Next Article in Journal
Differences in Cardiac Etiologies for Ischemic Stroke in Young and Middle-Aged Patients: A Single-Center Experience in Taiwan
Next Article in Special Issue
An Elevated FIB-4 Score Is Associated with an Increased Incidence of Depression among Outpatients in Germany
Previous Article in Journal
Body Composition and Serum Concentration of Thyroid Hormones in Euthyroid Men and Women from General Population
Previous Article in Special Issue
Cognitive Behavioral Therapy of Patients with Somatic Symptoms—Diagnostic and Therapeutic Difficulties
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 11
Issue 8
10.3390/jcm11082119
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Relationships between Abnormal Serum Lipid Levels, Depression, and Suicidal Ideation According to Sex

by
Kounseok Lee
1,
Sunhae Kim
1 and
Jung Ki Jo
2,*
1
Department of Psychiatry, Hanyang University Medical Center, Seoul 04763, Korea
2
Department of Urology, Hanyang University Medical Center, Seoul 04763, Korea
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(8), 2119; https://doi.org/10.3390/jcm11082119
Submission received: 15 March 2022 / Revised: 7 April 2022 / Accepted: 8 April 2022 / Published: 11 April 2022
(This article belongs to the Special Issue Depressive Disorders—Common Pathomechanisms of Somatic and Psychiatric Comorbidity)
Browse Figure
Versions Notes

Abstract

:
(1) Background: Serum lipid levels affect not only nutritional status but also emotional state. The purpose of this study was to examine the effects of various socio-demographic characteristics, abnormal cholesterol levels, and BMI indicators on depressive symptoms and suicidal ideation in the Korean population. (2) Methods: A total of 23,692 people were surveyed using data from the Korea National Health and Nutrition Examination Survey (KNHNES) 2014, 2016, and 2018. Data from 11,653 patients were analyzed. Age, sex, chronic disease, smoking, alcohol consumption, total cholesterol (HDL, triglycerides), BMI, depression, and suicidal ideation were measured. (3) Results: According to sex, low HDL, high triglycerides, and suicidal ideation were significant, along with low education level, smoking, binge drinking, and high BMI. High triglyceride level was shown to significantly increase the risk of depression in males (OR = 1.535, 95% CI = 1.098–2.147). Factors affecting suicidal ideation in males were age, binge drinking, and depression, while blood lipid factors were not significant. (4) Conclusions: Of the types of serum lipid factors affecting depression and suicidal ideation, high triglycerides were found to be a risk factor for depression in men. Serum lipids can be used as biomarkers to reflect depressive symptoms in men depending on cholesterol level.

