Wednesday, November 19, 2014

There's a Suicide Epidemic in Utah — And One Neuroscientist Thinks He Knows Why

Theresa Fisher
Nov. 18, 2014

This partner story is part of BrainMic, a collaboration with GE to share the latest advances in brain research and technology.

Living in Utah means packed powder in April, canyoneering in the clouds, snow-capped vistas so vivid they look Photoshopped — and the shortest average work week in the country. So it's not surprising that surveys show how much Utah residents love their outdoorsy, adventure-filled state.

But there's another side to Utah that isn't shown in surveys. Despite ranking as America's happiest state, Utah has disproportionately high rates of suicide and associated mood disorders compared to the rest of the country. In fact, it's the No. 1 state for antidepressant use. These polarized feelings of despondency and delight underlie a confusing phenomenon that Perry Renshaw, a neuroscientist at the University of Utah investigating the strange juxtaposition, calls the "Utah paradox."

Utah residents and experts are aware of the paradox, often attributing gun use, low population density and the area's heavy Mormon influence as potential factors. But Renshaw thinks he's identified a more likely cause for the Utah blues: altitude.

Renshaw believes that altitude has an impact on our brain chemistry, specifically that it changes the levels of serotonin and dopamine, two key chemicals in the brain that help regulate our feelings of happiness. America's favorite antidepressants (and party drugs) work by controlling the level of these chemicals in the brain.


In a 2011 study published in the American Journal of Psychiatry, a group of researchers, including Renshaw, analyzed state suicide rates with respect to gun ownership, population density, poverty, health insurance quality and availability of psychiatric care. Of all the factors, altitude had the strongest link to suicide — even the group of states with the least available psychiatric care had fewer suicides than the highest-altitude states, where psychiatric care was easier to find.

In a follow-up study, Renshaw looked at instances of suicide that involved guns and those that didn't. Again, he found a positive correlation between suicide and altitude across the board.

Renshaw also used CDC violent death data to examine the relationship between altitude and mental illness. The elevation at which people live, he found, is a strong predictor of their mental health status.

Renshaw discovered research supporting his theory. Doctors from Case Western University, it turned out, were crunching numbers based on a similar hunch about altitude and suicide. In a 2010 study published in High Altitude Medicine and Biology, the Case Western group analyzed suicide rates across 2,584 counties in 16 states and found that suicides start increasing between 2,000 and 3,000 feet in all U.S. regions. The U.S. isn't a special case — analysis of suicide rates in other countries, including South Korea and Austria, bore similar results.

Psychology research has also made a connection between mental health and elevation. In a 2005 study, the Naval Health Research Center measured mood changes in Marines who left seaside San Diego for 30 days of strenuous training in the Northern California mountains. Before training, the Marines completed a self-evaluation of their levels of anxiety, dejection, fatigue and bewilderment, among other mood symptoms. They completed the same evaluation after training ended, and then again 90 days later. While their physical fitness improved during training, their mental health disintegrated. Before training, the Marines reported more balanced mood levels than average college-aged men. By the time they finished, they described mood symptoms comparable to those of psychiatric patients. Ninety days later, they were just as sad and agitated.


Still, a host of evidence spoke to the other side of the paradox — the positive feelings associated with living in America's "happiest" state. Clinical trial participants who grew up in Utah and moved away, for example, often told Renshaw they returned home to the "call of the mountains." He spoke to researchers in Colorado who reported the same trend: People born and raised in the mountains moved to lower land and found themselves longing for their home state.


As anyone who saw Gravity knows, oxygen density decreases as altitude rises. Oxygen deprivation from high altitude induces a condition called hypobaric hypoxia, which ranges in severity based on how little oxygen is available. Some hypoxic effects are well known — nausea and headaches from altitude sickness, nosebleeds and lower alcohol tolerance, for example. But while physical afflictions associated with hypoxia have gained academic and mainstream attention, scientists have largely ignored its potential impact on mental health.

Renshaw believes that oxygen-poor air tampers with brain chemistry, leading to a drop in serotonin and an uptick in dopamine. Serotonin and dopamine are neurotransmitters, brain chemicals that relay signals between neurons and other cells.


"Nevada and Colorado also have high suicide rates," Gray said, reflecting on theories ventured over the years. "You tell me how Salt Lake City and Las Vegas have the same culture."


Renshaw, too, is confident his findings are beyond the realm of a fluke, but he isn't willing to dismiss other explanations for the suicide-altitude connection, including studies on gun access. Multiple overlapping factors, he says, are likely in play.

Nevertheless, some environmental factors we commonly accept as relevant to our mental welfare seemed absurd less than a generation ago. In the 1980s, for example, experts were skeptical that depression could stem from seasonal shifts in sunlight exposure. But 30 years after seasonal affective disorder got its name, SAD sufferers plant themselves in front of light boxes to combat the winter doldrums without anyone raising any eyebrows.


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