March 9, 2018 – High-altitude areas—particularly the US intermountain states—have increased rates of suicide and depression, suggests a review of research evidence in the Harvard Review of Psychiatry. The journal is published by Wolters Kluwer.
The increased suicide rates might be explained by blood oxygen levels due to low atmospheric pressure, according to the article by Brent Michael Kious, MD, PhD, of University of Utah, Salt Lake City, and colleagues. Pending further research, the evidence may point to possible treatments to reduce the effects of low blood oxygen on mood and suicidal thoughts.
Altitude Linked to Variations in Suicide Rate – Further Study of Mechanisms Needed
The researchers reviewed and analyzed previous evidence linking higher altitude of residence to increased risk of suicide and depression, and considered possible explanations for these associations. "There are significant regional variations in the rates of major depressive disorder and suicide in the United States, suggesting that sociodemographic and environmental conditions contribute," Dr. Kious and coauthors write.
They analyzed 12 studies, most performed in the United States, including population-based data on the relationship between suicide or depression and altitude. While the studies used varying methods, most reported that higher-altitude areas had increased rates of depression and suicide. In general, the correlation was stronger for suicide than for depression.
The highest suicide rates were clustered in the intermountain states: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming. (Alaska and Virginia also had high suicide rates.) In a 2014 study, the percentage of adults with "serious thoughts of suicide" ranged from 3.3 percent in Connecticut (average altitude 490 feet) to 4.9 percent in Utah (average altitude 6,100 feet).
Other key findings from previous research on altitude and suicide included:
Why would altitude affect suicide rates? Dr. Kious and coauthors suggest the answer might be "chronic hypobaric hypoxia": low blood oxygen related to low atmospheric pressure. That theory is supported by studies in animals and short-term studies in humans. The authors suggest two pathways by which hypobaric hypoxia might increase the risks of suicide and depression: by altering the metabolism of the neurotransmitter serotonin and/or through its effects on brain bioenergetics.
If borne out by future studies, these mechanisms suggest some possible treatments to mitigate the effects of altitude on depression and suicide risk: supplemental 5-hydroxytryptophan (a serotonin precursor) to increase serotonin levels, or creatinine to influence brain bioenergetics. Dr. Kious and colleagues identify several areas in need of further research, including the effects of prolonged exposure to altitude on both serotonin metabolism and brain bioenergetics.
About the Harvard Review of Psychiatry
The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics.
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