Graphical Abstract

1. Introduction

Serum lipids reflect an individual’s constitution and nutritional status and are significantly affected by emotional status [1]. In particular, cholesterol is a key member of the central nervous system (CNS) and is essential for the stability of cell membranes and proper nerve transmission [2]. Cholesterol is also related to the mechanism of action of antidepressants and mood stabilizers and plays an important role as a secondary messenger in the brain system involved in mood disorders [3,4].
According to the stress–diathesis model, suicide is associated with environmental stress; in particular, environmental stress in people with vulnerable constitutional predispositions such as genetic factors, family history, neurobiological characteristics, developmental factors, and personality characteristics. Suicide also is affected by substance abuse, mental illness, and/or physical illness [5]. Among the neurobiological factors related to suicide and genes, neurotransmitters and hormones can induce suicide-related mental disorders or increase susceptibility to suicide independent of mental disorders [6]. Cholesterol levels can be increased due to occupational stress or acute mental stress, and depending can affect the brain system and constitutional factors such as depression and suicide risk factors.
Interest in cholesterol and suicide has increased as a result of cholesterol treatment to lower the risk of cardiovascular disease and the associated increasing non-illness-related mortality [7,8,9]. In addition, since most causes of death in follow-up studies of low cholesterol levels and non-disease-related deaths were suicide [10,11,12], studies on the relationship between low cholesterol levels [13,14,15] and suicide attempts have continued [16,17].
Based on these studies, the relationship between suicide and depression according to cholesterol type and the level was elucidated. Low total cholesterol is associated with suicide [18], and patients with major depression have lower total cholesterol than those without depression [19,20]. Furthermore, there was a correlation between serum cholesterol and suicide attempts in major depressive disorder patients (md = −19.9 mg/dL, p = 0.004), so both factors are major in serum cholesterol [21]. In addition, patients with depression have lower concentrations of high-density lipoprotein cholesterol (HDL) and high ratios of total cholesterol/high-density lipoprotein cholesterol (TC/HDL) and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL/HDL) [12,22,23]. In previous studies, severe depressive symptoms occurred as a result of decreased cholesterol levels by treatment with pravastatin in hypercholesterolemic patients [24], associated with lowering of serum TC and LDL cholesterol. In males, it was found to be associated with depressive symptoms and low levels of HDL cholesterol [8,9,12].
As such, many studies have found that cholesterol is associated with suicide rates and depression [10,25] and that people with very low blood cholesterol are at a higher risk of suicide and a higher actual suicide rate [11,15,26]. These results indicate that blood cholesterol reflects the cholesterol content of the brain, and a decrease in lipids in the neuronal cell membrane causes 5-hydroxytryptamine (5-HT) receptor dysfunction and decreased neural synapse formation [26]. In the frontal lobe of suicide attempters, lipid metabolism-related fatty acid desaturase (FADS1), leptin receptor (LEPR), phosphoinositide-3-kinase class 2 alpha (PIK3C2A), and stearoyl-CoA desaturase (SCD) are downregulated [27].
Although the neurobiological principles of the effects of serum lipids and cholesterol on suicide and depression were studied, cholesterol levels are inconsistent and not integrated. Contrary to studies showing a relationship between low cholesterol levels and depressive symptoms, some studies have indicated higher serum cholesterol in the suicidal ideation group [28], no relationship between low serum cholesterol and depressive symptoms [24], or an inverse correlation [29]. Moreover, serum cholesterol levels in some depressed patients were reported to be within the normal range [30]. Although cholesterol levels for suicide risk have been shown to differ based on sex (202 mg/dL for men and 205 mg/dL for women) [31], or in other studies of the correlation between serum cholesterol and suicide attempt in MDD (major depressive disorder), latent variables excluding men did not play any role in the correlation [21], so additional research is needed.
Although studies on the relationships between cholesterol and depression, suicide, and aggressive behavior are progressing, consistent conclusions cannot be drawn, and the relationship between cholesterol and sex is lacking. Therefore, this study examined whether cholesterol type is related to suicide and depressive symptoms according to sex using the results of the Korea National Health and Nutrition Examination Survey (KNHNES), a large-scale survey conducted by the Korea Centers for Disease Control and Prevention.

2. Materials and Methods

2.1. Participants

The National Health and Nutrition Survey is a nationwide survey conducted based on Article 16 of the National Health Promotion Act enacted in 1995 in Korea. National health level, health behavior, and food and nutritional intake are representative and reliable statistics. The basics of health policy, such as setting and evaluating goals of the comprehensive national health promotion plan and developing health promotion programs, are designed using these data. In this study, data from the Korea National Health and Nutrition Examination Survey (KNHNES) from 2014, 2016, and 2018 contain items on depression. From a total of 23,692 people surveyed, 7064 who did not provide an answer on depression were excluded. Among the remaining people, 2914 did not respond to suicidal items and were excluded. Finally, data from a total of 11,653 participants were analyzed. This study was approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention (2018-01-03-P-A).

2.2. Measurements of General Variables

Measured variables were age, sex, chronic disease, smoking, alcohol consumption, total cholesterol (HDL, triglycerides), BMI, depression, and suicidal ideation. Chronic diseases comprised heart attack, osteoarthritis, diabetes, thyroid disease, hypertension, dyslipidemia, cerebral infarction, and pulmonary tuberculosis. Income was divided into quartiles. A low level of education was defined as no education to graduation from middle school. Patients who currently smoked were defined as smokers, and those who consumed alcohol more than twice a week were defined as heavy drinkers. Suicidal ideation was noted in the presence of suicidal thoughts or plans in the past year. The BMI was calculated using measured weight and height and was classified into three groups according to the World Health Organization standards: less than 18.5 m2/kg, underweight; 18.5 to 24 m2/kg, normal weight; and over 25 m2/kg, overweight.

2.2.1. Measurement of Lipid Levels

Blood samples from individual participants were collected for the determination of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides. Interlaboratory comparisons using the same samples were performed according to the guidelines of CLSI EP9-A2-IR (Clinical and Laboratory Standards Institute, PA, USA). Whole blood samples (5%) were re-evaluated to determine the reproducibility of test results. Since 2009, KNHNES has measured HDL-C levels according to the Centers for Disease Control and Prevention (CDC) Lipid Standardization Program [32]. Blood sample levels were defined as abnormal when total cholesterol was 200 or more, triglycerides were 150 or more, and HDL was 60 or less.

2.2.2. Measurement of Depression

The Patient Health Questionnaire (PHQ) is a self-report questionnaire designed to help detect and diagnose mental disorders that are common in primary clinical settings [33]. The questionnaire consists of nine items rated based on frequency over the last two weeks. In this study, the cut-off point was set to 10, and any score higher than that was defined as depression.

