İntihar girişim olan hastalar ile D vitamini arasındaki ilişki: Prospektif vaka-kontrol çalışma

Öz

Amaç: Kişinin bilinçli olarak ve isteyerek yaşamına son vermesine intihar denir. İntihar ile ilgili en çok araştırılan konulardan biri de zihinsel bozukluklardır. Son yıllarda birçok kronik hastalığın tedavisinde D vitamininin önemli bir rol oynadığı bildirilmiştir. Artan kanıtlarda güneş ışığının veya D vitaminin, nöropsikiyatrik hastalıkların etiyolojisinde önemli bir çevresel faktör olduğu bildirilmektedir. Bu çalışmanın amacı acil servisimize intihar girişimi nedeniyle başvuran D vitamini düzeylerini araştırmak ve sonuçlara göre klinik uygulamaların tedavisine katkıda bulunmaktı. Yöntemler: Çalışmaya intihar girişimi olan 59 kişi ve kontrol grubu olan 42 kişi dahil edildi. Sosyodemografik Bilgi Formu (SBF) Hastaların cinsiyeti, yaşı, eğitim düzeyi, medeni durumu ve ekonomik durumu, daha önce psikiyatrik tedavi almış veya intihar girişiminde bulunmuş olması her hasta için ayrı bir forma kaydedildi. Kategorik (nominal veya sıralı) ve ikili değişkenlere dayalı istatistiksel değerlendirmeler için Mann Whitney U testleri kullanıldı. Bulgular: Çalışma grubunun laboratuvar D vitamini düzeyleri minimum 4,4 ng/ml maksimum 33 ng/ml değerleri bulundu. İntihar girişiminde bulunanların D vitamin ortalaması 9,6 ng/ml, kontrol grubunun D vitamin ortalaması 13,8 ng/ml idi. D vitamini düzeyleri ile psikiyatrik hastalık varlığı arasındaki ilişki istatistiksel olarak anlamlı bulundu (P<0,001).D vitamini düzeyleri ile önceki intihar girişimleri arasındaki ilişki anlamlı bulundu (P=0,02). Sonuç: Psikiyatrik bir hastalık olan depresyonda intihar eğilimi artmaktadır. Özellikle depresyon hastalığında tedavi protokollerine D vitamini eklenerek intihar girişimlerinin azaltılabileceğini ve bu doğrultuda gelecekteki çalışmalara yön verebileceği kanaatindeyiz.

Anahtar Kelimeler

• Vitamin D
• İntihar
• Depresyon

Relationship between suicidal patients and vitamin D: A prospective case-control study

Abstract

Aim: When a person ends their life consciously and intentionally, it is called suicide. One of the most investigated issues related to suicide is mental disorders. It has been reported that vitamin D has a prominent role in the treatment of many chronic diseases in recent years. Growing evidence implicates sunlight, or vitamin D, is a key environmental factor in the etiology of neuropsychiatric diseases. The aim of this study was to investigate the vitamin D levels in patients admitted to our emergency department due to suicide intervention and contribute to the treatment of clinical applications according to the results. Methods: This study included 59 individuals with suicidal attempt and 42 control group subjects. The gender, age, educational level, marital status, and economic status of the patients, whether they had previously received psychiatric treatment, or attempted suicide were recorded in a separate Sociodemographic Information Form (SBF) for each patient. Mann Whitney U test was used for statistical evaluations based on categorical (nominal or ordinal) and binary variables. Results: The minimum and maximum Vitamin D laboratory parameters of the study group were 4.4 ng/ml and 33 ng/ml, respectively. The mean vitamin D levels in the suicide and control groups were 9.6 ng/ml and 13.8 ng/ml, respectively. There were statistically significant relationships between vitamin D levels, the presence of psychiatric disease (P<0.001) and previous suicide attempts (P=0.02). Conclusion: Suicidal tendency increases in depression, which is a psychiatric illness. We believe that suicide attempts may be reduced by adding vitamin D to treatment protocols, especially in depression, and that it may direct future studies in this direction.

