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Letters

Smoking as a confounder of the association of suicidality with serum lipid levels

Ivan Berlin, Amandine Luquiens and Henri-Jean Aubin
J Psychiatry Neurosci March 01, 2016 41 (2) E24; DOI: https://doi.org/10.1503/jpn.150361
Ivan Berlin
From the Département de pharmacologie, Hôpital Pitié-Salpêtrière —Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d’addictologie, Villejuif, France
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Amandine Luquiens
From the Département de pharmacologie, Hôpital Pitié-Salpêtrière —Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d’addictologie, Villejuif, France
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Henri-Jean Aubin
From the Département de pharmacologie, Hôpital Pitié-Salpêtrière —Université P. & M. Curie, Paris, France; and the Département de psychiatrie et d’addictologie, Villejuif, France
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A meta-analysis by Wu and colleagues1 reported an inverse association between serum lipid levels and suicidality. The authors compared total serum cholesterol (TC), high- (HDL-C) and low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) concentrations between individuals with psychiatric disorders (depression, schizophrenia, personality disorders, drug and alcohol addiction) with or without suicidality (ideation, threatened suicide, suicide attempts, suicide completion) to healthy controls. They found that suicidal persons had significantly lower serum TC, LDL-C and TG than nonsuicidal persons. There was no overall difference between suicidal patients and healthy controls for HDL-C with the exception of individuals with schizophrenia compared with controls.

The authors mentioned that some included studies did not adjust for important confounders, such as alcohol consumption or smoking. Smoking is the most prevalent health disorder worldwide, it is an independent risk factor for all aspects of suicide behaviour (ideation, wish to die, attempt)2 and it is dose-dependently associated with suicide.3 Smoking increases the risk of suicide attempt when controlling for all other potential confounders, among which prior suicide attempt is the strongest predictor of a subsequent suicide attempt.4,5 Moreover, smoking is strongly comorbid with psychiatric disorders,6 particularly schizoaffective disorders, and it can be hypothesized that smoking is an additive risk factor for suicide- related behaviours among the psychiatrically ill.

At the level of serum lipids, the most characteristic association with smoking is the reduced HDL-C7,8 even in healthy youth;9 HDL-C becomes normal7 or increases10 when smokers quit. Thus, adjusting for smoking status could potentially cancel the association between HDL-C and suicidality observed among suicidal patients with schizophrenia, suicidal patients with other disorders and controls. Similarly, because smoking is frequently associated with elevated TG and metabolic syndrome,8 controlling for smoking would reduce the difference between suicidal and nonsuicidal patients or controls. It is therefore of major interest to control for smoking behaviour when the association of suicidality with serum lipids is assessed.

References

  1. ↵
    1. Wu S,
    2. Ding Y,
    3. Wu F,
    4. et al
    .Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies.J Psychiatry Neurosci 2016;41:56–69.
    OpenUrl
  2. ↵
    1. Covey LS,
    2. Berlin I,
    3. Hu MC,
    4. et al
    .Smoking and suicidal behaviours in a sample of US adults with low mood: a retrospective analysis of longitudinal data.BMJ Open 2012;2:e000876
    OpenUrlPubMed
  3. ↵
    1. Li D,
    2. Yang X,
    3. Ge Z,
    4. et al
    .Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies.J Psychiatr Res 2012;46:1257–66.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Riala K,
    2. Taanila A,
    3. Hakko H,
    4. et al
    .Longitudinal smoking habits as risk factors for early-onset and repetitive suicide attempts: the Northern Finland 1966 Birth Cohort Study.Ann Epidemiol 2009;19:329–35.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Berlin I,
    2. Hakes KH,
    3. Hu MC,
    4. et al
    .Tobacco use and suicide attempt: longitudinal analysis with retrospective reports.PLoS ONE 2015;10:e0122607
    OpenUrlCrossRefPubMed
  6. ↵
    1. Lasser K,
    2. Boyd W,
    3. Woolhandler S,
    4. et al
    .Smoking and mental illness. A population-based prevalence study.JAMA 2000;284:2606–10.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Bakhru A,
    2. Erlinger TP
    .Smoking cessation and cardiovascular disease risk factors: results from the Third National Health and Nutrition Examination Survey.PLoS Med 2005;2:e160
    OpenUrlCrossRefPubMed
  8. ↵
    1. Berlin I,
    2. Lin S,
    3. Lima JA,
    4. et al
    .Smoking status and metabolic syndrome in the multi-ethnic study of atherosclerosis. A cross-sectional study.Tob Induc Dis 2012;10:9
    OpenUrlCrossRefPubMed
  9. ↵
    1. Craig WY,
    2. Palomaki GE,
    3. Johnson M,
    4. et al
    .Cigarette smoking-associated changes in blood lipid and lipoprotein levels in the 8- to19-year-old age group: a meta-analysis.Pediatrics 1990;85:155–8.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Forey BA,
    2. Frys JS,
    3. Lee PN,
    4. et al
    .The effect of quitting smoking on HDL- cholesterol — a review based on within-subject changes.Biomarker Research 2013;1:26
    OpenUrl
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In this issue

Journal of Psychiatry and Neuroscience: 41 (2)
J Psychiatry Neurosci
Vol. 41, Issue 2
1 Mar 2016
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Smoking as a confounder of the association of suicidality with serum lipid levels
Ivan Berlin, Amandine Luquiens, Henri-Jean Aubin
J Psychiatry Neurosci Mar 2016, 41 (2) E24; DOI: 10.1503/jpn.150361

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Smoking as a confounder of the association of suicidality with serum lipid levels
Ivan Berlin, Amandine Luquiens, Henri-Jean Aubin
J Psychiatry Neurosci Mar 2016, 41 (2) E24; DOI: 10.1503/jpn.150361
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