2.3. Statistical Analysis

For general characteristics of the subjects, frequency and cross-analyses (χ2-test) were performed to confirm the differences in variables according to sex. Logistic regression analysis was performed to determine the effects of abnormal clinical characteristics and lipid indicators on suicidal ideation or depression, and the odds ratio (OR) and 95% confidence interval (95% CI) were calculated. In order to assess the multicollinearity between variables, the tolerance limit and variance inflation factor (VIF) was calculated. All statistical analyses were performed using IBM SPSS statistics (version 24.0, IBM Corporation, New York, NY, USA), and the statistical significance level was set to 0.05.

3. Results

3.1. Experimental Results

General and Clinical Characteristics

Of the total 11,653 participants, 5049 were male (43.3%), and the average age was 51.07 years (SD = 16.77). Average total cholesterol was 192.12 mg/dL (SD = 37.65), and that of HDL cholesterol was 51.15 mg/dL (SD = 12.81, Table 1). As for the clinical characteristics according to sex, low HDL, high triglycerides, and suicidal ideation were significant, along with low education level, smoking, drinking, and BMI. Regarding abnormal serum lipid levels, a larger percentage of males than females had low HDL-C (87.4%) and high triglycerides (39.0%), indicating a significant sex difference (p < 0.01, Table 2).

3.2. Serum Cholesterol and Depression

Regression analysis confirmed that the VIF value was less than 10 in all models, and there was no multicollinearity. Of the clinical factors affecting depression, low-income level and low education level were related regardless of sex, as was smoking (Table 3). The largest clinical factor for depression in females was smoking (OR = 4.091, 95% CI = 3.059–5.472). High triglyceride levels had a significant effect on depression only in males (OR = 1.535, 95% CI = 1.098–2.147, Table 3).

3.3. Serum Cholesterol and Suicidal Ideation

As for risk factors affecting suicidal ideation, clinical factors were more significant than abnormal serum lipid factors (Table 4). In terms of clinical factors, age, in particular, had an effect on male suicidal ideation, and only in males did the risk increase as the age group increased. The highest level of suicidal ideation was shown in the elderly group over 64 years of age (OR = 3.430, 95% CI = 1.123–3.144, Table 4). Low-income level significantly increased suicidal ideation in both males and females (male OR = 1.879, 95% CI = 1.123–3.144; female OR = 1.624, 95% CI = 1.074–2.455), and low education level was significant only in females. Drinking significantly increased suicidal ideation in females (OR = 1.669, 95% CI = 1.16–2.519). As previously known, depression was the biggest risk factor for suicidal ideation in both males and females. Among all clinical factors and serum lipid factors, depression in males significantly on suicidal ideation (male OR = 10.794, 95% CI = 6.053–19.248; female OR = 7.526, 95% CI = 4.904–11.549, Table 4). No serum lipid factors (total cholesterol, HDL-C, TG) were significant. In both suicidal ideation and depression, neither BMI nor chronic disease was a significant clinical factor (Table 3 and Table 4).

