Utah's high altitude and high suicide rate warrant further discussion, clinicians agree

SALT LAKE CITY – Local neuropsychologists met Wednesday to discuss University of Utah research connecting Utah's high altitude with the state's higher-than-average suicide and depression rates.

The research was published in 2018, but is still making the rounds among clinicians and families.

Sari Soutor Farhart is a licensed psychologist specializing in childhood neuropsychological evaluations. She and other neuropsychologists meet as the Greater Utah Child Neuropsychology Education Group.

"The group was tremendously excited to understand this and really to have the ability to pass the information along to our clients," she said. "I think providers have been trying to understand why life in Utah might also be so difficult when we have so much beauty and motivation around us to enjoy being outside."

In the review published in Harvard Review of Psychiatry, University of Utah psychiatrist Brent M. Kious and colleagues said one environmental factor deserves more attention: altitude. A growing body of research suggests that living at higher elevations may contribute to depression and suicide risk, although experts emphasize it is only one of many factors involved.

Kious, Douglas G. Kondo and Perry F. Renshaw examined evidence linking higher altitude with increased rates of major depressive disorder and suicide across the U.S., specifically seen in the Mountain West region. The theory centers on hypoxia, a condition that occurs when the body receives less oxygen.

"We really need oxygen to fuel our entire body," explained Soutor Farhart. "When we don't get enough oxygen, our body has to take a step back from what it narrowly sees as less essential functions."

At Salt Lake City's elevation of roughly 4,300 feet, residents live with slightly lower oxygen levels than people living closer to sea level.

According to the review, lower oxygen levels may affect the brain in at least two important ways: by changing serotonin metabolism and by reducing the brain's ability to efficiently produce energy. Both mechanisms have previously been linked to depression.

Researchers theorize that lower oxygen availability may interfere with serotonin production because oxygen is required for key steps in the process.

"Additionally, people with depression, especially people with depression living at high elevation, are less efficient at producing energy in their brains," Kious explained to KSL. "That means that in areas of their brains that maybe require an extra amount of energy, they are not able to keep up with those demands, and then those areas of the brain don't work as well."

For Soutor Farhart, the altitude research helped explain patterns she had observed in some patients, including children and families who recently moved to the Mountain West.

She said some clients developed symptoms such as reduced appetite or new depressive symptoms after relocating to higher elevations.

The review notes that altitude is unlikely to affect every person in the same way. Instead, it may increase risk among people who already have biological or environmental vulnerabilities to depression. Kious said the findings may be particularly relevant for people with conditions that further reduce oxygen levels, including asthma, chronic lung disease and sleep apnea.

"For the typical person who's thinking about how to keep from becoming depressed or who has depression and wants to treat it a little bit better, I think the critical things are to talk to your doctor," Kious said. "Exercise is a really powerful antidepressant, probably as powerful as any medication. Good nutrition ... [and] sleeping well, if you can, is really helpful."

The review also discusses potential treatments that warrant further study, including nutritional supplements like creatine monohydrate and serotonin-related supplements such as tryptophan and 5-hydroxytryptophan. The authors noted these approaches are suggested by the hypoxia theory but require additional research.

The review specifically states that depression and suicide arise from "many interrelated factors," and altitude should not be viewed as a sole cause.

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