Is altitude causing suicide in the West? 

Regional View

The West's mountain towns, from Jackson to Taos, Silverton to Park City, Truckee to Ketchum, tend to float to the top of what I'll call Listicles of Happiness: Those inane rankings of the "best towns" in the nation, whether it's the best small towns, the best ski towns or, a recent favorite to hate, "20 Colorado Mountain Towns That Are Paradise in Winter," the writers of which have some fetish for stoplights, or the lack thereof.

Judging from these lists, we mountain townies are a joyous bunch, working high-paying jobs that not only allow us to follow our passion, but also to go fly fishing on our lunch break, mountain bike after that (without stoplights to slow us down!), and then, fueled by a runner's high, party long into the night.

But there's another set of lists, too, that aren't published by the usual magazines or websites, but on which those very same mountain towns and states tend to rank highly: The Lists of Misery. Western states are among the national leaders in alcohol abuse and depression rates, and rank low for mental health.

A few days ago, the Centers for Disease Control — the usual compilers of the Lists of Misery — put out a report on alcohol-related poisoning fatalities. The Interior West had the highest rates, by far. Then there's the ultimate List of Misery, suicide rates, which the Interior West has long topped, earning the Rocky Mountain states the morbid moniker of The Suicide Belt.

The root causes of this mountain misery have remained a mystery. Maybe we kill ourselves at a higher rate because we have so many guns at our disposal, and maybe we reach that extreme of misery because we are physically and emotionally isolated: We not only live farther apart from one another, but our independent Western spirit prevents us from seeking help and support. Maybe the notion of driving over mountain passes for mental health care is too daunting.

But a group of researchers think they may have found the reason the mountain states top not only the Lists of Misery, but maybe also the Listicles of Happiness: high altitude.

Two studies, each by an overlapping group of scientists looking into the matter, were published back in 2010 and 2011. The findings didn't get a lot of play at the time. But after the CDC released its latest data, for 2012, showing that the suicide rate has been increasing nationwide, particularly in Western states like Utah and Colorado, and after an article on the altitude findings was published at the website Mic.com in November, the theory attracted more attention.

In the paper "Positive Association between Altitude and Suicide in 2,584 U.S. Counties," published in 2011 in High Altitude Medicine and Biology, the authors looked at every county in the U.S., and found a strong positive correlation between the average altitude of the county and the suicide rate. Counties that lie below 2,000 feet above sea level had an overall suicide rate that was about half that of counties lying between 4,000 and 5,000 feet in altitude. Counties above 9,000 feet had the highest suicide rate. And so on. This in spite of the fact that high altitude counties generally have a lower mortality rate from all other causes. The authors note:

Prior reports of increased suicides in the U.S. Mountain Region have prompted speculation that the excess is owing to greater access to firearms, increased isolation, or reduced income. Even after controlling for these variables in our analysis, the positive correlation between altitude and suicide still exists, which suggests that the increased suicide rate in the regions with greatest altitude, such as the Mountain Region, may be owing to, at least in part, its altitude per se.

How could altitude lead someone to end his or her own life? Possibly through hypoxia, or lack of adequate oxygen to the brain, the phenomenon that causes us to get dizzy, or drunk faster, at high altitude.

"Altitude is a well-known cause of hypoxia," the authors say, "and the greater the elevation, the greater the hypoxia. Chronic hypoxia also is thought to increase mood disturbances, especially in patients with emotional instability." The authors go on to admit that hypoxia's effect on mood is complex, and more study is needed.

One of the researchers, at least, has continued that study, and thinks he's closer to solving the mystery.

In the Mic.com article, writer Theresa Fisher spoke with Utah neuroscientist Perry Renshaw about his findings. Renshaw told her that he believes altitude messes with our bodies' levels of dopamine and serotonin, chemicals that regulate our sense of happiness. Hypoxia, he says, causes serotonin to go down in our brains (which usually results in depression) and dopamine to increase (which usually creates a sense of euphoria, e.g., "runner's high").

Whether this conflicting combination of effects makes us happy or makes us sad depends on the makeup of our brains. Folks with a history of depression are more likely to get more depressed if they move to the mountains, as are women, according to the Mic.com article. And people who are naturally happy are likely to get downright ecstatic at higher altitudes. And that would explain how so many mountain towns can top both the Listicles of Happiness and the Lists of Misery.

When I first caught wind of the theory a few months ago, it seemed absurd. I've lived all but one year of my life between 5,000 and 9,300 feet. Looking back at those times — as well as the year I spent at sea level — I don't see any correlations between my mental health and the altitude at which I was living. Sure, my sanity often wore a little thin while living in Silverton, at 9,300 feet, but then there were many other factors aside from altitude to consider: A tiny populace, psychotic politics, a treacherous drive to the nearest movie theater and, yeah, I was running the town newspaper, a sure road to mental illness.

Having said all of that, suicide has been a shockingly common cause of death in Silverton since the heydays of mining, and many of its current residents — the ones who aren't fighting over at Town Hall — can tend to get wrapped up in a sort of hypoxic euphoria.

I always thought it was the scenery. Perhaps it's the altitude.

Jonathan Thompson is a senior editor at High Country News, which first published this piece online.


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