4. Discussion

In this study, abnormal serum lipid factors affecting suicide and depression were analyzed along with clinical factors. Unlike previous studies, cholesterol, HDL cholesterol, and TG were analyzed as serum lipid factors affecting depression and suicidal thoughts. High TG significantly increased in the depression phase only in males (OR = 1.535, 95% CI = 1.098–2.147). As in previous studies, the strongest predictors of suicidal ideation were depression and male age. As for demographic factors, smoking was significantly associated with depression, and drinking was significantly associated with suicidal thoughts in both males and females.
Data from the National Health and Nutrition Survey in the United States found that low HDL-C was associated with an increased prevalence of suicide attempts in females, but no significant association was found in males [19,34]. Among patients with major depressive disorder, patients with recent suicide attempts had lower serum TG levels and higher HDL-C levels than healthy controls [9,35], and suicide attempters with mood disorders had lower TG levels than healthy controls [36]. However, a recent study examining the relationship between serum cholesterol levels and depressive symptoms in a Korean sample found that the higher was the HDL-C level in middle-aged adults [37], the higher was the risk of depression, and the lower blood cholesterol level in the elderly aged 60 years or older [38]. There was also a study that found no association between suicidal ideation and suicide attempts. The cause of these different results might be the difference in diet between Western and Korean societies. Moreover, in the case of triglycerides, one study shows no certain pattern of TG during stress [39].
The associations between high TG levels and depression and suicide, which were significant in this study, can be explained by a psycho-neuroimmunological hypothesis where a T-cell-mediated immune reaction is activated in depressed patients [40]. As a result, the production of cytokines, including interleukin-2 (IL-2), is increased, which lowers the concentration of serum cholesterol, especially HDL, and increases serum TG to inhibit the secretion of melatonin from the pineal gland. This induces an increase in impulsivity and suicide. Therefore, the significance of high TG in depression supports the epidemiological hypothesis related to serum cholesterol concentration. In particular, serum TG was significantly linked to depressive symptoms, indicating that they affect psychological characteristics [28,41,42,43].
Previous studies showed a correlation between low HDL levels and depressive symptoms, but a Korean study showed no such correlation [44]. Although HDL is a protective factor for coronary artery disease, it is thought to show more complex relationships with depression and suicide. Although many studies showed an association between serum lipid levels and depression and suicide, most compared serum TC levels and comparative studies between serum lipids are lacking. In addition, conflicting results were reported on the relationships between serum lipid levels and suicide; serum cholesterol and TG levels were not lower in survivors of suicide attempts [45], and the association between low serum cholesterol and suicide attempts was not confirmed by international replication studies [46].
This study has strengths as epidemiological research uses a relatively large sample size to reduce the overall discrepancy between cholesterol, suicide, and depression. We found that TG is the most significant factor affecting depression in males and plan to investigate whether the mechanism of change in serum lipid concentration due to stress can mediate depression. In addition, international replication studies of serum cholesterol and suicide and depression were verified, and the effects of serum cholesterol on psychiatric factors were supported. Moreover, of studies analyzing serum cholesterol, depression, and suicide, ours has the strength of analyzing serum lipid factors (TC, HDL cholesterol, TG) and depression and suicidal ideation separately. This study identified an overall relationship between depression and serum lipid factors on suicide by integrating clinical factors. Though serum TG level is closely related to BMI [47], this study showed no association between BMI and either suicidal ideation or depression. Relationships between clinical factors should be verified.
Despite the strengths of this study, its limitations are as follows. First, causal relationships between serum lipid level and depression and suicidal ideation could not be identified due to the cross-sectional nature of the study. Second, suicide is a measure of suicidal ideation, and more severe suicidal tendencies such as suicide attempts and suicidal behaviors were not analyzed. Third, for TG less than 200 mg/dL, the LDL cholesterol level was not disclosed in the raw data, preventing analysis of the effect on LDL cholesterol. Fourth, medical conditions thought to be related to depression or drug history that could affect serum lipid concentrations were not taken into account.
The relationships between serum lipids and depression and suicide remain controversial. Meanwhile, omega-3 fatty acids are thought to be helpful in the prevention and treatment of various mental disorders due to their antidepressant effects [48]; research on the relationships between lipids and depression and suicide has received renewed attention [49]. The results of this study partially explain why omega-3 fatty acids, such as ∂-linolenic acid, have an effect on depression.

5. Conclusions

Serum lipid levels can be used as biomarkers to reflect the risk of depression and suicide. This study found that high TG levels among TC, HDL cholesterol, and TG significantly increased the risk of depression in male subjects.

Author Contributions

Conceptualization, K.L. and J.K.J.; methodology, K.L.; validation, K.L. and S.K.; formal analysis, K.L.; investigation, resources, K.L. and S.K.; data curation, K.L.; writing—original draft preparation, K.L. and S.K.; writing—review and editing, K.L., S.K., and J.K.J.; visualization, J.K.J.; supervision, J.K.J.; funding acquisition, J.K.J. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by research funds from Hanyang University (HY-2019) and by the Technology Innovation Program, also referred to as the Industrial Strategic Technology Development Program (20016364), funded by the Ministry of Trade, Industry, and Energy (MOTIE, Korea).

