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Lack of replication of the association of low serum cholesterol and attempted suicide in another country raises more questions

Jose de Leon, MD

Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA

Paula Mallory, RD

Dietetic Service, Eastern State Hospital, Lexington, KY, USA

Lorraine Maw, MA

Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA

Margaret T. Susce, RN, MLT

Mental Health Research Center, Eastern State Hospital, Lexington, KY, USA

M. Mercedes Perez-Rodriguez, MD

Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA

Enrique Baca-Garcia, MD

Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonoma University of Madrid, Madrid, Spain, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA

BACKGROUND: In 2 Spanish case-control studies, low cholesterol levels in males were consistently associated with suicide attempts.

METHODS: This US study tried to replicate the association between low cholesterol levels and suicide attempts, using a case-control design to study all patients admitted to Eastern State Hospital in Lexington, Kentucky, during a 1-year period. Psychiatric patients who had currently attempted suicide were studied as cases, and psychiatric patients who had not currently attempted suicide served as controls. A fasting serum total cholesterol <160 mg/dL was considered a possible risk factor for suicide. Logistic regression provided an adjusted estimate of the univariate odds ratios (ORs) for confounding factors.

RESULTS: There were 193 current suicide attempters (cases) and 1091 non–current suicide attempters (controls). In the total sample logistic regression model, low cholesterol levels were significantly associated with lower risk of current suicide attempt (OR, 0.60; confidence interval (CI), 0.39 to 0.92) after adjusting for confounding variables. After sex stratification, low cholesterol levels were significant only among men (OR, 0.47; CI, 0.26 to 0.86). This US study did not replicate our prior Spanish findings; to the contrary, low cholesterol levels were not associated with increased suicide risk but with a decreased risk in US men.

CONCLUSIONS: It is possible cholesterol abnormalities and low body mass index may be markers of suicide risk, particularly in some male patients.

KEYWORDS: alcohol-related disorders, body mass index, cholesterol, depression, schizophrenia, suicide


CORRESPONDENCE: Jose de Leon, MD Mental Health Research Center, Eastern State Hospital, 627 West Fourth Street, Lexington, KY 40508 USA, E-MAIL:
Annals of Clinical Psychiatry ©2011 Quadrant HealthCom Inc.

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