The Association Between Dyslipidemia and Lethality of Suicide Attempts: A Case-Control Study

Abstract

Evidence supports the existence of an association between dyslipidemia, psychiatric disorders, and suicide risk due to the effects of altered lipid profiles on serotoninergic neuron membranes. The aim of this study was to investigate the differences in c-reactive protein (CRP), thyroid functioning, total cholesterol, high lipoprotein density cholesterol (HDL-c), low-lipoprotein density cholesterol (LDL-c), and triglycerides (TG) serum levels in low lethality (LLSA) vs. high lethality suicide attempters (HLSA) within 24 h from the suicide attempt and inpatients who never attempted suicide (NAS). After attempting suicide, subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the section of Psychiatry from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics, serum lipids profile, CRP, and thyroid functioning were collected. The sample consisted of 133 individuals with a HLSA, 299 subjects with LLSA, and 200 patients NAS. HLSA subjects were more likely to be males and diagnosed as having a bipolar disorder. Furthermore, HLSA subgroup showed significantly lower total cholesterol and LDL-c levels and higher CRP serum levels compared to LLSA and control group, respectively. LLSA subgroup showed higher HDL-c levels compared to HLSA subgroup (no differences between HLSA and control group were observed). Additionally, the control group reported higher triglycerides levels compared to patients admitted to psychiatric ward for a suicide attempt. Only male gender, having a diagnosis of bipolar disorder, lower total cholesterol, and higher CRP serum levels predicted HLSA. Investigating the relation between dyslipidemia and the severity of suicide attempts may contribute to reveal the complex determinants underlying at-risk behaviors such as suicide, thus playing a relevant role in the possible prevention of this disabling phenomenon.

Are Lipids Possible Markers of Suicide Behaviors?

“…Aguglia and co-workers [ 44 ] conducted a study with a sample of 632 attempts. They demonstrated that those who attempted high-lethality suicide had significantly lower total cholesterol.…”

“…Aguglia et al [ 44 ] showed that high lethality suicide attempters had considerably lower LDL compared to low lethality attempters and the control group [ 44 ].…”

“…Aguglia et al [ 44 ] compared the low lethality group (LLSA) including 299 subjects with a group of high lethality suicide attempters (HLSA) including 133 subjects. The LLSA group exhibited higher HDL-c levels compared to HLSA group.…”

“…Many researchers [ 6 , 18 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] have attempted to identify biological markers that could be linked to suicidal behavior and potentially be used as additional preventive factors. Some of them tried to find the link between cytokines, such as TNF-α, IL-1β, and IL-6 and suicide [ 59 , 60 ]; others measured plasma phospholipid levels of arachidonic acid (AA%), docosahexaenoic acid (DHA%) and eicosapentaenoic acid (EPA%) [ 61 ].…”

Lipid and Glycemic Profiles in Patients with Bipolar Disorder: Cholesterol Levels Are Reduced in Mania

“…Other authors have argued that lipid profiles, in particular, are linked to suicide attempts and their lethality in patients with severe mental disorders, including BD. However, evidence is still contrasting [18][19][20][21].…”