Institutional Review Board Statement

This study was approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention (2018-01-03-P-A).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical restrictions.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Bogdonoff, M.; Nichols, C.R. Psychogenic effects on lipid metabolism. In Handbook of Physiology: Adipose Tissue; American Physiological Society: Washington, DC, USA, 1965. [Google Scholar]
  2. Ghaemi, S.N.; Shields, G.S.; Hegarty, J.D.; Goodwin, F.K. Cholesterol levels in mood disorders: High or low? Bipolar Disord. 2000, 2, 60–64. [Google Scholar] [CrossRef] [PubMed]
  3. Gambi, F.; De Berardis, D.; Campanella, D.; Carano, A.; Sepede, G.; Salini, G.; Scorrano, B.; Spinella, S.; Conti, C.; La Rovere, R. A retrospective evaluation of the inflammatory marker C-reactive protein (CRP), cholesterol and high-density lipoproteins in patients with major depression: Preliminary findings. Eur. J. Inflamm. 2005, 3, 127–134. [Google Scholar] [CrossRef]
  4. De Berardis, D.; Conti, C.; Campanella, D.; Carano, A.; Scali, M.; Valchera, A.; Serroni, N.; Pizzorno, A.; D’Albenzio, A.; Fulcheri, M. Evaluation of C-reactive protein and total serum cholesterol in adult patients with bipolar disorder. Int. J. Immunopathol. Pharmacol. 2008, 21, 319–324. [Google Scholar] [CrossRef] [PubMed]
  5. Mann, J.J.; Waternaux, C.; Haas, G.L.; Malone, K.M. Toward a clinical model of suicidal behavior in psychiatric patients. Am. J. Psychiatry 1999, 156, 181–189. [Google Scholar] [PubMed]
  6. Mann, J.J. A current perspective of suicide and attempted suicide. Ann. Intern. Med. 2002, 136, 302–311. [Google Scholar] [CrossRef]
  7. Frick, M.H.; Elo, O.; Haapa, K.; Heinonen, O.P.; Heinsalmi, P.; Helo, P.; Huttunen, J.K.; Kaitaniemi, P.; Koskinen, P.; Manninen, V. Helsinki Heart Study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N. Engl. J. Med. 1987, 317, 1237–1245. [Google Scholar] [CrossRef]
  8. Muldoon, M.F.; Manuck, S.B.; Matthews, K.A. Lowering cholesterol concentrations and mortality: A quantitative review of primary prevention trials. Br. Med. J. 1990, 301, 309–314. [Google Scholar] [CrossRef] [Green Version]
  9. Steegmans, P.; Fekkes, D.; Hoes, A.W.; Bak, A.; van der Does, E.; Grobbee, D.E. Low serum cholesterol concentration and serotonin metabolism in men. BMJ Br. Med. J. 1996, 312, 221. [Google Scholar]
  10. Lindberg, G.; Råstam, L.; Gullberg, B.; Eklund, G.A. Low serum cholesterol concentration and short term mortality from injuries in men and women. Br. Med. J. 1992, 305, 277–279. [Google Scholar] [CrossRef] [Green Version]
  11. Muldoon, M.F.; Rossouw, J.E.; Manuck, S.B.; Glueck, C.J.; Kaplan, J.R.; Kaufmann, P.G. Low or lowered cholesterol and risk of death from suicide and trauma. Metabolism 1993, 42, 45–56. [Google Scholar]
  12. Maes, M.; Smith, R.; Christophe, A.; Vandoolaeghe, E.; Gastel, A.V.; Neels, H.; Demedts, P.; Wauters, A.; Meltzer, H. Lower serum high-density lipoprotein cholesterol (HDL-C) in major depression and in depressed men with serious suicidal attempts: Relationship with immune-inflammatory markers. Acta Psychiatr. Scand. 1997, 95, 212–221. [Google Scholar] [CrossRef] [PubMed]
  13. Golier, J.A.; Marzuk, P.M.; Leon, A.C.; Weiner, C.; Tardiff, K. Low serum cholesterol level and attempted suicide. Am. J. Psychiatry 1995, 152, 419–423. [Google Scholar]
  14. Zureik, M.; Courbon, D.; Ducimetiere, P. Serum cholesterol concentration and death from suicide in men: Paris prospective study I. BMJ 1996, 313, 649–651. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  15. Kunugi, H.; Takei, N.; Aoki, H.; Nanko, S. Low serum cholesterol in suicide attempters. Biol. Psychiatry 1997, 41, 196–200. [Google Scholar] [CrossRef]
  16. De Berardis, D.; Conti, C.; Serroni, N.; Moschetta, F.; Carano, A.; Salerno, R.; Cavuto, M.; Farina, B.; Alessandrini, M.; Janiri, L. The role of cholesterol levels in mood disorders and suicide. J. Biol. Regul. Homeost. Agents 2009, 23, 133. [Google Scholar]
