Association between suicidal behaviour and impaired glucose metabolism in depressive disorders

BMC Psychiatry

Mauno Vanhala¹  Pekka Mäntyselkä⁵  Esa Leppänen³  Hannu Kautiainen⁴  Hannu Koponen² 

[1] Department of Health Sciences, University of Eastern Finland, Kuopio, Finland;Old Age Psychiatry, University of Helsinki, and Helsinki University Hospital, Helsinki, FIN-00014, Finland;Public Utility Laboratory KESLAB, Central Finland Hospital District, Jyväskylä, Finland;Primary Health Care Unit, Central Hospital of Central Finland, Jyväskylä, Finland;Primary Health Care Unit, Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland

关键词: Triglyceride;    Suicide attempt;    Suicidality;    Ideation;    Suicidal behaviour;    Insulin resistance;    Glucose;    Depression;    Cholesterol;   

Others  :  1221352
DOI  :  10.1186/s12888-015-0567-x

 received in 2015-04-08, accepted in 2015-07-16,  发布年份 2015

【 摘 要 】

Background

Disturbances in lipid metabolism have been linked to suicidal behaviour, but little is known about the association between suicide risk and abnormal glucose metabolism in depression. Hyperglycaemia and hyperinsulinaemia may increase the risk of depression and also the risk for suicide, we therefore studied associations between suicidal behaviour and disturbances in glucose metabolism in depressive patients who had been referred to depression nurse case managers.

Methods

Patients aged 35 years and older (N = 448, mean age 51 years) who were experiencing a new depressive episode, who were referred to depression nurse case managers in 2008–2009 and who scored ≥10 on the Beck Depression Inventory were enrolled in this study. The study was conducted in municipalities within the Central Finland Hospital District (catchment area of 274 000 inhabitants) as part of the Finnish Depression and Metabolic Syndrome in Adults study. The patients’ psychiatric diagnoses and suicidal behaviour were confirmed by the Mini-International Neuropsychiatric Interview. Blood samples, for glucose and lipid determinations, were drawn from participants after 12 h of fasting, which was followed by a 2-hour oral glucose tolerance test (OGTT) when blood was drawn at 0 and 2 h. Insulin resistance was measured by the Quantitative Insulin Sensitivity Check Index (QUICKI) method.

Results

Suicidal ideation (49 %) and previous suicide attempts (16 %) were common in patients with major depressive disorder or dysthymia. Patients with depression and suicidal behaviour had higher blood glucose concentrations at baseline and at 2 hours in the OGTT. Glucose levels associated positively with the prevalence of suicidal behaviour, and the linearity was significant at baseline (p for linearity: 0.012, adjusted for age and sex) and for 2-hour OGTT glucose (p for linearity: 0.004, adjusted for age and sex). QUICKI levels associated with suicidal behavior (p for linearity across tertiles of QUICKI: 0.026). Total and LDL cholesterol and triglyceride levels were also higher in those patients with suicidal behaviour. Multivariate analysis revealed that blood glucose levels, BDI scores and antidepressive medications associated with suicidal behaviour.

Conclusion

Insulin resistance and disturbances in glucose and lipid metabolism may be more common in middle-aged depressive patients with suicidal behaviour.

