SALT LAKE CITY — Utah has a high number of men who die by suicide, and researchers have long drawn conclusions to the fact that high altitude may play a part.

Something that is often ignored, however, is that women are affected by the same brain chemistry issues caused by altitude, perhaps even more so, said University of Utah research assistant and professor of psychiatry Shami Kanekar. She said that her animal tests show that females are actually more vulnerable to behavioral changes caused by a lack of oxygen at higher altitudes.

"People are happy living here, they wouldn't live here if they were not," Kanekar said. But she believes the high rates of depression and anxiety, especially among women in Utah, shows something is off.

The difference between being at sea level and being at altitude can actually change your brain chemistry. – Shami Kanekar, University of Utah research assistant and professor of psychiatry

"The difference between being at sea level and being at altitude can actually change your brain chemistry," Kanekar said. Having less oxygen in the brain leads to a condition called hypoxia, which can make symptoms of depression and anxiety worse.

Women in general, Kanekar said, have lower levels of serotonin in their brains than do men, meaning the impact of living at altitude might be more detrimental for women.

"Low brain serotonin is linked to more depression, more anxiety, treatment resistance and other biological risks for suicide, including more impulsivity and aggression," she said.

Another factor, Kanekar's research shows, is that common treatments for depression and anxiety — selective seratonin reuptake inhibitors, or SSRIs — don't work as well in people at high altitudes. Utah is the third-highest state in the country, with an average elevation of 6,100 feet, though most of the population is at around 4,500 feet.

Hypoxia, however, isn't only caused by living at high altitudes.

The condition is apparent in people with chronic obstructive pulmonary disease, asthma, chronic bronchitis and atherosclerosis that can be caused by cigarette smoking. Sleep apnea also has ties to greater levels of depression for the same reasons.

A report published by the Institute for Women's Policy Research and YWCA Utah indicates that more women in Utah died by suicide in 2018 than in 2016.

Utah ranks fifth in female suicide rates among eight states in the Mountain West, which includes Arizona, Colorado, Idaho, New Mexico, Montana, Nevada, Utah and Wyoming, according to the report.

There's mention, too, in recent publications that the gender gap between men and women who die by suicide is closing, not because fewer men are committing suicide, but because more women are.

"Policy changes must be holistic in their approach, taking into account the unique backgrounds, circumstances and obstacles facing women and families in Utah," the report by the Institute for Women's Policy Research states.

And that is exactly what Kanekar is hoping to help effort. Her research aims to find better medications or treatment methods to help with the higher levels of depression and anxiety among people in Utah. It might still be years away, but her animal modeling is proving impactful.

"It just doesn't seem like this is a problem that is going to go away by itself," she said. "And it's getting worse."

Researchers are only just beginning to learn how women respond to drugs for depression and anxiety, as many of the studies for decades only looked at men and eliminated women for the variable issues caused by their monthly cycles. Kanekar's study, conducted within the Renshaw Group on campus, is one of the newer ones that focuses primarily on females.

It's about time, she said, adding that depression and anxiety are "much more common in women."

It just doesn't seem like this is a problem that is going to go away by itself. – Shami Kanekar, University of Utah research assistant and professor of psychiatry

"Women need to be aware that it might be a biological thing and not isolated to them," Kanekar said. "If you understand that it is biological and it is made worse at altitude, women can see if that is part of the issue."

Aside from gender, an average of 628 Utahns died by suicide each year from 2015 to 2017 — the fifth highest age-adjusted suicide rates in the U.S. during this time period, according to data from the Utah Department of Health.

In 2017, suicide was the leading cause of death for Utahns ages 10 to 17 and ages 18 to 24. It is the second leading cause of death for ages 25 to 44 and the fourth-leading cause of death for ages 45-64.

Overall, health department data show that suicide is the eighth-leading cause of death for all Utahns. Utah's suicide rate has been consistently higher than the national rate.

"While sociocultural and economic risk factors clearly play a large role in women's suicide rates, our studies suggest that the biological impact of living at altitude may also be considered an important risk factor, and one that is modifiable," Kanekar said.

She said vacationing at sea level a week or so at a time might make someone feel better because it is a vacation, or actual time spent away from regular duties, but there might be a lot more to it. People who visit Utah for long periods of time and experience altitude-related hypoxia have reported to Kanekar and her research team that the SSRIs they're used to taking don't seem to work as well.

It is worth testing on an individual basis, spending time at sea level, she said.

Kanekar's research will continue based on funding she can secure through competitive grants. Her goal is to ultimately help people in Utah to feel better, and to turn Utah's upward trending suicide rates around with better treatments available.

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If someone you know is struggling with thoughts of suicide, resources are available. In Utah, the SafeUT app provides a direct connection to a crisis line. Other resources include:

National Hotline: 1-800-273-8255 (TALK)

University Neuropsychiatric Institute Crisis line: 801-587-3000

National Suicide Prevention Lifeline: www.suicidepreventionlifeline.org/