  17. Zhang, J. Epidemiological link between low cholesterol and suicidality: A puzzle never finished. Nutr. Neurosci. 2011, 14, 268–287. [Google Scholar] [CrossRef]
  18. Wu, S.; Ding, Y.; Wu, F.; Xie, G.; Hou, J.; Mao, P. Serum lipid levels and suicidality: A meta-analysis of 65 epidemiological studies. J. Psychiatry Neurosci. 2016, 41, 56–69. [Google Scholar] [CrossRef] [Green Version]
  19. Morgan, R.E.; Palinkas, L.A.; Barrett-Connor, E.L.; Wingard, D.L. Plasma cholesterol and depressive symptoms in older men. Lancet 1993, 341, 75–79. [Google Scholar] [CrossRef]
  20. Olusi, S.O.; Fido, A.A. Serum lipid concentrations in patients with major depressive disorder. Biol. Psychiatry 1996, 40, 1128–1131. [Google Scholar]
  21. Bartoli, F.; Crocamo, C.; Dakanalis, A.; Riboldi, I.; Miotto, A.; Brosio, E.; Clerici, M.; Carrà, G. Association between total serum cholesterol and suicide attempts in subjects with major depressive disorder: Exploring the role of clinical and biochemical confounding factors. Clin. Biochem. 2017, 50, 274–278. [Google Scholar] [CrossRef]
  22. Cadeddu, G.; Fioravanti, P.; Antonicelli, R.; Gasparrini, P.; Gaetti, R. Associazione tra livelli di colesterolo e depressione nell’anziano. Minerva Med. 1995, 86, 251–256. [Google Scholar] [PubMed]
  23. Shibata, H.; Kumagai, S.; Watanabe, S.; Suzuki, T. Relationship of serum cholesterols and vitamin E to depressive status in the elderly. J. Epidemiol. 1999, 9, 261–267. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Lechleitner, M.; Hoppichler, F.; Konwalinka, G.; Patsch, J.; Braunsteiner, H. Depressive symptoms in hypercholesterolaemic patients treated with pravastatin. Lancet 1992, 340, 910. [Google Scholar] [CrossRef]
  25. Sullivan, P.F.; Joyce, P.R.; Bulik, C.M.; Mulder, R.T.; Oakley-Browne, M. Total cholesterol and suicidality in depression. Biol. Psychiatry 1994, 36, 472–477. [Google Scholar] [CrossRef]
  26. Engelberg, H. Low serum cholesterol and suicide. Lancet 1992, 339, 727–729. [Google Scholar] [CrossRef]
  27. Lalovic, A.; Klempan, T.; Sequeira, A.; Luheshi, G.; Turecki, G. Altered expression of lipid metabolism and immune response genes in the frontal cortex of suicide completers. J. Affect. Disord. 2010, 120, 24–31. [Google Scholar] [CrossRef]
  28. Strandberg, T.; Valvanne, J.; Tilvis, R.; Smith, G.; Shipley, M.; Payne, N.; Redgrave, P.; Dealberto, M.; Ducimetiere, P.; Mainard, F. Serum lipids and depression. Lancet 1993, 341, 433–435. [Google Scholar] [CrossRef]
  29. Lindberg, G.; Larsson, G.; Setterlind, S.; Råstam, L. Serum lipids and mood in working men and women in Sweden. J. Epidemiol. Community Health 1994, 48, 360–363. [Google Scholar] [CrossRef] [Green Version]
  30. Cummings, P.; Psaty, B.M. The association between cholesterol and death from injury. Ann. Intern. Med. 1994, 120, 848–855. [Google Scholar] [CrossRef]
  31. Olié, E.; Picot, M.C.; Guillaume, S.; Abbar, M.; Courtet, P. Measurement of total serum cholesterol in the evaluation of suicidal risk. J. Affect. Disord. 2011, 133, 234–238. [Google Scholar] [CrossRef]
  32. Myers, G.L.; Cooper, G.R.; Winn, C.L.; Smith, S.J. The centers for disease control-national heart, lung and blood institute lipid standardization program: An approach to accurate and precise lipid measurements. Clin. Lab. Med. 1989, 9, 105–136. [Google Scholar] [CrossRef]
  33. Spitzer, R.L.; Kroenke, K.; Williams, J.B. 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 1999, 282, 1737–1744. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Zhang, B.; Tomura, H.; Kuwabara, A.; Kimura, T.; Miura, S.-i.; Noda, K.; Okajima, F.; Saku, K. Correlation of high density lipoprotein (HDL)-associated sphingosine 1-phosphate with serum levels of HDL-cholesterol and apolipoproteins. Atherosclerosis 2005, 178, 199–205. [Google Scholar] [CrossRef]
