Culture, Medicine, and Psychiatry

, Volume 40, Issue 1, pp 1–11 | Cite as

Depression and Altitude: Cross-Sectional Community-Based Study Among Elderly High-Altitude Residents in the Himalayan Regions

  • Motonao IshikawaEmail author
  • Gaku Yamanaka
  • Naomune Yamamoto
  • Takashi Nakaoka
  • Kiyohito Okumiya
  • Kozo Matsubayashi
  • Kuniaki Otsuka
  • Hiroshi Sakura
Original Paper


Suicide rates are higher at high altitudes, and some hypothesize that hypoxia is the cause. There may be a significant correlation between rates of depression and altitude, but little data exist outside the United States. The purpose of the present study is to conduct a survey of depression among the elderly highlanders in Asia. We enrolled 114 persons aged 60 years or older (mean, 69.2 ± 6.7 years; women, 58.8 %) in Domkhar (altitude, 3800 m), Ladakh, India and 173 ethnic Tibetans (mean, 66.5 ± 6.1 years; women, 61.3 %) in Yushu (altitude, 3700 m), Qinghai Province, China. The two-item Patient Health Questionnaire (PHQ-2) and the geriatric depression scale were administered. A psychiatrist interviewed the subjects who had a positive score on the PHQ-2. The results of the interview with the residents conducted by the specialist showed that two cases (1.8 %) from Domkhar and four (2.3 %) from Qinghai had depression. Despite the high altitude, the probability of depression was low in elderly highlander in Ladakh and Qinghai. Our finding seems to indicate that cultural factors such as religious outlook and social/family relationship inhibit the development of depression.


Depression Hypoxia High altitude Ladakhi Tibetan 



We appreciate all those elderly highlanders in Ladakh and Qinghai who participated in the community-based geriatric examinations. In addition, we would like to express our cordial gratitude to Hongxin Wang, Qingxiang Dai, Airong Yang, Haisheng Qiao, Zhanquan Li, Huining Xu, Haiying Tong, and Ri-Li Ge from Qinghai University Affiliated Hospital and Qinghai Academy Animal and Veterinary Sciences, the staff of the People’s Hospital of Yushu county, and Tsering Norboo, and the staff of Ladakh Institute of Prevention who kindly supported us. This study was mainly supported by a Grant-in-Aid of the Research Institute for Humanity and Nature (3-4 FR): Human Life, Aging, and Disease in High-Altitude Environments: Physio-medical, Ecological and Cultural Adaptation in “Highland Civilizations.” (Leader: Kiyohito Okumiya). This study was funded by a Grant-in-Aid for Scientific Research (C) No. 22590668.

