Suicide does not fall evenly across the United States. In 2024 the national age-adjusted suicide rate was 13.7 per 100,000, reflecting 48,824 deaths (CDC, 2024). But that single number hides an enormous spread: the highest-rate state records roughly five times the rate of the lowest.
The pattern behind that spread is remarkably consistent from year to year. A tight cluster of states across the Mountain West and Great Plains — Alaska, Wyoming, Montana, New Mexico, the Dakotas, Idaho — sits at the top of the ranking, a band epidemiologists have long called the “suicide belt.” The lowest rates concentrate in the dense Northeast and Mid-Atlantic, plus California. Geography, in other words, is one of the strongest predictors of suicide risk we have.
This article ranks the states by age-adjusted rate, shows the raw death counts behind those rates, and unpacks the four factors that most reliably explain the map: rurality, firearm access, altitude, and access to care. For the full national picture, see our suicide statistics overview.
If you or someone you know is struggling or in crisis, help is available. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7.
The 10 States With the Highest Suicide Rates
Age-adjusted suicide rates let us compare states fairly, correcting for differences in their age structures. By that measure, the ten highest states in 2024 were (CDC/WISQARS, 2024):
| Rank | State | Age-adjusted rate (per 100,000) | Suicide deaths |
|---|---|---|---|
| 1 | Alaska | 29.78 | 222 |
| 2 | Wyoming | 27.81 | 169 |
| 3 | Montana | 26.83 | 320 |
| 4 | New Mexico | 24.40 | 532 |
| 5 | South Dakota | 21.99 | 198 |
| 6 | Idaho | 21.23 | 437 |
| 7 | Oklahoma | 20.85 | 868 |
| 8 | Colorado | 20.82 | 1,313 |
| 9 | Oregon | 19.91 | 941 |
| 10 | Nevada | 19.61 | 676 |
Just outside the top ten, several more Western and Plains states cluster in the high-teens: Utah (19.52), North Dakota (19.28), Maine (19.02), Arkansas (18.88), and Arizona (18.80) (CDC/WISQARS, 2024). Notice how rate and raw count diverge. Alaska tops the rate ranking with only 222 deaths, while Colorado’s 1,313 deaths — the largest count in the top ten — reflect both a high rate and a larger population. Rankings by rate and by total deaths tell different stories, and both matter.
The Five States With the Lowest Suicide Rates
At the other end of the distribution, five jurisdictions sit far below the national average (CDC/WISQARS, 2024):
| Rank | Jurisdiction | Age-adjusted rate (per 100,000) | Suicide deaths |
|---|---|---|---|
| 1 | District of Columbia | 5.67 | 44 |
| 2 | New Jersey | 6.65 | 682 |
| 3 | New York | 8.12 | 1,701 |
| 4 | Massachusetts | 8.26 | 648 |
| 5 | Rhode Island | 8.88 | 105 |
California (9.55), Maryland (9.68), and Connecticut (9.94) round out the low end (CDC/WISQARS, 2024). The gap is striking: Alaska’s rate of 29.78 is more than five times the District of Columbia’s 5.67. Every jurisdiction in this table is dense, urban, and coastal — the mirror image of the suicide belt.
The ‘Suicide Belt’: Why the Mountain West Leads
The high-rate states share a distinct profile. They are sparsely populated, mountainous, heavily armed, and far from mental health care. Four interlocking drivers explain most of the pattern.
Rurality and isolation
Rural residence is one of the clearest risk multipliers in the data. In 2018, the suicide rate among rural males was 30.7 per 100,000, compared with 21.5 for urban males; rural females were at 8.0 versus 5.9 for urban females (CDC/NCHS, 2020). The rural rate has also been climbing faster: overall rural suicide rose 48%, from 13.1 in 2000 to 19.4 in 2018 (CDC/NCHS, 2020).
The mechanisms are geographic as much as clinical. Long distances, social isolation, agricultural and extraction-economy stress, and small-community stigma all raise risk while making help harder to reach. The suicide-belt states are among the most rural in the country, which is why they lead the ranking year after year.
Firearm ownership and access
Method matters enormously, because firearms are far more lethal than other means. Nationally, firearms account for roughly 55% of all suicide deaths — about 27,300 in 2023, the single most common method (NIMH, 2024). Access magnifies rural risk: in 2018, the rural male firearm suicide rate of 18.7 per 100,000 was 63% higher than the urban male rate of 11.5 (CDC/NCHS, 2020).