  35. Baek, J.H.; Kang, E.-S.; Fava, M.; Mischoulon, D.; Nierenberg, A.A.; Yu, B.-H.; Lee, D.; Jeon, H.J. Serum lipids, recent suicide attempt and recent suicide status in patients with major depressive disorder. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2014, 51, 113–118. [Google Scholar] [CrossRef]
  36. Da Graça Cantarelli, M.; Nardin, P.; Buffon, A.; Eidt, M.C.; Godoy, L.A.; Fernandes, B.S.; Gonçalves, C.-A. Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders. J. Affect. Disord. 2015, 172, 403–409. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  37. Shin, H.-Y.; Kang, G.; Kang, H.-J.; Kim, S.-W.; Shin, I.-S.; Yoon, J.-S.; Kim, J.-M. Associations between serum lipid levels and suicidal ideation among Korean older people. J. Affect. Disord. 2016, 189, 192–198. [Google Scholar] [CrossRef] [PubMed]
  38. Kim, J.; Shin, D.; Yoon, S.; Baek, J.; Jeon, D.; Moon, J. Risk factors for suicide and depression in the elderly over sixty years of age. J. Korean Soc. Biol. Ther. Psychiatry 2010, 16, 1–23. [Google Scholar]
  39. Dimsdale, J.E.; Herd, J.A. Variability of plasma lipids in response to emotional arousal. Psychosom. Med. 1982, 44, 413–430. [Google Scholar] [CrossRef]
  40. Penttinen, J. Hypothesis: Low serum cholesterol, suicide, and lnterleukin-2. Am. J. Epidemiol. 1995, 141, 716–718. [Google Scholar] [CrossRef]
  41. Tieger, M.; Kunkel, R.; Tracy, T.; Speirs, J.; Streicher, P.; Illig, E.; Vandegrift, J.; Glueck, C. Amelioration of depression by treatment of severe hypertriglyceridemia. In Clinical Research; Slack Inc.: Thorofare, NJ, USA, 1991; p. A464. [Google Scholar]
  42. Fowkes, F.; Leng, G.; Donnan, P.; Housley, E.; Deary, I.; Riemersma, R. Serum cholesterol, triglycerides, and aggression in the general population. Lancet 1992, 340, 995–998. [Google Scholar] [CrossRef]
  43. Glueck, C.J.; Tieger, M.; Kunkel, R.; Tracy, T.; Speirs, J.; Streicher, P.; Illig, E. Improvement in symptoms of depression and in an index of life stressors accompany treatment of severe hypertriglyceridemia. Biol. Psychiatry 1993, 34, 240–252. [Google Scholar] [CrossRef]
  44. Hong, H.J.; Min, S.K.; Koh, K.B.; Kim, J.H. Relationship between Serum Lipids and Psychiatric Symptoms. Korean J. Psychopharmacol. 1999, 10, 120–129. [Google Scholar]
  45. McCallum, J.; Simons, J.; Simons, L.; Friedlander, Y. Low serum cholesterol is not associated with depression in the elderly: Data from an Australian community study. Aust. N. Z. J. Med. 1994, 24, 561–564. [Google Scholar] [CrossRef] [PubMed]
  46. Jose de Leon, M.; Mallory, P.; Maw, R.L.; Susce, M.T.; Perez-Rodriguez, M.M.M.; Baca-Garcia, E. Lack of replication of the association of low serum cholesterol and attempted suicide in another country raises more questions. Ann. Clin. Psychiatry 2011, 23, 163–170. [Google Scholar]
  47. Shamai, L.; Lurix, E.; Shen, M.; Novaro, G.M.; Szomstein, S.; Rosenthal, R.; Hernandez, A.V.; Asher, C.R. Association of body mass index and lipid profiles: Evaluation of a broad spectrum of body mass index patients including the morbidly obese. Obes. Surg. 2011, 21, 42–47. [Google Scholar] [CrossRef]
  48. Lin, P.-Y.; Su, K.-P. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J. Clin. Psychiatry 2007, 68, 11738. [Google Scholar] [CrossRef]
  49. Golomb, B.A. Cholesterol and violence: Is there a connection? Ann. Intern. Med. 1998, 128, 478–487. [Google Scholar] [CrossRef]
Table
Table 1. General characteristics of the participants (n = 11,653).
Table 1. General characteristics of the participants (n = 11,653).
VariableValue
age (years)51.07 ± 16.77
sex (male)5049 (43.3%)
chronic disease2256 (19.4%)
smoker2136 (18.3%)
drinker3851 (33.3%)
TC192.12 ± 37.65
HDL51.15 ± 12.81
TG137.10 ± 115.19
BMI23.98 ± 3.55
PHQ-9 total2.52 ± 3.66
