Talk about gambling: The odds of committing suicide increase enormously if a person lives in, or is even visiting, Las Vegas.
Tourists and other travelers to the slot-machine-saturated city are at double the risk of suicide compared with those who stay home, according to an analysis just published in the journal Social Science & Medicine. For people who put down roots in the desert community, the suicide risk is approximately 50 percent higher than for those who make their homes elsewhere.
"We made the same kind of risk calculation that's been used regarding exposure to cigarette smoke," said lead author Matt Wray, a sociologist at Temple University in Philadelphia. "We asked: If exposure to cigarette smoke increases your risk of cancer, does exposure to Las Vegas increase your risk of suicide? We found the answer is yes.
"We're agnostic about why," he added. "It could be something about the place, something about the people or something about contagion affects, such as the suicide copycat phenomenon. They're equally good contenders."
Wray and his colleagues call their study, "Leaving Las Vegas," a wry allusion to the 1995 film in which a failed screenwriter played by Nicholas Cage moves to the Nevada city to drink himself to death. Six years after its release, Wray moved to the fast-growing metropolis to take a faculty job at the University of Nevada, Las Vegas. He conceived of the study before departing in 2006 to pursue a post-doctorate fellowship at Harvard University.
Like all sociologists, Wray was aware that Nevada in general and Las Vegas in particular have very high suicide rates. But he discovered the subject has been "surprisingly understudied" and decided to give it a closer look.
"Whenever you see a cluster of specific kinds of deaths, you find yourself wondering what's going on," he said. "Is there something in the water? Is there an ecological explanation? Alternatively, if it's not the place, could it be the people? Do the sort of people who are attracted to this place bring with them a risk of that particular form of mortality?"
To attempt to answer those questions, Wray and his colleagues examined four types of suicide risk: risk among Las Vegas residents compared with those who live in other countries; risk to visitors compared with people who stayed home; risk among residents who are visiting elsewhere; and risk among visitors to Las Vegas compared with people who are visiting other counties in the U.S.
Using cause-of-death data from the National Center for Health Statistics, they calculated that suicides accounted for 2.6 percent of deaths in Las Vegas from 1995 to 2004, compared to a national rate of 1.5 percent. Among visitors to Las Vegas who died during their stay, 4.6 percent were suicides.
Breaking down the numbers, the researchers concluded that "the odds of suicide among Las Vegas residents was at least 50 percent greater than among residents elsewhere in each of the three decades we observed (that is, from 1975 to 2004)." One way for city dwellers to tilt those odds in their favor was to leave town: Las Vegas residents who were out of town at the time of their death were significantly less likely to be suicide victims.
To determine if the increased risk for visitors was specific to Las Vegas, Wray looked at another set of statistics. He found that among people who died away from home between 1995 and 2004 (that is, in a county other than the one where they live), those who expired in Las Vegas were twice as likely to be suicides than those who died elsewhere.
None of this will be welcome news to the Las Vegas tourism bureau (which would presumably prefer this research stay in Vegas). But it should be of great interest to mental-health experts, who are welcome to weigh in with their hypotheses. Wray notes there are many possible causes for this phenomenon, adding, "The most significant questions remain not only unanswered, but completely unexplored.
"What does Las Vegas mean?" he asked. "For many Americans, it symbolizes a second chance, a horizon of opportunities. For some, it might represent their last chance: If things don't work out in Vegas, they're not going to work out anywhere. That could lead to deep, self-destructive despair."
Wray notes that the high risk to visitors and the high risk to residents could have different causes, or perhaps overlapping ones. While the gambling culture, and its resultant highs and lows, may be a factor among visitors, he believes there are far more powerful stressors on residents.
"One explanation for suicide among sociologists has been low levels of social cohesion," he said. "In situations where there is isolation and social fragmentation, suicide rates are high. Las Vegas is a community with low social cohesion. It has weak social ties and poor support networks — the sort of things you expect to find in a boomtown.
"Eight- to 10,000 people a month move there. The growth creates so many needs and problems, and the infrastructure (to deal with them) is simply not there. Some people bring their social networks with them and don't need a lot of support from the community. But that's certainly not true of everyone."
What can, or should, health agencies be doing?
"Really acknowledge the magnitude of the problem," he said. "There is some important movement in that direction. There is a state-level office of suicide prevention, but it has never received the resources it deserves. This also holds true for local departments of health. They're aware of the problem and are doing very good work but on a small scale.
"Some of this may not be preventable," he admitted. "If some people are coming to Las Vegas specifically with the intention of killing themselves, there may not be much that can be done about that. But the risk among residents is high enough that there needs to be intervention needs at a local level. That doesn't appear to be high on anyone's agenda right now. Our study, I believe, gives empirical evidence of the size of this risk."
Of course, public health officials can't do anything about the four or more months of oppressive 100-degree heat that can be counted on every summer — or the fact the rapidly built city has a utilitarian, sterile look once one gets away from the tourist areas.
"My sense is the physical environment is probably less of a factor than the built environment," Wray said. "The developments in Las Vegas tend to be monotonously uniform. Of course, that sort of building is happening in more and more places around the country."
Which leads to one final point about a worrying trend.
"In the first period we look at, around 1979-1984, people who traveled away from Las Vegas reduced their suicide risk by about 40 percent," Wray noted. "By the most recent period, 1995-2004, the reduction in risk was only about 13 percent. So it appears that, for residents, leaving Las Vegas conferred a much bigger protective benefit against suicide in that earlier period than it does now.
"That suggests that Las Vegas has become more like the rest of the country — or, conversely, that the rest of the country has become more like Las Vegas. If that's true, we ought to think about what might travel with that Las Vegasization. If that includes a higher suicide risk, we ought to be alerted."
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