Household firearm ownership is highest precisely in the Mountain West and Great Plains states that top the ranking. Where more homes contain a firearm, more suicide attempts involve one — and attempts involving a firearm are far more likely to be fatal. This method effect is a major reason the belt’s rates are so elevated.
Altitude
A more surprising correlate is elevation itself. Researchers have repeatedly observed that suicide rates rise with a region’s altitude, and the belt states — Wyoming, Colorado, Utah, Montana, New Mexico, Idaho — are among the highest-elevation states in the country. Proposed biological explanations center on the effects of chronic mild hypoxia on brain metabolism and mood at altitude. The link remains an area of active study rather than settled science, but it is a consistent feature of the geographic pattern.
Access to care
Finally, the belt states have some of the thinnest mental health provider networks in the nation. Rural counties frequently lack a practicing psychiatrist, telehealth depends on broadband that many remote areas still lack, and travel times to care can stretch for hours. When crisis support is far away and firearms are close at hand, the window for intervention narrows. Occupational stress compounds the picture — many of the highest-risk jobs concentrate in these same rural economies, as detailed in our analysis of suicide rates by profession.
Why the Northeast and California Rank Lowest
The lowest-rate states invert every belt factor. They are densely urban, with short distances to a large supply of mental health providers. Household firearm ownership is comparatively low, shifting attempts toward less lethal methods and lowering case fatality. And their terrain is low-lying and coastal. The District of Columbia, New Jersey, New York, and Massachusetts combine all of these protective conditions at once, which is why they anchor the bottom of the ranking. California, at 9.55, shows how a large, heavily urbanized population can hold a state’s overall rate well below the national figure even across enormous internal variation.
Reading the Rankings Carefully
State rankings are a starting point, not a diagnosis. A few caveats keep them honest:
- Rate versus count. A high rate signals concentrated risk; a high count signals the largest absolute burden. Alaska leads on rate with 222 deaths, while more populous states like Colorado carry far larger totals.
- Small-state volatility. In low-population states such as Wyoming and the Dakotas, a modest change in the number of deaths can swing the rate noticeably from year to year.
- Within-state variation. Statewide averages mask sharp rural-urban gaps inside a single state’s borders — the same divide visible in the national rural and urban data.
The geography is stable, but it is not destiny. Means-safety efforts, crisis-line access, telehealth expansion, and provider recruitment all target the specific factors that drive the belt’s elevated rates. For the wider context behind these numbers, see our suicide statistics overview and the flagship suicide deaths data hub. Age patterns add another layer — explore our breakdown of suicide statistics by age.
Frequently Asked Questions
Which state has the highest suicide rate?
Alaska had the highest age-adjusted suicide rate in 2024 at 29.78 per 100,000, followed by Wyoming (27.81) and Montana (26.83) (CDC/WISQARS, 2024). These Mountain West and Great Plains states consistently lead the national ranking year after year.
What is the ‘suicide belt’?
The “suicide belt” is the cluster of Mountain West and Great Plains states — including Alaska, Wyoming, Montana, New Mexico, Idaho, and the Dakotas — with persistently high suicide rates. The pattern is driven by rurality, high household firearm ownership, high altitude, and limited access to mental health care.
Which state has the lowest suicide rate?
Excluding jurisdictions, New Jersey had the lowest state rate in 2024 at 6.65 per 100,000, followed by New York (8.12) and Massachusetts (8.26) (CDC/WISQARS, 2024). The District of Columbia was lower still at 5.67. All are dense, urban, and coastal.
Why are suicide rates higher in rural areas?
Rural areas combine greater isolation, longer distances to care, occupational stress, small-community stigma, and higher firearm access. In 2018, the rural male suicide rate was 30.7 per 100,000 versus 21.5 for urban males, and the rural male firearm rate was 63% higher than the urban male rate (CDC/NCHS, 2020).
Do firearms explain the state differences?
Firearms are a major factor. They account for roughly 55% of U.S. suicides — the most lethal common method (NIMH, 2024). States with higher household firearm ownership, concentrated in the West and Plains, see more suicide attempts involving firearms and therefore higher fatality rates.
Sources
- National Institute of Mental Health. Suicide. NIMH; updated 2025. https://www.nimh.nih.gov/health/statistics/suicide
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Suicide Data and Statistics. CDC; 2026. https://www.cdc.gov/suicide/data/
- Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS). CDC/NCIPC; 2026. https://wisqars.cdc.gov/
- Pettrone K, Curtin SC. Urban-Rural Differences in Suicide Rates, by Sex and Three Leading Methods: United States, 2000-2018. NCHS Data Brief No. 373. National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/products/databriefs/db373.htm