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. APA (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Association, Washington DC.Google Scholar
  2. Arancibia A, Paulos C, Chávez J, Ritschel WA (2003) Pharmacokinetics of lithium in healthy volunteers after exposure to high altitude. Int J Clin Pharmacol Ther 41: 200-206.CrossRefGoogle Scholar
  3. Arregui A, Hollingsworth Z, Penney JB, Young AB (1994) Autoradiographic evidence for increased dopamine uptake sites in striatum of hypoxic mice. Neurosci let 167: 195-197.CrossRefGoogle Scholar
  4. Baldwin RC, Chiu E, Katona C, Graham N (2002) Guidelines on depression in older people-Practicing the evidence. Martin Dunitz, London.CrossRefGoogle Scholar
  5. Beekman AT, Copeland JR, Prince MJ (1999) Review of community prevalence of depression in later life. Br J Psychiatry 174: 307-311.CrossRefGoogle Scholar
  6. Bland RC, Orm H, Newman SC (1988) Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand Suppl 77: 24-32.CrossRefGoogle Scholar
  7. Blazer D, William CD (1980) Epidemiology of dysphoria and depression in an elderly population. Am J Psychiatry 137: 439-444.CrossRefGoogle Scholar
  8. Blazer DG, Landerman LR, Hays JC, Simonsick EM, Saunders WB(1998) Symptoms of depression among community-dwelling elderly African-American and White older adults. Psychol Med 28: 1311-1320.CrossRefGoogle Scholar
  9. Brenner B, Cheng D, Clark S, Camargo CA (2011) Positive Association between Altitude and Suicide in 2584 U.S. Counties. High Alt Med Biol 12: 31-35.CrossRefGoogle Scholar
  10. Cheng D. Higher suicide death in rocky mountain states and a correlation to altitude (2010) Wilderness Environ Med 21: 177-8.CrossRefGoogle Scholar
  11. Copeland JR, Dewey ME, Wood N, Searle R, Davidson IA, McWilliam C (1987) Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatry 150: 815-823.CrossRefGoogle Scholar
  12. DelMastro K, Hellem T, Kim N, Kondo D, Sung YH, Renshaw PF (2011) Incidence of major depressive episode correlates with elevation of substate region of residence. J Affect Disord 129: 376-9.CrossRefGoogle Scholar
  13. Dunlop BW, Nemeroff CB (2007) The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry 64: 327-337.CrossRefGoogle Scholar
  14. Forsell Y, Winblad B (1999) Incidence of major depression in a very elderly population. Int J Geriatr Psychiatry 14: 368-372.CrossRefGoogle Scholar
  15. Gerard AB, McElroy MK, Taylor MJ, Grant I, Powell FL, Holverda S, Sentse N, West JB (2000) Six percent oxygen enrichment of room air at 5,000 m altitude improves neuropsychological function. High Alt Med Biol 1: 51-61.CrossRefGoogle Scholar
  16. Haws CA, Gray DD, Yurgelun-Todd DA, Moskos M, Meyer LJ, Renshaw PF (2009) The possible effect of altitude on regional variation in suicide rates. Med Hypotheses 73: 587-590.CrossRefGoogle Scholar
  17. Hibbeln JR (1998): Fish consumption and major depression. Lancet 351:1213.CrossRefGoogle Scholar
  18. Ishikawa M, Yamamoto N, Yamanaka G, Suwa K, Nakajima S, Hozo R, Norboo T, Okumiya K, Matsubayashi K, Otsuka K (2013) Disaster-related psychiatric disorders among survivors of flooding in Ladakh, India. Int J Soc Psychiatry 59: 467-473.CrossRefGoogle Scholar
  19. Jürgens G, Christensen HR, Brøsen K, Sonne J, Loft S, Olsen NV (2002) Acute hypoxia and cytochrome P450-mediated hepatic drug metabolism in humans. Clin Pharmacol Ther 71: 214-220.CrossRefGoogle Scholar
  20. Li C, Friedman B, Conwell Y, Fiscella K (2007) Validity of the Patient Health Questionnaire 2 (PHQ-2) in Identifying Major Depression in Older People. J Am Geriatr Soc 55: 596-602.CrossRefGoogle Scholar
  21. Livingston G, Hawkins A, Graham N, Blizard B, Mann A (1990) The Gospel Oak Study: prevalence rates of dementia, depression, and activity limitation among elderly residents in inner London. Psychol Med 20: 137-146.CrossRefGoogle Scholar
  22. Lucca G, Comim CM, Valcassori SS, Reus GZ, Vuolo F, Gavioli EC, Dal-Pizzol F, Quevedo J (2009) Increased oxidative stress in submitochongrial particles into the brain of rats submitted to the chronic mild stress paradigm. J Psychiatr Res 43: 846-849.CrossRefGoogle Scholar
  23. Maldonado MD, Reiter RJ, Pérez-San-Gregorio MA (2009) Melatonin as a potential therapeutic agent in psychiatric illness. Hum Psychopharmacol 24: 391-400.CrossRefGoogle Scholar
  24. Nicolas M, Thullier-Lestienne F, Bouquet C, Gardette B, Gortan C, Richalet JP, Abraini JH (2000) A study of mood changes and personality during a 31-day period of chronic hypoxia in a hypobaric chamber (Everest-Comex 97). Psychol Rep 86: 119-126.CrossRefGoogle Scholar
  25. Østbye T, Kristjansson B, Hill G, Newman SC, Brouwer RN, McDowell I (2005) Prevalence and predictors of depression in elderly Canadians: Canadian Study of Health and Aging. Chronic Dis Can 26: 93-99.Google Scholar
  26. Penninx BW, Deeg DJ, van Eijk JT, Guralnik JM (2000) Changes in depression and physical decline in older adults; A longitudinal perspective. J Afect Disord 61: 1-12.CrossRefGoogle Scholar
  27. Samuelsson G, McCamish-Svensson C, Hagberg B, Sundström G, Dehlin O (2005) Incidence and risk factors for depression and anxiety disorders: results from a 34-year longitudinal Swedish cohort study. Aging Ment Heath 9: 571-574.CrossRefGoogle Scholar
  28. Schory TJ, Piecznski N, Nair S, el-Mallakh RS (2003) Barometric pressure, emergency psychiatric visits, and violent acts. Can J Psychiatry 48: 624-7.Google Scholar
  29. Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In: Brink TL (ed) Clinical Gerontology: A Guide to Assessment and Intervention. The Haworth Press Inc, New York, pp165-173.Google Scholar
  30. Simon GE, Goldberg DP, Von Korff M, Ustün TB (2002) Understanding cross-national differences in depression prevalence. Psychol Med 32:585-594.CrossRefGoogle Scholar
  31. Smit F, Ederveen A, Cuijpers P, Deeg D, Beekman A (2006) Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Arch Gen Psychiatry 63: 290-296.CrossRefGoogle Scholar
  32. Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA 282: 1737-1744.CrossRefGoogle Scholar
  33. Tsai YF, Yeh SH, Tsai HH (2005) Prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan. Int J Geriatr Psychiatry 20:1097-1102.CrossRefGoogle Scholar
  34. Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpolevv L, Hoffing M, Della Penna RD, Noël PH, Lin EH, Areán PA, Hegel MT, Tang L, Belin TR, Oishi S, Langston C (2002) Collaborative care management of late-life depression in the primary care setting : a randomized controlled trial. JAMA 288: 2836-2845.CrossRefGoogle Scholar
  35. Watson L, Pignone M (2003) Screening accuracy for late-life depression in primary care: systematic review. J Fam Pract 52: 956-964.Google Scholar
  36. Weissman MM, Leaf PJ, Tischler GL, Blazer DG, Karno M, Bruce ML, Florio LP (1988) Affective disorders in five United States communities. Psychol Med 18: 141-153.CrossRefGoogle Scholar
  37. Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lépine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen H, Yeh EK (1996) Cross-national epidemiology of major depression and bipolar disorder. JAMA 276:293-299.CrossRefGoogle Scholar
  38. Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 12: 439-445.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Motonao Ishikawa
    • 1
    Email author
  • Gaku Yamanaka
    • 1
  • Naomune Yamamoto
    • 2
  • Takashi Nakaoka
    • 1
  • Kiyohito Okumiya
    • 3
  • Kozo Matsubayashi
    • 3
  • Kuniaki Otsuka
    • 1
  • Hiroshi Sakura
    • 1
  1. 1.Department of Medicine, Medical Center EastTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Department of Internal MedicineAino HospitalOsakaJapan
  3. 3.Center for Southeast Asian StudiesKyoto UniversityKyotoJapan

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