Values are presented as mean ± SD or n (%). TC: total cholesterol; HDL: the high-density lipoprotein cholesterol; TG: triglyceride; BMI: body mass index; PHQ-9: Patient Health Questionnaire-9.
Table
Table 2. Clinical characteristics according to sex.
Table 2. Clinical characteristics according to sex.
Male (n = 5030)Female (n = 6573)χ2p
n%n%
age (years)19–44194038.4%244537.0%3.7410.15
44–64183536.3%251138.0%
≥64127425.2%164825.0%
income (low)124024.6%160724.3%0.0790.79
education (low)107121.2%220433.4%209.45<0.01
chronic diseases102920.4%122718.6%5.9420.02
Smoker176134.9%3755.7%1629.71<0.01
Drinker200539.7%184628.0%178.79<0.01
TC (high)189138.3%254740.1%3.5510.06
HDL (low)431187.4%440869.4%512.932<0.01
TG (high)192439.0%138221.7%399.215<0.01
BMI<18.51142.3%3134.8%178.774<0.01
18.5–25284756.6%427565.0%
≥25206941.1%198530.2%
suicidal ideation (yes)771.5%1131.7%54.211<0.01
depression (yes)486496.3%615693.2%0.6170.43
Data shown are n (participant numbers) and percentage. Calculated by cross-analysis (χ2-test). TC: total cholesterol; HDL: the high-density lipoprotein cholesterol; TG: triglyceride; BMI: body mass index.
Table
Table 3. Association between serum cholesterol and depression according to sex.
Table 3. Association between serum cholesterol and depression according to sex.
MaleFemale
age (years)19–44referencereference
44–640.696 (0.467–1.038)0.768 (0.579–1.020)
≥641.168 (0.722–1.890)1.051 (0.735–1.505)
income (low)3.271 (2.398–4.462)1.862 (1.509–2.299)
education (low)1.695 (1.122–2.559)1.906 (1.426–2.546)
chronic diseases0.760 (0.502–1.151)0.928 (0.710–1.213)
smoker1.850 (1.336–2.562)4.091 (3.059–5.472)
drinker1.187 (0.864–1.629)1.078 (0.865–1.344)
TC (high)0.813 (0.581–1.138)1.010 (0.814–1.252)
HDL (low)0.812 (0.505–1.306)0.903 (0.710–1.149)
TG (high)1.535 (1.098–2.147)1.161 (0.907–1.485)
BMI<18.5referencereference
18.5–250.727 (0.322–1.641)0.691 (0.439–1.086)
≥250.692 (0.300–1.597)0.822 (0.511–1.325)
Calculated by adjusted odds ratios (ORs) and 95% confidence intervals (CIs). TC: total cholesterol; HDL: the high-density lipoprotein cholesterol; TG: triglyceride; BMI: body mass index.
Table
Table 4. Association between serum cholesterol and suicidal ideation according to sex.
Table 4. Association between serum cholesterol and suicidal ideation according to sex.
MaleFemale
age (years)19–44referencereference
44–642.121 (1.047–4.296)1.030 (0.570–1.860)
≥643.430 (1.537–7.658)0.683 (0.333–1.404)
income (low)1.879 (1.123–3.144)1.624 (1.074–2.455)
education (low)1.204 (0.673–2.155)3.013 (1.738–5.222)
chronic diseases1.661 (0.976–2.828)0.766 (0.453–1.297)
smoker1.514 (0.889–2.578)1.709 (0.926–3.153)
drinker1.325 (0.806–2.180)1.669 (1.106–2.519)
TC (high)1.205 (0.710–2.045)1.221 (0.805–1.852)
HDL (low)0.805 (0.394–1.648)1.303 (0.792–2.145)
TG (high)0.656 (0.378–1.137)0.779 (0.478–1.272)
BMI<18.5(-)(-)
18.5–251.153 (0.259–5.123)1.987 (0.473–8.341)
≥251.359 (0.297–6.215)1.813 (0.418–7.854)
depression10.794 (6.053–19.248)7.526 (4.904–11.549)
Calculated by adjusted odds ratios (ORs) and 95% confidence intervals (CIs). TC: total cholesterol; HDL: the high-density lipoprotein cholesterol; TG: triglyceride; BMI: body mass index.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Lee, K.; Kim, S.; Jo, J.K. The Relationships between Abnormal Serum Lipid Levels, Depression, and Suicidal Ideation According to Sex. J. Clin. Med. 2022, 11, 2119. https://doi.org/10.3390/jcm11082119

AMA Style

Lee K, Kim S, Jo JK. The Relationships between Abnormal Serum Lipid Levels, Depression, and Suicidal Ideation According to Sex. Journal of Clinical Medicine. 2022; 11(8):2119. https://doi.org/10.3390/jcm11082119

Chicago/Turabian Style

Lee, Kounseok, Sunhae Kim, and Jung Ki Jo. 2022. "The Relationships between Abnormal Serum Lipid Levels, Depression, and Suicidal Ideation According to Sex" Journal of Clinical Medicine 11, no. 8: 2119. https://doi.org/10.3390/jcm11082119

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop