Reno Elaine, Brown Talia L, Betz Marian E, Allen Michael H, Hoffecker Lilian, Reitinger Jeremy, Roach Robert, Honigman Benjamin
1 Department of Emergency Medicine, University of Colorado School of Medicine , Aurora, Colorado.
2 Boulder County Public Health, Colorado School of Public Health , Aurora, Colorado.
High Alt Med Biol. 2018 Jun;19(2):99-108. doi: 10.1089/ham.2016.0131. Epub 2017 Nov 21.
Reno, Elaine, Talia L. Brown, Marian E. Betz, Michael H. Allen, Lilian Hoffecker, Jeremy Reitinger, Robert Roach, and Benjamin Honigman. Suicide and high altitude: an integrative review. High Alt Med Biol 19:99-108, 2018.
Suicide rates are greater at high altitudes, and multiple mechanisms have been suggested for this relationship, including hypoxia, differences in population density, characteristics of suicide victims, and firearms ownership and access. To better understand these potential mechanisms, studies evaluating the associations between high altitude and suicide were examined.
A literature review of published studies on high altitude and suicide was conducted in Medline, Embase, Web of Science, the Cochrane Database of Systematic Reviews, and the Cochrane CENTRAL database. We extracted and analyzed all studies that met the inclusion criteria, excluding foreign language studies and letters. Most of the measurements and results were synthesized using modified Letts' criteria.
Searches using an extensive list of keywords returned 470 articles, but only 6 met the inclusion criteria. The studies' samples ranged in size from 8871 to 596,704, while studies which did not document sample size reported suicide rates. In five of the studies selected, individuals living at high altitudes were at greater risk of suicide. Four studies used aggregated data at a county or state level to analyze variables, such as age, gender, race, socioeconomic factors, and firearms access. All the studies found that high altitude was independently associated with suicide. One study found that many individual characteristics of those who committed suicide were different at high altitudes than low altitude, including a lack of access or barriers to mental healthcare. Depression exacerbated by hypoxia was hypothesized as a possible biologic mechanism in three studies.
These research studies published since 2009 support an association between high altitude and suicide rates at the state or county level, but do not provide sufficient data to estimate the effect of high altitude on an individuals' suicide risk. Although the impact of hypoxia on mood and depression has been hypothesized to be a contributing cause, many other individual factors likely play more important roles.
《自杀与高海拔：综合综述》，作者：里诺、伊莱恩、塔莉亚·L·布朗、玛丽安·E·贝茨、迈克尔·H·艾伦、莉莲·霍费克、杰里米·赖廷格、罗伯特·罗奇和本杰明·霍尼格曼，发表于《高海拔医学与生物学》2018年第19卷，第99 - 108页。
高海拔地区的自杀率更高，针对这种关系已提出多种机制，包括缺氧、人口密度差异、自杀受害者特征以及枪支拥有情况和获取途径。为更好地理解这些潜在机制，对评估高海拔与自杀之间关联的研究进行了审查。
在医学数据库（Medline）、医学与健康数据库（Embase）、科学引文索引数据库（Web of Science）、考克兰系统评价数据库（Cochrane Database of Systematic Reviews）和考克兰对照试验中心注册库（Cochrane CENTRAL database）中对已发表的关于高海拔与自杀的研究进行文献综述。我们提取并分析了所有符合纳入标准的研究，排除了外语研究和信函。大多数测量和结果使用修改后的莱茨标准进行综合。
使用大量关键词搜索返回了470篇文章，但只有6篇符合纳入标准。这些研究的样本量从8871到596,704不等，而未记录样本量的研究报告了自杀率。在所选的5项研究中，生活在高海拔地区的个体自杀风险更高。4项研究使用县或州层面的汇总数据来分析年龄、性别、种族、社会经济因素和枪支获取等变量。所有研究都发现高海拔与自杀独立相关。一项研究发现，自杀者的许多个体特征在高海拔地区与低海拔地区不同，包括缺乏心理保健服务或存在获取障碍。在3项研究中，缺氧加剧的抑郁症被假设为一种可能的生物学机制。
这些自2009年以来发表的研究支持了州或县层面高海拔与自杀率之间的关联，但没有提供足够的数据来估计高海拔对个体自杀风险的影响。尽管缺氧对情绪和抑郁症的影响被假设为一个促成因素，但许多其他个体因素可能起着更重要的作用。
