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Air Quality and Suicide

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Claudia Persico conducts the first-ever large-scale study of the relationship between air pollution and suicide.

Image courtesy of interviewee. March 20, 2024

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This video video discusses the increasing rates of suicide in the United States and explores various factors contributing to this trend, particularly the potential impact of air quality on mental health and suicidal behavior. The author highlights that while there is existing research on economic factors, substance abuse, and gun access influencing suicide rates, the role of air pollution remains underexplored.

The speaker introduces the concept of neuroinflammation, emphasizing how air pollution can lead to inflammation in the body, which may worsen depression. They reference small epidemiological studies suggesting a correlation between air pollution and heightened feelings of depression and anxiety. The speaker's research aims to fill the gap by systematically studying the causal relationship between air quality and suicide rates across the U.S.

Utilizing daily wind direction as a proxy for local air pollution exposure, the study finds that increased particulate matter (PM2.5) correlates with higher rates of suicide and suicide-related hospitalizations. The implications of the findings suggest that improved air quality could potentially mitigate some mental health issues, leading to recommendations for air purification in therapeutic settings and homes of those with depression.

Furthermore, the research points to the heightened risk of suicide in areas with more permissive gun laws on high pollution days and identifies an overall increase in depressive symptoms and risky behaviors, such as binge drinking, associated with poor air quality. The study concludes that regulatory measures to reduce air pollution could significantly impact public health, possibly saving lives and decreasing hospitalizations related to suicide.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.065 --> 00:03.685
To start out, suicides are rapidly increasing in this

00:03.685 --> 00:08.005
country, and the drivers of suicide are very complex.

00:08.425 --> 00:10.965
So there have been a variety of studies on

00:11.625 --> 00:13.685
how things like mass layoffs

00:13.685 --> 00:16.365
and economic conditions impact suicides.

00:16.575 --> 00:19.885
There are, there's more recent literature on

00:20.025 --> 00:24.605
how things like the opioid epidemic, drug use, alcohol use,

00:25.225 --> 00:29.045
and the availability of firearms impact suicide.

00:29.905 --> 00:32.645
But there's, very little research right now on

00:33.185 --> 00:35.605
air quality and its potential impact on suicide.

00:36.305 --> 00:39.765
Um, and the reason, so to start at the beginning, the reason

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that we think that air quality could impact suicide is that,

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air pollution creates,

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basically inflammation in the body.

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So there are these neuroinflammatory markers called

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cytokines that,

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are increased when people are exposed to air pollution.

00:58.715 --> 01:02.445
This also happens when people are exposed to allergens

01:02.465 --> 01:03.965
or other types of things like that.

01:04.545 --> 01:07.765
Um, but essentially this inflammation in the body can

01:07.965 --> 01:08.965
actually worsen depression.

01:08.965 --> 01:11.605
So there's neuroinflammatory hypothesis of depression

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that basically shows that depressed people

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have much more inflammation in their bodies.

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Um, the reason for this is not entirely known,

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and that worsening inflammation exacerbates the symptoms

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of depression, so it makes people more depressed.

01:26.625 --> 01:28.765
So if you have somebody who's already depressed

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and they're exposed to air pollution,

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there are some small epidemiological studies that suggest

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that this worsens their mood and worsens their depression.

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There's never been a study that is large scale

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and sort of, you know,

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covering everyone in the United States and systematic

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and using acausal inference design.

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And so that's what this study's contribution to.

01:51.445 --> 01:54.165
The literature is attempting to be the first study to sort

01:54.165 --> 01:57.085
of show systematically that air pollution, in fact,

01:57.515 --> 01:58.765
does cause suicides.

01:58.865 --> 02:01.165
Um, this has a lot of important implications for policy

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in terms of, how we handle depressed patients,

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whether we might be giving 'em air purifiers

02:06.945 --> 02:09.685
and things like that of, you know,

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maybe running air purifiers in therapy offices could be a,

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an intervention, right?

02:15.305 --> 02:17.885
And so this opens the door to sort

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of more thinking about this.

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Um, so our study uses sort of three main,

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measures of suicide and mood.

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So we look at all cause mortality for,

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ba basically using daily deaths

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for every day in the United States,

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over a a nine year period.

02:38.225 --> 02:42.045
We also look at, suicide related hospitalizations,

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over in five states over a longer period.

02:44.825 --> 02:48.005
And we also look at self-reported mood according

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to the behavioral risk factor, social survey, the bar.

02:52.185 --> 02:55.445
Um, and we find that increased air pollution,

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worsens mood increases the likelihood

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that people are hospitalized for suicide related,

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conditions and increases suicides, deaths by suicide.