【 授权许可】

   
2015 Koponen et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Ayuso-Mateos JL, Vasquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G: ODIN Group: Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 2001, 179:308-316.
• [2]Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:8-19.
• [3]Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003, 289:3095-3105.
• [4]Isometsä E, Henriksson M, Marttunen M, Heikkinen M, Aro H, Kuoppasalmi K, Lönnqvist J: Mental disorders in young and middle aged men who commit suicide. BMJ 1995, 310:1366-1367.
• [5]Bertolote JM, Fleischman A, De Leo D, Wasserman D: Suicide and mental disorders: do we know enough? Br J Psychiatry 2003, 183:382-383.
• [6]Van Reedt Dortland AKB, Vreeburg SA, Giltay EJ, Licht CMM, Vogelzangs N, van Veen T, de Geus EJ, Penninx BW, Zitman FG: The impact of stress systems and lifestyle on dyslipidemia and obesity in anxiety and depression. Psychoneuroendocrinology 2013, 38:209-18.
• [7]Ceretta LB, Reus GZ, Abelaira HM, Jordana LK, Schwalm MT, Hoepers NJ, Tomazzi CD, Gulbis KG, Ceretta RA, Quevedo J: Increased prevalence of mood disorders and suicidal ideation in type 2 diabetic patients. Acta Diabetol 2012, 49(suppl 1):S227-S234.
• [8]Han SJ, Kim HJ, Choi YJ, Lee KW, Kim DJ: Increased risk of suicidal ideation in Korean adults with both diabetes and depression. Diabetes Res Clin Pract 2013, 101:14-17.
• [9]Bot M, Pouwer F, de Jonge P, Tack JC, Geelhoed-Duijvestin PHLM, Snoek FJ: Differential associations between depressive symptoms and glycemic control in outpatients with diabetes. Diabet Med 2013, 30:e115-e122.
• [10]Troisi A: Low cholesterol is a risk factor for attentional impulsivity in patients with mood symptoms. Psychiatry Res 2011, 188:83-7.
• [11]Stahl SM: Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. 3rd edition. Cambridge University Press, Cambridge, UK; 2008.
• [12]Muldoon MF, Mackey RH, Korytkowski MT, Flory JD, Pollock BG, Manuck SB: The metabolic syndrome is associated with reduced central serotonergic responsivity in healthy community volunteers. J Clin Endocrinol Metabolism 2006, 91:718-721.
• [13]Dunn AJ, Swiergiel AH, de Beaurepaire R: Cytokines as mediators of depression: What can we learn from animal studies? Neurosci Biobehav Rev 2005, 29:891-909.
• [14]Christmas DM, Potocar JP, Davies SJC: A biological pathway linking inflammation and depression: activation of indoleamine 2,3-dioxygenase. Neuropsychiatr Dis Treat 2011, 7:431-439.
• [15]Maes M: Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression. Progr Neuro-Psychopharmacol Biol Psychiatry 2011, 35:664-675.
• [16]Maes M, Ringel K, Kubera M, Berk M, Rybakowski J: Increased autoimmune activity against 5-HT: A key component of depression that is associated with inflammation and activation of cell-mediated immunity, and with severity and staging of depression. J Affect Disord 2012, 136:386-392.
• [17]Banerjee M, Saxena M: Interleukin-1 (IL-1) family of cytokines: Role in Type 2 diabetes. Clinica Chimica Acta 2012, 413:1163-1170.
• [18]Silic A, Karlovic D, Serretti A: Increased inflammation and lower platelet 5-HT in depression with metabolic syndrome. J Affect Disord 2012, 141:72-78.
• [19]Valkanova V, Ebmeier KP, Allan CL: CRP, IL-6 and depression: Asystematic review and meta-analysis of longitudinal studies. J Affect Disord 2013, 150:736-744.
• [20]Serafini G, Pompili M, Seretti ME, Stefani H, Palermo M, Coryell W, Girardi P: The role of imflammatory cytokines in suicidal behavior: A systematic review. European Neuropsychopharmacol 2013, 23:1672-86.
• [21]Kan C, Silv N, Golden SH, Rajala U, Timonen M, Stahl D, Ismail K: A systematic review and meta-analysis of the association between depression and insulin resistance. Diabetes Care 2013, 36:480-489.
