J Psychiatry Neurosci 2016;41(1):56-69
Shunquan Wu, MD*; Yingying Ding, PhD*; Fuquan Wu, MD*; Guoming Xie, PhD; Jun Hou, PhD; Panyong Mao, PhD
Background: We conducted a systematic review and meta-analysis to determine the association between serum lipid levels and suicidality, as evidence from previous studies has been inconsistent.
Methods: We identified relevant studies by searching Medline, Web of Science, EMBASE, and the Cochrane Database of Systematic Reviews (1980 to Dec. 5, 2014). Studies assessing the association between serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) levels and suicidality were included. We used a random-effects model to take into account heterogeneity among studies.
Results: We included 65 studies with a total of 510 392 participants in our analysis. Compared with the nonsuicidal patients, suicidal patients had significantly lower serum TC (weighted mean difference [WMD] −22.35, 95% confidence interval [CI] −27.95 to −16.75), LDL-C (WMD −19.56, 95% CI −26.13 to −12.99) and TG (WMD −23.40, 95% CI −32.38 to −14.42) levels, while compared with the healthy controls, suicidal patients had significantly lower TC (WMD −24.75, 95% CI −27.71 to −21.78), HDL-C (WMD −1.75, 95% CI −3.01 to −0.48) and LDL-C (WMD −3.85, 95% CI −7.45 to −0.26) levels. Furthermore, compared with the highest serum TC level category, a lower serum TC level was associated with a 112% (95% CI 40%–220%) higher risk of suicidality, including a 123% (95% CI 24%–302%) higher risk of suicide attempt and an 85% (95 CI 7%–221%) higher risk of suicide completion. The cut-off values for low and high serum TC level were in compliance with the categories reported in the original studies.
Limitations: A major limitation of our study is the potential heterogeneity in most of the analyses. In addition, the suicidal behaviour was examined using different scales or methods across studies, which may further explain heterogeneity among the studies.
Conclusion: We identified an inverse association between serum lipid levels and suicidality. More mechanistic studies are needed to further explain this association.
*These authors contributed equally to this article.
Submitted Mar. 18, 2015; Revised May 21, 2015; Accepted June 24, 2015; Early-released Oct. 27, 2015
Acknowledgments: The authors thank the researchers in the Research Center for Clinical Medicine of the 302nd Hospital of PLA, who offered generous assistance with this study.
Affiliations: From the Research Center for Clinical Medicine, the 302nd Hospital of PLA, Beijing, China (S. Wu, Xie, Hou, Mao); the Department of Medical Microbiology and Parasitology, Second Military Medical University, Shanghai, China (Ding); and the 309th Hospital of PLA, Beijing, China (F. Wu).
Competing interests: None declared.
Contributors: All authors designed the study. S. Wu, Y. Ding and F. Wu acquired and analyzed the data, which J. Hou and P. Mao also analyzed. S. Wu, Y. Ding and F. Wu wrote the article, which all authors reviewed and approved for publication.
Correspondence to: P. Mao or J. Hou, Research Center for Clinical Medicine, the 302nd Hospital of PLA, No. 100 of West Fourth Ring, Middle Road, Beijing, China, 100039; firstname.lastname@example.org or email@example.com