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There is evidence that suicides,

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or suicide related hospitalizations can be increased,

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on days of high air pollution.

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Um, so there are a few different studies showing that.

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Um, there are also a few epidemiological studies

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that have shown that, when people are exposed to days

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of higher air pollution, they report worse mood,

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and that if you, give them air purifiers,

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the mood improves.

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Um, but again, these are sort of small end studies.

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There's sort of mixed evidence, from Japan,

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from Tokyo and, a variety of other sort

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of large cities in Mexico

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and other places looking at days

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of higher pollution and suicides.

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Um, some studies find an effect, some studies don't.

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Um, and so,

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and then there is a paper by Shan,

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Lia, I'm pronouncing her name wrong, that,

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that shows that, I think it's yet unpublished

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and I'm not sure if she has a working paper out yet,

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but showing that,

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suicides are increased on days of high pollen.

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And so we're starting to realize that the stuff

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that's in the air potentially affects mood is potentially

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affecting hospitalizations.

04:21.225 --> 04:22.925
And this is sort of the first study to try

04:22.925 --> 04:25.925
to look at the entire United States using the best data

04:25.925 --> 04:27.445
that we have to try to figure out if

04:27.445 --> 04:29.325
that's what's really going on

04:29.505 --> 04:32.085
and if that's going on in the us,

04:32.355 --> 04:35.645
because that is sort of policy relevant,

04:35.705 --> 04:36.965
to our current situation.

04:37.235 --> 04:39.725
Just to, to back up a little bit, I just wanna explain

04:39.725 --> 04:40.725
what we do in this study.

04:41.225 --> 04:45.525
Um, so we use daily wind direction as an instrument

04:45.625 --> 04:48.005
or proxy for daily pollution.

04:48.625 --> 04:51.005
Um, and so the,

04:51.265 --> 04:54.365
the direction the wind blows from on a particular day in a

04:54.365 --> 04:56.365
particular county is plausibly random.

04:57.185 --> 04:59.885
And so what we're doing is we're identifying off

04:59.885 --> 05:03.845
of these large point sources of pollution that are external

05:03.865 --> 05:05.245
to a county, such

05:05.245 --> 05:08.085
that when the wind blows from the polluted direction,

05:08.805 --> 05:10.725
everyone in the county is treated with some,

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sort of pollution.

05:12.285 --> 05:15.885
So this is an identification strategy that was adapted,

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from darina and colleagues.

05:18.025 --> 05:22.365
Um, and essentially the intuition here is that,

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say if you take a city like Boston, Boston,

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when the wind blows from the east,

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is gonna get clean air off of the water,

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but when the wind blows actually, from the north,

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there's actually, or the south,

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there's actually some heavy industry

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and highways and things like that.

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And so people get worse air quality in Boston on those days

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compared to when the wind blows from the east.

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And this is true for pretty much every

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county in the United States.

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Um, and so you, what doing this buys us is it sort

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of addresses measurement error.

05:52.425 --> 05:55.885
Um, so most, pollution monitors are placed sort

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of endogenously near highways

05:57.565 --> 05:59.405
or near sources of pollution from

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factories and things like that.

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Um, and we're trying to capture sort of a pure effect,

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that is generalizable to everyone in the county,

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not just sort of these local potentially more endogenous

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sources of pollution, that could be spurred

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by economic activity or other things.

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And so doing this allows us

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to just get a very clean estimate of the causal effect

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of an increase in pollution on an entire county

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that's treated by just the direction

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of the wind happened to be blowing that day.

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So we do that and we find that a one microgram increase,

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per meter cubed increase in particulate matter 2.5.

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So that's a, that's a fancy term

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for fine particulate matter, which is very, very, very tiny.

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You can't see it with the naked eye.

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Um, it can penetrate walls, it can penetrate your brain,

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it can penetrate pretty much everything in the human

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body 'cause it's so tiny.

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It just slips into cells and it causes, inflammation.

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There's evidence that it also affects test scores,

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for children in school.

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It can affect, the, the likelihood

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that those kids engage in risky behavior.

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There's evidence that push should cause crime.

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And so this is also, adding to that literature sort

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of suggesting that there are these other mechanisms for why

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that might be going on, which is

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that pollution is actually affecting mood.

07:21.625 --> 07:24.765
And so, a main mechanism of the study is this sort

07:24.765 --> 07:26.605
of neuroinflammation hypothesis

07:26.605 --> 07:29.005
that this inflammation is worsening mood

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and maybe for people with underlying depression

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or susceptibilities to this, this is actually causing them

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to, unfortunately engage in suicidal behavior.