• [22]Akbaraly TN, Kumari M, Head J, Ritchie K, Ancelin M-L, Tabak AG, Brunner E, Chaudieu I, Marmot MG, Ferrie JE, Shipley MJ, Kivimäki M: Glycemia, insulin resistance, insulin secretion, and risk of depressive symptoms in middle age. Diabetes Care 2013, 36:928-934.
• [23]Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961, 4:561-71.
• [24]Sheehan DV, Lecrubier Y: Mini-International Neuropsychiatric Interview (MINI). University of South Florida, Institute for Research in Psychiatry, Tampa, FL; 1994.
• [25]Katz A, Nambi SS, Mather K, Baron AD, Follman DA, Sullivan G, Quon MJ: Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrin Metab 2000, 85:2402-2410.
• [26]Sokero PT, Melartin TK, Rytsälä HJ, Leskelä US, Lestelä-Mielonen PS, Isometsä ET: Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 2003, 64:1094-1100.
• [27]Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJM, Seshasai SRK, McMurray JJ, Freeman DJ, Jukema JW, Macfarlane PW, Packard CJ, Stott DJ, Westendorp RG, Shepherd J, Davis BR, Pressel SL, Marchioli R, Marfasi RM, Maggioni AP, Tavazzi L, Tagnoni L, Kjekshus J, Pedersen TR, Cook TJ, Gotto AM, Clearfield MB, Downs JR, Nahamura H, Ohashi Y, Mizuno K, Ray KK, Ford I: Statins and the risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010, 375:735-42.
• [28]Mather AA, Cox BJ, Enns MW, Sareen J: Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. J Psychosom Res 2009, 66:277-285.
• [29]Kressel G, Trunz B, Bub A, Hülsman O, Wolters M, Lichtinghagen R, Stichtenoth DO, Hahn A: Systemic and vascular markers of inflammation in relation to metabolic syndrome and insulin resistance in adults with elevated atherosclerosis risk. Athetosclerosis 2009, 202:263-271.
• [30]Sublette ME, Galfalvy HC, Fuchs D, Lapidus M, Grunebaum MF, Oquendo MA, Mann JJ, Postolache TT: Plasma kynurine levels are elevated in suicide attempters with major disorder. Brain Behav Immun 2011, 25:1272-1278.
• [31]Suokas JT, Perälä J, Suominen K, Saari S, Lönnqvist J, Suvisaari JM: Epidemiology of suicide attempts among persons with psychotic disorder in the general population. Schizophrenia Res 2010, 124:22-8.
• [32]Mäntyselkä P, Korniloff K, Saaristo T, Koponen H, Eriksson J, Puolijoki H, Timonen M, Sundvall J, Kautiainen H, Vanhala M: Association of depressive symptoms with impaired glucose regulation, screen-detected and previously known type 2 diabetes – findings from the Finnish D2D survey. Diabetes Care 2011, 34:71-6.
• [33]Stetler C, Miller GE: Depression and hypothalamic-pituitary-adrenal activation: A quantitative summary of four decades of research. Psychosomatic Med 2011, 73:114-126.
• [34]Belvedere Murri R, Pariante C, Mondelli V, Masotti M, Atti AR, Mellacqua Z, Antonioli M, Ghio L, Menchetti M, Zanetidou S: HPA axis and aging in depression: Systematic review and meta-analysis. Psychoneuroendocrinology 2014, 41:46-62.
• [35]Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ: Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders. Am J Psychiatry 2003, 160:773-779.
• [36]Olie E, Picot MC, Guillaume S, Abbar M, Courtet P: Measurement of total serum cholesterol in the evaluation of suicidal risk. J Affect Disord 2011, 133:234-238.
• [37]Tedders SH, Fokong KD, McKenzie LE, Wesley C, Yu L, Zhang J: Low cholesterol is associated with depression among US household population. J Affect Disord 2011, 135:115-21.
• [38]Tanskanen A, Vartiainen E, Tuomilehto J, Viinamäki H, Lehtonen J, Puska P: High serum cholesterol and risk of suicide. Am J Psychiatry 2000, 157:648-50.
• [39]Mather KJ, Hunt AE, Steinberg HO, Paradisi G, Hook G, Katz A, Quon MJ, Baron AD: Repeatability characteristics of simple indices of insulin resistance: Implications for research applications. J Clin Endocrinol Metabolism 2001, 86:5457-5464.