in the nation with a rate of 21.8 per 100,000. Ouch, that's terrible, much like the terrible rates in other high altitude states. Here's the top ten and their rates per 100,000:

1. Montana — 26
2. Alaska — 25.4
3. Wyoming — 25.2
4. New Mexico — 22.5
5. Utah — 21.8
6. Nevada — 21.4
7. Idaho — 21.3
8. Oklahoma — 20.9
9 (tie). Colorado — 20.5
9 (tie). South Dakota — 20.5

You can see the LDS population of these states in Wikipedia's page on LDS population in the U.S., and then on their page for LDS population in various countries, you can see national statistics for much of the world, and these can be compared to suicide statistics for various countries for an interesting exercise in looking at the complexity of suicide.

As I thought about island states or countries, I considered Hawaii, with a rate of 12, giving it a rank of 41 in the U.S. Not bad. Hawaii's 5.2% LDS population does not seem to be domoralizing the population all that much. But then I remembered Samoa. American Samoa has a sizable LDS population. I was almost afraid to look at the suicide statistics because I had the image of a country with a poor economy and big, aggressive men under a lot of pressure. Surely the news wouldn't be good. To my surprise, American Samoa, with 40% Latter-day Saints, has a suicide rate of 5.4, less than half that of Hawaii. A fluke? Then comes Tonga, with 60% LDS population -- more LDS than Utah! -- and yet its suicide rate is even lower than American Samoa: 4.0, ranked #156 in the world.

Yes, I know, the culture is much different and guns are not abundant, but it shows that a high LDS population is not necessarily driving people to suicide. Maybe a change in altitude could be a good thing for those struggling with depression and suicidal thoughts. Maybe Tonga or Samoa is the place for you?

Yet both island nations face increasing trouble with suicides and they, like all nations, have more work to do to reduce the tragedy of suicide. 

Related stories:


14 comments:

Anonymous said...

Any other NON-EXPERTS care to weigh in?
Holy crap, Jeff, this is a new low.

Anonymous said...

This non-expert would like to chime in. Just like to remind everyone about suicide by cop or conflict. Inner city populations that tend to have poverty and unemployment rates twice their surrounding zip codes sometime tend to have much lower suicide rates, but higher murder rates. This is usually explained by suicidal people committing suicide via conflict, anyone that has committed career suicide should now exactly how easy that is to do. Of course, these do now show up in the data. Oh, and overdoses do not either, unless maybe there is a suicide note. Oh and alcohol induced cirrhosis of the liver usually does not show up as suicide. Alcohol induced cirrhosis is usually a slow suicide using alcohol to self medicate depression.

Anonymous said...

So you admit that if the "restored" gospel as true there should be a noticeable reduction in suicide and depression, but there isn't a noticeable reduction ... So it turns out your cheerful disposition was all you. Being modest, you just gave credit to your religion.

Jeff Lindsay said...

Studies show that active religious participation reduces suicide, and that those who are active LDS in Utah have higher mental health, healthier lives, and reduced suicide rates. What I admit is that I'd like to see all of the Mountain West have much lower rates, Utah included. Note that active, attending LDS people are a minority in all of those states, Utah also included.

See Sterling C. Hilton, Gilbert W. Fellingham, and Joseph L. Lyon, "Suicide Rates and Religious Commitment in Young Adult Males in Utah," American Journal of Epidemiology, 155/5 (March 1, 2002): 413–419, https://doi.org/10.1093/aje/155.5.413. Here is the abstract:

"Previous studies have used population data to demonstrate an inverse association between suicide rates and religious commitment. This report examines Utah suicide rates for young men aged 15–34 years, stratified by their membership in and commitment to the Church of Jesus Christ of Latter-day Saints (LDS), the predominant religion in Utah. All state death records for males from 1991 to 1995 were obtained and linked to LDS church deceased membership records to obtain a measure of religious commitment that is not self-reported. Religious commitment for LDS church members was determined by age-appropriate priesthood office. Of the 27,738 male deaths reported, 15,555 (56%) linked to an LDS church record using a probabilistic linking program. Using active (high religious commitment) LDS as the reference group, the less-active (low religious commitment) LDS group had relative risks of suicide ranging from 3.28 (ages 15–19 years) to 7.64 (ages 25–29 years); nonmembers of the LDS church had relative risks ranging from 3.43 (ages 15–19 years) to 6.27 (ages 20–24 years). Although the mechanism of the association is unclear, higher levels of religiosity appear to be inversely associated with suicide."