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And so, we sort of find

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that the results are worse in counties

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that have less restrictive gun loss.

07:47.865 --> 07:51.285
Um, so in places with easier access to guns on days

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of higher pollution, you see,

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larger increases in suicides compared to counties

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with fewer accesses to gun loss.

07:58.905 --> 08:02.805
We also see about a 50% increase in suicides,

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in the month, in a month

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where there's one microgram per meter cubed increase in

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a particulate matter, 2.5 pm 2.5.

08:13.225 --> 08:16.005
So, we also see that, you know,

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if you just look at complete deaths by suicides,

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you actually miss a huge portion of the folks

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that attempt suicides

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because actually most of them are saved.

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So most of them don't actually die.

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Um, and so the true effect on suicidal behavior is much

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larger if you look at hospitalizations than if you

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look at death by suicide.

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That's actually a relatively rare outcome.

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Luckily, we're pretty good

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at intervening and saving people.

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And then we also find that a one microgram

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increase over a month, you know,

08:49.325 --> 08:53.205
increases binge drinking behavior, it decreases,

08:53.205 --> 08:54.245
self-reported mood.

08:54.305 --> 08:57.365
So people report feeling more down, depressed and hopeless.

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Um, they'll report feeling sadder in the past month,

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and they'll report more drinking behavior,

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which is also associated with both mood

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and a higher risk of suicidal behavior.

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Drinking is actually, not good to do for people

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who are suffering from depression.

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One implication of this work is that,

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air purification could be used

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to help potentially depress patients.

09:22.185 --> 09:25.205
So if folks are feeling depressed,

09:25.585 --> 09:27.565
and it's a higher air pollution day, it, you know,

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we right now tell people to go out and exercise.

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That might not be the best idea, maybe better

09:32.165 --> 09:33.365
to hit the gym,

09:33.515 --> 09:35.845
with a good HVAC system or something like that.

09:36.265 --> 09:38.605
Um, maybe it's a good idea for depressed people

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to be running air purifiers in their home.

09:40.525 --> 09:43.205
Maybe that might improve their symptoms of depression.

09:43.665 --> 09:46.165
Um, it also might be important for hospitals

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and in inpatient treatment facilities, to

09:50.115 --> 09:52.965
improve their air quality for, a variety

09:52.985 --> 09:54.365
of different types of patients

09:54.635 --> 09:57.605
that might improve mood across the board for a variety

09:57.605 --> 09:58.885
of different types of disorders.

09:59.225 --> 10:02.325
Um, you could also imagine this potentially affecting people

10:02.325 --> 10:04.645
who are in treatment for alcoholism or things like that.

10:05.225 --> 10:09.965
So I think part of, the implications are

10:09.965 --> 10:13.285
that we could, now know that,

10:13.345 --> 10:16.165
air quality does affect mood and suicidal behavior,

10:16.225 --> 10:19.085
and that we could maybe avoid some of those costs.

10:19.625 --> 10:22.205
But also this, I think, paper contributes

10:22.265 --> 10:25.085
to a literature on the true cost air pollution, which is

10:25.805 --> 10:27.765
a big part of my research agenda.

10:27.795 --> 10:31.045
Essentially, my research agenda shows that,

10:31.115 --> 10:34.725
pollution has much higher costs than we realize,

10:34.835 --> 10:37.365
because air pollution affects the brain

10:37.585 --> 10:38.885
and it affects cognition.

10:39.345 --> 10:41.165
And so, some of my work shows

10:41.165 --> 10:43.805
that our pollution affects children in school in terms

10:43.805 --> 10:47.005
of their test scores, absences from school

10:47.225 --> 10:48.565
and suspensions from school,

10:49.025 --> 10:51.525
but also now this, kind

10:51.525 --> 10:53.885
of creates an interesting mechanism for part of how

10:53.885 --> 10:56.885
that might be going on, which is that maybe kids,

10:57.135 --> 10:58.205
moods are being affected.

10:58.825 --> 11:03.365
So, you know, maybe higher pollution in school is,

11:03.395 --> 11:04.605
causing some kids

11:04.785 --> 11:07.005
who are already experiencing maybe a bad day

11:07.025 --> 11:09.125
or some bad mood to have a worse mood

11:09.125 --> 11:10.325
and then they hit the kid next to them

11:10.345 --> 11:11.685
or something like that, right?

11:11.745 --> 11:15.485
So I think that this broadly, is interesting

11:15.485 --> 11:18.885
because it's showing the way that air pollution impacts all

11:18.885 --> 11:21.005
of us in our daily lives,

11:21.585 --> 11:25.085
and why regulation might be really important.

11:25.265 --> 11:29.765
So the Biden administration just reduced, the limit

11:29.865 --> 11:32.285
of air pollution by one microgram.

11:32.505 --> 11:36.525
And so that, according to my study, I find

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that a one microgram increase would lead

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to about 154 additional suicides a year.

11:41.505 --> 11:44.205
So, you know, if, if people follow this law,

11:44.225 --> 11:46.485
we could be saving 154 lives a year.

11:47.065 --> 11:49.285
Um, so that's some evidence

11:49.315 --> 11:51.205
that the Biden administration is potentially

11:51.205 --> 11:52.285
doing the right thing here.

11:52.745 --> 11:56.165
Um, and also it would avoid 228 more suicide related

11:56.445 --> 11:57.645
hospitalizations in that year.

11:58.625 --> 12:01.685
And so, you know, these are relatively modest numbers,

12:01.825 --> 12:03.525
but I think that every life is important.

12:03.905 --> 12:06.565
So I think there might be a more imperative there as well

12:06.825 --> 12:08.485
as, you know, the cost.

Air Quality's Impact on Suicide Rates

00:00:00 - To start out, suicides are rapidly increasing in this country, and the drivers of suicide are very complex. So there have been a variety of studies on how things like mass layoffs and economic conditions impact suicides. There are, there's more recent literature on how things like the opioid epidemic, drug use, alcohol use, and the availability of firearms impact suicide. But there's, very little research right now on
00:00:36 - and the reason, so to start at the beginning, the reason that we think that air quality could impact suicide is that, air pollution creates, basically inflammation in the body. So there are these neuroinflammatory markers called cytokines that, are increased when people are exposed to air pollution. This also happens when people are exposed to allergens or other types of things like that.
00:01:07 - actually worsen depression. So there's neuroinflammatory hypothesis of depression that basically shows that depressed people have much more inflammation in their bodies. the reason for this is not entirely known, and that worsening inflammation exacerbates the symptoms of depression, so it makes people more depressed. So if you have somebody who's already depressed and they're exposed to air pollution, there are some small epidemiological studies that suggest
00:01:38 - There's never been a study that is large scale and sort of, you know, covering everyone in the United States and systematic and using acausal inference design. And so that's what this study's contribution to. The literature is attempting to be the first study to sort of show systematically that air pollution, in fact, does cause suicides. this has a lot of important implications for policy in terms of, how we handle depressed patients, whether we might be giving 'em air purifiers
00:02:09 - maybe running air purifiers in therapy offices could be a, an intervention, right? And so this opens the door to sort of more thinking about this. so our study uses sort of three main, measures of suicide and mood. So we look at all cause mortality for, ba basically using daily deaths for every day in the United States, over a a nine year period.
00:02:42 - over in five states over a longer period. And we also look at self-reported mood according to the behavioral risk factor, social survey, the bar. and we find that increased air pollution, worsens mood increases the likelihood that people are hospitalized for suicide related, conditions and increases suicides, deaths by suicide. There is evidence that suicides,

Air Pollution, Mood, and Suicide Risk

00:03:12 - on days of high air pollution. so there are a few different studies showing that. there are also a few epidemiological studies that have shown that, when people are exposed to days of higher air pollution, they report worse mood, and that if you, give them air purifiers, the mood improves. but again, these are sort of small end studies. There's sort of mixed evidence, from Japan, from Tokyo and, a variety of other sort
00:03:43 - and other places looking at days of higher pollution and suicides. some studies find an effect, some studies don't. and so, and then there is a paper by Shan, Lia, I'm pronouncing her name wrong, that, that shows that, I think it's yet unpublished and I'm not sure if she has a working paper out yet, but showing that, suicides are increased on days of high pollen.
00:04:16 - that's in the air potentially affects mood is potentially affecting hospitalizations. And this is sort of the first study to try to look at the entire United States using the best data that we have to try to figure out if that's what's really going on and if that's going on in the us, because that is sort of policy relevant, to our current situation. Just to, to back up a little bit, I just wanna explain what we do in this study. so we use daily wind direction as an instrument
00:04:48 - and so the, the direction the wind blows from on a particular day in a particular county is plausibly random. And so what we're doing is we're identifying off of these large point sources of pollution that are external to a county, such that when the wind blows from the polluted direction, everyone in the county is treated with some, sort of pollution. So this is an identification strategy that was adapted,
00:05:18 - and essentially the intuition here is that, say if you take a city like Boston, Boston, when the wind blows from the east, is gonna get clean air off of the water, but when the wind blows actually, from the north, there's actually, or the south, there's actually some heavy industry and highways and things like that. And so people get worse air quality in Boston on those days compared to when the wind blows from the east. And this is true for pretty much every county in the United States.
00:05:50 - of addresses measurement error. so most, pollution monitors are placed sort of endogenously near highways or near sources of pollution from factories and things like that. and we're trying to capture sort of a pure effect, that is generalizable to everyone in the county, not just sort of these local potentially more endogenous sources of pollution, that could be spurred by economic activity or other things.

