Research paperSerum lipid levels in depression and suicidality: The Korea National Health and Nutrition Examination Survey (KNHANES) 2014
Introduction
The association between serum lipid concentration and depression and suicidality has been continuously investigated over past decades since it was hypothesized by Engelberg in 1992 (Engelberg, 1992). Lowering serum lipid levels was related to increased mortality that was not related to medical illnesses (Muldoon et al., 1990, Steegmans et al., 1996), and high incidence of suicide and violent deaths were reported in middle-aged men with low serum lipids (Lindberg et al., 1992). Subsequent studies had indicated that low plasma cholesterol level was significantly related to depression in elderly men (Morgan et al., 1993) and men with low cholesterol levels had a higher risk of depression (Steegmans et al., 1996) and suicide risk (Engelberg, 1992, Kunugi et al., 1997).
On the basis of these observations, the relationship between lipid types and depression and suicidality were investigated. Low concentration of high-density lipoprotein cholesterol (HDL-C) was associated with depressive symptoms in men (Maes et al., 1997, Muldoon et al., 1990, Steegmans et al., 1996), and low level of total cholesterol was related to suicidality in depression (Lindberg et al., 1992; Sullivan et al., 1994). Data from the national health and nutrition survey in United States showed that low HDL-C was associated with increased prevalence of suicide attempts in women, but men did not show any significant relationship (Morgan et al., 1993, Zhang et al., 2005). In patients with major depressive disorder, recent suicide attempters had a lower serum triglyceride and a higher HDL-C than healthy controls (Baek et al., 2014, Steegmans et al., 1996) and suicide attempters with mood disorders showed a decreased triglyceride level (da Graça Cantarelli et al., 2015). Recent study examining association between serum cholesterol levels and depressive symptoms in Korean sample found that higher HDL-C levels were associated with increased risk of depression in middle-aged adults (Shin et al., 2016).
Although the number of studies reported significant association between serum lipids concentration and depression or suicidality, other studies did not detect any relationship (Deisenhammer et al., 2004, Tanskanen et al., 2000), even in a community study (McCallum et al., 1994). Furthermore, conflicting results between serum lipid levels and suicidality were also reported; the level of serum cholesterol and triglyceride were not lower in resuscitated suicide attempters (Pompili et al., 2010), and association of low serum cholesterol and suicide attempts lacked replication across countries (de Leon et al., 2011). These discrepancies across studies might be related to the number of sample size and differences in the measurement of depression. Experimental studies assessed depression and suicidality with widely used measurement tools (e.g. Hamilton Depression Rating Scale or Beck Depression Inventory) but had a relatively small sample size (n<100), whereas the epidemiological studies with relatively large sample size (n>1000) lacked a relevant standardized psychiatric measurement.
In the present study, to examine how the depression and suicidality are related to serum lipid levels in large sample, we used the data from 6th Korea National Health and Nutrition Examination Survey (KNHNES VI) which is a national-wide survey conducted from 2013 to 2014 in Korea. KNHNES VI is different from previous surveys in that participants self-administered the Patient Health Questionnaire 9 (PHQ-9) (Kroenke et al., 2001), which briefly measures the depression severity. Thus, KNHNES VI made it possible to quantitatively measure the existence and the degree of depression in relatively large sample.
Section snippets
Study participants
We addressed the data of the KNHNES VI. The KNHNES is a national-wide survey conducted by the Division of Chronic Disease Surveillance, Korea Centers for Disease Control and Prevention since 1998 and the KNHNES VI was surveyed from 2013 to 2015. In this analysis, the data of the second year (KNHNES VI-2, 2014) were included. Since 2007, KNHANES was performed year round and surveyed about 10,000 individuals aged 1 year and over in each year. The second round of the sixth KNHANES targeted the
Demographic properties of the weighted sample
Selected characteristics of the weighted samples are presented in Table 1. As the KNHANES sample was acquired by stratified, clustered and systematic sampling, we also presented both the actual sample size (n) and the effective sample size (neff) in the tables.
Gender-specific adjusted association between serum lipids and depression and suicidality
Table 2 shows the association between serum lipid levels and PHQ-9 total score in men and women. Among men, HDL-C was higher in depression group than in controls and HDL-C was the only significant association among lipid profiles
Discussion
With a validated measure for depression in a national survey, we have examined the association between serum lipids concentration and depression and suicidality in adults. After adjusting covariates, the level of HDL-C was significantly higher in men with depression, and in women, high level of triglyceride was associated with depression. Higher level of triglyceride was an only factor that predicted suicidality age under 65. In the group older than 65, the serum concentration of triglyceride
Acknowledgments
The authors wish to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2014.
References (46)
- et al.
Gender and genotype modulation of the association between lipid levels and depressive symptomatology in community-dwelling elderly (the ESPRIT study)
Biol. Psychiatry
(2010) - et al.
Serum lipids, recent suicide attempt and recent suicide status in patients with major depressive disorder
Prog. Neuro-Psychopharmacol. Biol. Psychiatry
(2014) - et al.
Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders
J. Affect Disord.
(2015) - et al.
Alexithymia, suicide risk and serum lipid levels among adult outpatients with panic disorder
Compr. Psychiatry
(2013) - et al.
No evidence for an association between serum cholesterol and the course of depression and suicidality
Psychiatry Res.
(2004) Low serum cholesterol and suicide
Lancet
(1992)- et al.
Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study
Compr. Psychiatry
(2008) - et al.
Longitudinal associations between serum cholesterol levels and suicidal ideation in an older Korean population
J. Affect Disord.
(2014) - et al.
Low serum cholesterol in suicide attempters
BPS
(1997) - et al.
Framingham risk score and prediction of lifetime risk for coronary heart disease
Am. J. Cardiol.
(2004)
Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9)
J. Affect Disord.
Serum lipid levels and suicidality among male patients with schizoaffective disorder
Prog. Neuro-Psychopharmacol. Biol. Psychiatry
Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population
Gen. Hosp. Psychiatry
Plasma cholesterol and depressive symptoms in older men
Lancet
Serum lipid concentrations in patients with major depressive disorder
BPS
No association between serum cholesterol and death by suicide in patients with schizophrenia, bipolar affective disorder, or major depressive disorder
Behav. Brain Funct.
Associations between serum lipid levels and suicidal ideation among Korean older people
J. Affect Disord.
Total cholesterol and suicidality in depression
BPS
Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National Health and Nutrition Examination Survey
J. Affect Disord.
Suicidal behavior in schizophrenia may be related to low lipid levels
Med. Sci. Monit.
Sampling Design of the 6th KNHANES and Weighting Adjustment of the 5th(2010–2012) KNHANES [WWW Document]
The PHQ-9 as a brief assessment of lifetime major depression
Psychol. Assess.
Elevation of plasma high-density lipoprotein concentration reduces interleukin-1-induced expression of E-selectin in an in vivo model of acute inflammation
Circulation
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