Psychological correlates of acute mountain sickness: a prospective study

Extreme high-altitude environments pose significant challenges to both physiological adaptation and mental health. This study aimed to characterize the dynamic relationship between Acute Mountain Sickness (AMS) and psychological health, identifying symptom-level drivers of psychological distress in mountaineers. Fifteen mountaineers participating in three expeditions were assessed one week before ascent, upon arrival at high altitude, immediately post-climb, and one week after. The expeditions covered a maximum altitude range of 5276 m to 6621 m (Erfeng of Siguniang Mountain: 5276 m, 4 days; Mount Wukuchu: 5526 m, 6 days; Mount Geladandong: 6621 m, 9 days). Linear Mixed Models (LMM) were employed to isolate the effects of AMS status from environmental confounders, and Generalized Estimating Equations (GEE) were used to identify specific symptom-level predictors of psychological outcomes. LMM analysis revealed that AMS-positive status significantly impaired overall mental health (p = 0.009). Specifically, AMS led to significant elevations in somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, and hostility (all p < 0.05). Notably, AMS specifically exacerbated mental fatigue (p = 0.022) but had no significant impact on physical fatigue or general affect. GEE scanning further identified symptom-specific drivers: headache was a pervasive predictor of somatization and interpersonal sensitivity, while dizziness emerged as the most robust predictor of physical fatigue (p = 0.002). AMS primarily drives specific pathological psychological distress and mental exhaustion rather than generalized mood fluctuations. These findings underscore the necessity of symptom-specific psychological monitoring during high-altitude adaptation.