Impact of Air Pollution on Mental Health

00:06:18 - to just get a very clean estimate of the causal effect of an increase in pollution on an entire county that's treated by just the direction of the wind happened to be blowing that day. So we do that and we find that a one microgram increase, per meter cubed increase in particulate matter 2.5. So that's a, that's a fancy term for fine particulate matter, which is very, very, very tiny. You can't see it with the naked eye.
00:06:51 - it can penetrate pretty much everything in the human body 'cause it's so tiny. It just slips into cells and it causes, inflammation. There's evidence that it also affects test scores, for children in school. It can affect, the, the likelihood that those kids engage in risky behavior. There's evidence that push should cause crime. And so this is also, adding to that literature sort of suggesting that there are these other mechanisms for why
00:07:19 - that pollution is actually affecting mood. And so, a main mechanism of the study is this sort of neuroinflammation hypothesis that this inflammation is worsening mood and maybe for people with underlying depression or susceptibilities to this, this is actually causing them to, unfortunately engage in suicidal behavior. And so, we sort of find that the results are worse in counties that have less restrictive gun loss. so in places with easier access to guns on days
00:07:53 - larger increases in suicides compared to counties with fewer accesses to gun loss. We also see about a 50% increase in suicides, in the month, in a month where there's one microgram per meter cubed increase in a particulate matter, 2.5 pm 2.5. So, we also see that, you know, if you just look at complete deaths by suicides, you actually miss a huge portion of the folks
00:08:24 - because actually most of them are saved. So most of them don't actually die. and so the true effect on suicidal behavior is much larger if you look at hospitalizations than if you look at death by suicide. That's actually a relatively rare outcome. Luckily, we're pretty good at intervening and saving people. And then we also find that a one microgram increase over a month, you know, increases binge drinking behavior, it decreases,
00:08:54 - So people report feeling more down, depressed and hopeless. they'll report feeling sadder in the past month, and they'll report more drinking behavior, which is also associated with both mood and a higher risk of suicidal behavior. Drinking is actually, not good to do for people who are suffering from depression. One implication of this work is that, air purification could be used to help potentially depress patients. So if folks are feeling depressed,

Air Quality's Impact on Mental Health

00:09:27 - we right now tell people to go out and exercise. That might not be the best idea, maybe better to hit the gym, with a good HVAC system or something like that. maybe it's a good idea for depressed people to be running air purifiers in their home. Maybe that might improve their symptoms of depression. it also might be important for hospitals and in inpatient treatment facilities, to improve their air quality for, a variety of different types of patients that might improve mood across the board for a variety
00:09:59 - you could also imagine this potentially affecting people who are in treatment for alcoholism or things like that. So I think part of, the implications are that we could, now know that, air quality does affect mood and suicidal behavior, and that we could maybe avoid some of those costs. But also this, I think, paper contributes to a literature on the true cost air pollution, which is a big part of my research agenda.
00:10:31 - pollution has much higher costs than we realize, because air pollution affects the brain and it affects cognition. And so, some of my work shows that our pollution affects children in school in terms of their test scores, absences from school and suspensions from school, but also now this, kind of creates an interesting mechanism for part of how that might be going on, which is that maybe kids, moods are being affected.
00:11:03 - causing some kids who are already experiencing maybe a bad day or some bad mood to have a worse mood and then they hit the kid next to them or something like that, right? So I think that this broadly, is interesting because it's showing the way that air pollution impacts all of us in our daily lives, and why regulation might be really important. So the Biden administration just reduced, the limit
00:11:32 - And so that, according to my study, I find that a one microgram increase would lead to about 154 additional suicides a year. So, you know, if, if people follow this law, we could be saving 154 lives a year. so that's some evidence that the Biden administration is potentially doing the right thing here. and also it would avoid 228 more suicide related hospitalizations in that year. And so, you know, these are relatively modest numbers,
00:12:06 - So I think there might be a more imperative there as well as, you know, the cost.

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