If I understand that properly, it indicates that the suicide risk in Utah increases by about 3 to 7 times, relative to the lower rate for active LDS members, for those who are inactive or non-LDS. But I'd love to move this much lower for everyone in Utah and everywhere else.

Jeff Lindsay said...

Dear "this is a new low" Anon, can you tell me ghastly "new low" blunder I've committed by looking at LDS populations and suicide rates in low altitude regions? Just how many degrees in whatever field you are looking for does it take to allow somebody to make a simple point with readily available data? Or is the problem that you dispute all of the altitude-related studies? If so, care to justify your position?

If LDS populations cause communities to become more suicidal, as some wish to imply, then why does that alleged trend (which may be heavily influenced by altitude) not show up when we "level the playing field" to sea level and look at high LDS concentrations in Oceania? Is it a new low to merely point out that this effect weighs against the idea that LDS bodies in the neighborhood will increase the body count?

Jared said...

I'll chime in with citations. My post will be split into multiple, depending on comment limits. By and large, the more religious someone is, the lower the rates of suicidality. This is a well-established link that has been shown for many years (at least since Emile Durkheim's research first published in 1897). The only data that might counter the significant benefits religion has on reducing suicidal ideation and behavior is recent research with LGBQ youth/young adults. I'll present a selection of the research. Note: not all of these citations represent equal quality research. I am trying to include only research published in generally respected and higher impact journals. I'm also preferring recent research to older research. Not that it is intrinsically better or more important - it's just more relevant to today's culture.

Protective effects: There are hundreds of articles (not exaggerating) demonstrating protective effects of religion.

Svob, C., Wickramaratne, P. J., Reich, L., Zhao, R., Talati, A., Gameroff, M. J., ... & Weissman, M. M. (2018). Association of parent and offspring religiosity with offspring suicide ideation and attempts. JAMA psychiatry, 75(10), 1062-1070.

"Parent belief in the high importance of religion was associated with an approximately 80% decrease in risk in suicidal ideation/attempts in their offspring compared with parents who reported religion as unimportant. The association of parental belief was independent of the offspring’s own belief in the importance of religion and other parental risk factors and was statistically significant."

Jacob, L., Haro, J. M., & Koyanagi, A. (2018). The association of religiosity with suicidal ideation and suicide attempts in the United Kingdom. Acta Psychiatrica Scandinavica.

"Compared to those without a religion, the prevalence of past 12‐month suicidal ideation (3.2% vs. 5.4%), past 12‐month suicide attempts (0.4% vs. 0.9%), lifetime suicidal ideation (11.2% vs. 16.4%), and lifetime suicide attempts (3.6% vs. 6.0%) was lower among those with a religion."

Burshtein, S., Dohrenwend, B. P., Levav, I., Werbeloff, N., Davidson, M., & Weiser, M. (2016). Religiosity as a protective factor against suicidal behaviour. Acta Psychiatrica Scandinavica, 133(6), 481-488.

"Religiosity has a protective effect against suicide attempts, which is independent of social functioning, psychopathology, and substance use."

Gearing, R. E., & Lizardi, D. (2009). Religion and suicide. Journal of religion and health, 48(3), 332-341.

"Research has established that degree of religiosity is directly related to degree of suicidality, with greater religiosity predicting decreased risk of suicidal behavior. Several mechanisms have been attributed to the protective role of religion, including a decrease of aggression and hostility and an increase in reasons for living. The protective role of religion can be found across major religious denominations; thus, assessing a client’s degree of religious affiliation may serve as an effective indicator of suicide risk."

Jared said...

Note the next two studies are with depressed inpatients: Dervic, K., Oquendo, M. A., Grunebaum, M. F., Ellis, S., Burke, A. K., & Mann, J. J. (2004). Religious affiliation and suicide attempt. American Journal of Psychiatry, 161(12), 2303-2308.

