Higher-than-national rates of death by suicide have been a consistent trend in Colorado, along with other mountain states like Montana and Wyoming. Developing research suggests that higher depression and suicide rates in mountain towns may be a result of their higher altitudes.

According to a 2018 Utah University study, low atmospheric pressure at altitude can create lower blood oxygen levels, causing a decrease in the brain’s serotonin levels (a mood-boosting hormone). The study also found that lower oxygen levels impair energy flow in the brain. Unfortunately, lower energy flows, oxygen levels, and serotonin concentrations are all associated with depression in individuals.

Another study, conducted in 2014 by the Harvard Review of Psychiatry, suggests a similar link between altitude and depression levels. According to this study, which analyzed population-based data, sociodemographic and environmental factors like high altitude can increase suicide rates, especially at altitudes higher than 2,000 and 3,000 feet.

Dr. Brent Micheal Kios, a contributor to the 2014 study, specifically studied a condition known as Chronic Hypobaric Hypoxia: low blood oxygen related to low atmospheric pressure. According to Kios, Chronic conditions of Hypoxia can alter the metabolism of the neurotransmitter serotonin and/or through its effects on the brain. Kios suggest that this alteration can increase the risk of depression in individuals living at high altitudes, especially those who have a history of depression.

Although there are ongoing studies linking depression to altitude, the answer remains elusive. Mary Horn is a Psychiatric Nurse Practitioner at Mind Springs Health in Pitkin County. Horn mentions that the correlation between altitude and serotonin levels is complex, and pending further research.

“Much of the information regarding serotonin and altitude is still in research settings. Altitude is associated with ski towns, resort environment substance abuse, loneliness, seasonal workforce, adrenaline junkies, etc., which are also shown to increase risks of depression and suicide,” Horn said.

Horn references that other factors associated with ski towns may also be contributing to high depression and suicide rates. Aside from the science of altitude and serotonin, ski towns are generally accompanied by overpriced living standards, creating poverty-induced stress on residents.

Cam Daniels, Pitkin County sheriff’s deputy and former addiction counselor, touches on how other factors like over-priced housing in ski towns can contribute to depression and suicide.

“It is really hard to afford living here [Pitkin County], and so where most people in their late 30s to mid-40s might have already bought a home and are halfway through paying it off, people here are just still breaking even,” Daniels said.

Aside from housing prices, Daniels also mentions that the culture in ski towns may cause prolonged substance abuse in adults. Prolonged substance abuse can cause changes in the brain, which can lead to mental health issues including paranoia, depression, anxiety, aggression, hallucinations, and other problems.

“I think that one thing that also can’t be ignored is there’s a culture here in ski towns where it kind of becomes not out of the norm to continue to party really hard probably later than most adults do. I think what happens when you have long onset substance use is that it starts to pile up,” Daniels said.

Regardless of contributing factors such as housing, ski-town culture, and substance abuse, elevation may still be a likely factor in mountain town depression and suicide rates. Colorado has one of the highest suicide rates in the country, with Pitkin County’s average elevation sitting at 9,216 feet. Pitkin County is approximately 6,000 feet above the 2014 study’s danger zone of 3,000 feet.

“Growing evidence, based on large data sets, suggests that altitude of residence is specifically associated with increased risk of suicide and depression,” concludes the University of Utah researchers in the Harvard Review of Psychiatry.