Abstract
To the Editor:
I was very interested to read the report on anxiety disorders at high altitude. 1 While auditing medical data from a United Kingdom (UK) expedition company a few years ago, I was surprised by the notable prevalence of serious incidents occurring on expeditions attributable to mental health–related issues, such as depression, deliberate self harm, and acute psychosis. Between 2002 and 2004, 9938 individuals aged 14–18 years took part in expeditions lasting between 1 and 4 weeks and managed by this company. The number of serious incidents (defined as incidents requiring activation of an emergency position indicator radio beacon [EPIRB] or that were severe or life threatening) were incredibly low (78 incidents, 0.78%) with repatriation rates averaging 0.37%. This compares well with 3 previous studies citing repatriations rates of 0.34%, 0.24%, and 0.34%, respectively.2–3 On closer examination of the 78 serious incidents, there was a steady increase in the proportion attributable to mental health issues: 3 of 28 (10.71%) in 2002, 3 of 19 (15.79%) in 2003, and 7 of 31 (22.5%) in 2004.
Review of pretrip medical history forms revealed a relatively small percentage of declared past mental health history in the study population (0.95%, 1.5%, and 0.8% in 2002, 2003, and 2004, respectively), making this incidence of serious mental health incidents interesting but perhaps not too surprising. A report by the British Medical Association 4 estimates that 1 in 10 children aged 1–15 years in the UK suffer mental health problems, with between 1% and 3% of adolescents suffering from depression at any one point. An Australian study 5 also highlights increasing first-time presentations of children and adolescents with mental health disorders to emergency departments. There is also a suggestion that increasing numbers of children in the United States with mental health concerns are attending summer camps. 6 Although these studies focus on a slightly lower age group, the majority of mental health disorders first present in the 16–30-year-old population 7 —one of the most common expedition age groups.
Although the causes behind psychological stress on expedition and traveling are well documented, 8 –13 a literature search exploring expedition mental health morbidity in this population revealed little.
The exact origins behind many mental health incidents on expedition will perhaps never be discovered. However, the author would suggest (perhaps controversially) that the prevalence of people on expedition with known but undisclosed mental health problems is higher than pre-expedition questionnaires would imply. This idea is supported by anecdotal evidence gained over numerous years working as an expedition medic, wilderness medical instructor, and advisor to expedition companies. The reasons for patients not disclosing past medical history in the planning stage of an expedition are multifaceted. This author would welcome further, more rigorous studies into pre-expedition medical and mental health screening, in particular focusing on the 16–30-year-old age group, which forms a large proportion of the charity and commercial expedition market.