"Religiously unaffiliated subjects had significantly more lifetime suicide attempts and more first-degree relatives who committed suicide than subjects who endorsed a religious affiliation. Unaffiliated subjects were younger, less often married, less often had children, and had less contact with family members. Furthermore, subjects with no religious affiliation perceived fewer reasons for living, particularly fewer moral objections to suicide. In terms of clinical characteristics, religiously unaffiliated subjects had more lifetime impulsivity, aggression, and past substance use disorder. No differences in the level of subjective and objective depression, hopelessness, or stressful life events were found."

Mosqueiro, B. P., da Rocha, N. S., & de Almeida Fleck, M. P. (2015). Intrinsic religiosity, resilience, quality of life, and suicide risk in depressed inpatients. Journal of affective disorders, 179, 128-133.

"In a sample of depressed inpatients, intrinsic religiosity was found to be associated with resilience, quality of life, and fewer previous suicide attempts."

Potentially harmful (LGBQ-specific). This is the only population I found so far where greater religiosity appears to be associated with greater suicidality.

Lytle, M. C., Blosnich, J. R., De Luca, S. M., & Brownson, C. (2018). Association of Religiosity With Sexual Minority Suicide Ideation and Attempt. American journal of preventive medicine, 54(5), 644-651.

"Increased importance of religion was associated with higher odds of recent suicide ideation for both gay/lesbian and questioning students. The association between sexual orientation and self-directed violence were mixed and varied by strata. Lesbian/gay students who viewed religion as very important had greater odds for recent suicidal ideation and lifetime suicide attempt compared with heterosexual individuals."

Shearer, A., Russon, J., Herres, J., Wong, A., Jacobs, C., Diamond, G. M., & Diamond, G. S. (2018). Religion, sexual orientation, and suicide attempts among a sample of suicidal adolescents. Suicide and Life‐Threatening Behavior, 48(4), 431-437.

"The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same‐sex attraction but fewer attempts in those reporting opposite‐sex attraction only."

Gibbs, J. J., & Goldbach, J. (2015). Religious conflict, sexual identity, and suicidal behaviors among LGBT young adults. Archives of suicide research, 19(4), 472-488.

"LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict."

Jared said...

Conclusions

The more religious someone is, the less likely they are to have suicidal ideation and attempts. Interestingly, at least one study showed parental religiosity was a significant protective factor, regardless of what the child believed. With Utah being about 51% LDS (although not all of those are active), this suggests Utah would have higher rates of suicide without the influence of The Church of Jesus Christ of Latter-day Saints. I didn't cite research showing the other positives effects religion has on health but generally the more religious someone is, the longer and healthier he/she lives.

Okay, I'll give a few citations.

Kark, J. D., Shemi, G., Friedlander, Y., Martin, O., Manor, O., & Blondheim, S. H. (1996). Does religious observance promote health? mortality in secular vs religious kibbutzim in Israel. American Journal of Public Health, 86(3), 341-346.

"Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors."

Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87(6), 957-961.

"Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance."

McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: a meta-analytic review. Health psychology, 19(3), 211.

"A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20–1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement."

LGBQ

Church culture in Utah, like most church cultures, could be a factor in increased suicidality in LGBQ youth. This is an area where improvements can be made. I'm not suggesting any doctrine needs to change, just attitudes and acceptance of individuals and communities. I need to add that regions beliefs do not explain all of the increased risk of suicidality in LGBQ individuals.
This is also true for the protective effects it has for the general population. Previous suicide attempts, depression, and drug and alcohol use/abuse are strong predictors of suicidality.

Trying to pin blame on suicides in Utah on The Church of Jesus Christ of Latter-day Saints is anti-science. It goes against all the evidence, other than specifically with LGBQ individuals. That is, however, not specific to the restored church. It is an issue all major religions face. This also means the mental health and physical health benefits offered by religions are not specific to the restored church. Those who go to church more tend to benefit the most so our encouraging of weekly attendance on Sundays with weekly activities for youth, ministering assignments where people are being taken care of individually and as families (ideally), and the other regular support are all beneficial.

Anonymous said...

