Elsevier

Journal of Affective Disorders

Volume 213, 15 April 2017, Pages 51-58
Journal of Affective Disorders

Research paper
Serum lipid levels in depression and suicidality: The Korea National Health and Nutrition Examination Survey (KNHANES) 2014

https://doi.org/10.1016/j.jad.2017.02.002Get rights and content

Highlights

  • We investigated the association between serum lipid levels and depression with suicidality in Korean population.

  • Patient Health Questionnaire 9 was used to validly measure the degree of depression.

  • High level of triglycerides and HDL-C were associated with depression.

  • High level of triglycerides was related to depression and suicidality in middle-aged adults.

Abstract

Background

The level of serum lipids has been reported to be associated with depression and suicidality, but the exact relationship between these factors remains controversial. The aim of this study was to investigate the association between lipid levels and depression with suicidality in large sample.

Methods

We examined the association between serum lipid levels and the existence of mild depression measured using Patient Health Questionnaire 9 (PHQ-9) in a national sample of Korean. The data of 2055 men and 2894 women who participated in the 6th Korea National Health and Nutrition Examination Survey (KNHNES VI) were used. The serum concentration of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, and total cholesterol were dichotomized and complex samples logistic regression was employed in the analysis.

Results

There was a significant association between high level of HDL-C (≥40 mg/dl) and depression in adult men, and between high level of triglyceride (≥150 mg/dl) and depression in adult women. In middle-aged adults 45–64 year), increased level of depression and suicidality was related to high level of triglyceride, respectively. (depression, OR=2.20 (95% CI 1.26–3.85); suicidality, OR=3.66 (95% CI 1.41–9.51). Furthermore, we found that the increased number of abnormal lipids level was significantly associated with the increased prevalence of depression in women (OR =1.34, 95% CI =1.12–1.60) and in middle-aged adults (OR=1.43, 95% CI =1.12–1.82).

Limitations

As this study had a cross-sectional design, it was hard to investigate causation between lipid levels and depression, and the assessment of suicidality needs more validation.

Conclusion

Our findings support a significant association between the high level of HDL-C, triglyceride and depression in large sample data. Triglyceride was highly associated with suicidality in younger and middle-aged adults, but not in elderly adults. Further assessment could delineate relationship between serum lipid levels and depression with suicidality in other ethnic groups.

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.

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