Jared -

Good analysis. We often forget correlation is not causation (Stats 101) and things like religiosity is often just a proxy for parental involvement. In these types of discussion we sometimes forget we are all individuals and not statistics. If Church cultural is a factor for LGBQ, then it can be a factor non-LGBQ individuals also, but you may not see it in the stats.

“This also means the mental health and physical health benefits offered by religions are not specific to the restored church.” Bingo. That is the point of the critics.

Anonymous said...

@Jeff Lindsay 7:54 AM, January 11, 2019

Reading the methodology, one realizes that the study only measures parental involvement with male adolescents. The study measures if the LDS parent regularly took the male adolescent to church between the ages of 12-19, by observing the actual ages of priesthood ordinations with the expected ages. Interesting to note that for the study’s proxy (“surrogate measure“) for activity (age group 12-19), the active LDS, male, Utahan adolescent suicide rates is the same as the national average.  Pause on that.  For the actual “surrogate measure“, there is no difference to the national average.  If the national average also accounted for parental involvement, the active LDS male adolescents suicide rate would most likely be higher than the national.
 
There is plenty of anecdotal evidence of depressed LDS adults whose parents took them to church regularly between the ages of 12-19 who testify that the “restored” gospel did little to help them find happiness.  However, the study should comfort those parents, for it suggests their involvement kept their children alive longer.  For this study to apply to the “restored” gospel, it would require a similar analysis of male adolescent Methodists, Baptists, etc, whose parents regularly took them to church, or some other parental involvement proxy such as attending parent-teacher conferences.

I suspect the truth is suicide is like war.  People can attempt to connect war and death to the religious just as easily as they can to the a-religious.  As for the mountain west, my first thought would be access to firearms, not altitude.  Any studies?

Jeff Lindsay said...

Guns are absolutely a big factor in suicides, just as altitude appears to be a very big factor in light of the statistics. Regarding guns, there is a big difference in the ratio of completed suicide to attempted suicide from region to region. One of the apparent reasons why those in rural communities have higher completed suicide rates is that they have easier access to effective means of committing suicide. In Asia, for example, those in rural regions are more likely to use pesticides with a high rate of success, whereas those in cities in many parts of the world might use an overdoes of medication which is less likely to kill. I read a study on this effect in Asia recently and will try to track it down again. In the US, especially in rural regions in the West, guns are readily available and give a high likelihood of fatality. I don't think it's that guns drive people to suicide, but make it easier to attempt and especially to complete.

In one of the more dramatic moments in my life (discussed in a 2007 post here at Mormanity), a young mother I cared for deeply called me from a location in Appleton, Wisconsin one night to say good-bye. "Bishop, tell my family that I love them" was all she wanted to say. When I gently pressed for more, I learned that she was about to commit suicide. I was able to help because of two important factors: 1) she didn't have a gun, but was about to get back in her car and use a high-speed crash to kill herself, and 2) I was miraculously blessed to have just received my repaired cell phone that very day, after being without it for a month, and was able to call 911 for help at the same time I kept her talking on my landline. A few minutes later, before she could hang up and zoom to oblivion, some very kind police officers showed up and escorted her to safety. She got the help and love she needed in the coming days, and today is a remarkably successful woman. It was one of the most frightening and happiest moments of my life, and one of my most cherished little miracles. Had she called with a gun to her head, it may have been another tragedy.

Jeff Lindsay said...

Jared, thanks for the valuable information! Have you written more on this topic that I can cite?

Anonymous said...

If the Baptist, Methodist, etc now now believe in faith, repentance, baptism by immersion, and taking on the name of Christ, then they have the restored gospel. Who are these anti's always tells what we LDS believe?

Jared said...

Jeff, no I don't. While I'm trained as a clinical psychologist, I do aging research so I don't have special expertise in this topic (other than my broad psychology education and training). I've meant to cover the topic of suicide and (LDS) religion in an essay/article but never got around to it. Your posts at least spurred me to put together some of the research I've collected on the topic. There isn't great LDS-specific research anywhere (by great I mean at least peer-reviewed). Despite what certain anonymous commentators might state or believe, you're doing an excellent job of covering the issue. It's complicated. Depression and suicides are concerning, particularly those who are in the generally vulnerable LGBQ group.

I'll try to comment more later but have family time to attend to.