Keywords

• vitamin D
• suicide
• Depression

References

1. 1. Alec R. Psychiatric Emergencies Suicide. 2031-2040. In: BJ Sadock, VA Sadock (Eds). Comprehensive Textbook of Psychiatry 2. Volume 8. Printing, Philadelphia, Williams & Wilkins 2000.
2. 2. Garnfinkel BD. Suicide attempts in children and adolescents. Am J Psychiatry. 1982;139:1257-62.
3. 3. Robbins D, Alessi NE. Depressive symptoms and suicidal behaviour in adolescents. Am J Psychiatry. 1985;142:588-92.
4. 4. Goldstein RB, Black DW, Nasrallah A, et al. The prediction of suicide. Arch Gen Psychiatry. 1991;48:418-22.
5. 5. Henrikson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsä ET, Kuoppasalmi KI. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993;150:935-40.
6. 6. Isometsa ET, Henriksson MM, Hillevi MA. Suicide in major depression. Am J Psychiatry. 1994;151:530-6.
7. 7. Conner KR, Duberstein PR, Conwell Y, Seidlitz L, Caine ED. Psychological vulnerability to completed suicides: A review of empirical studies. Suicide and Life Threatening Behavior. 2001;31:367–86.
8. 8. Bertolote JM, Fleischmann A, De Leo D, Wasserman D. Psychiatric diagnosis and suicide: Revisiting the evidence. Crisis. 2004;25:147–55.

9. 9. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: A systematic review. Psychological Medicine. 2003;33:395–405.
10. 10. Milner A, Jerneja SJ, Leo DD. Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries. International Journal of Social Psychiatry. 2012;59(6):545–54.
11. 11. Pfeiffer CP, Klerman GL, Hurt SW. Suicidal children grow up: Demographic and clinical risk factors for adolescent suicide attempts. J Am Acad, Child Adolesc Psychiatry. 1991;30:609-16.
12. 12. Rund BR. Is schizophrenia a neurodegenerative disorder? Nord J Psychiatry. 2009;63:196–201.
13. 13. Enkhjargal B, McBride DW, Manaenko A, Reis C, Sakai Y, Tang J, Zhang JH. Intranasal administration of vitamin D attenuates blood–brain barrier disruption through endogenous upregulation of osteopontin and activation of CD44/P-gp glycosylation signaling after subarachnoid hemorrhage in rats. Journal of Cerebral Blood Flow & Metabolism. 2017;37(7):2555–66.
14. 14. Reinhart TA, Ramberg CF, Horst RL. Comparison of receptor binding, biological activity, and in vivo tracer kinetics for 1,25-dihydroxyvitamin D3 and, 1,25-dihydroxyvitamin D2, and its 24 epimer. Arch Biochem Biophys. 1989;273:64-71.
15. 15. Guyton AC, Hall JE. Medical Physiology. 9. Printing, (Trans. H Çavuşoğlu), Istanbul, Nobel Medical Bookstores. 1996, pp: 985-998.
16. 16. Holick MF. Vitamin D: photobiology, metabolism, mechanism of action, and clinical applications. In: Favus, MJ (eds). Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Washington, DC: American Society for Bone and Mineral Research, 2003, pp: 129-137.
17. 17. Armas LAG, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387-91.
18. 18. Garcion E, Sindji L, Montero-Menei C, Andre C, Brachet P, Darcy F. Expression of inducible nitric oxide synthase during rat brain inflammation: regulation by 1,25-dihydroxyvitamin D3. Glia. 1998;22:282–94.
19. 19. Garcion E, Sindji L, Leblondel G, Brachet P, Darcy F. 1,25-dihydroxyvitamin D3 regulates the synthesis of gamma-glutamyl transpeptidase and glutathione levels in rat primary astrocytes. J Neurochem. 1999;73:859–66.
20. 20. Kalueff A, Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition. Curr Opin Clin Nutr Metab Care. 2007;10:12–9.
21. 21. Hahn S, Haselhorst U, Tan S, Quadbeck B, Schmidt M, Roesler S, et al. Low 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2006;114:577-83.
22. 22. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80:1678-88.
23. 23. Orces CH, Gavilánez EL. Determinants of vitamin D supplementation among older adults and its effect on 25(OH)D levels according to bone mineral density status. Nutr Hosp. 2020;37(1):28-36.
24. 24. Yeni̇lmez E, Çeti̇nkaya R. Evaluation of initial results of naïve HIV-infected patients regarding bone health. J Surg Med. 2019;3(5):384-9.
25. 25. Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality- a review of recent evidence. Autoimmun Rev. 2013;12:976-89.
26. 26. Yüksel RN, Altunsoy N, Tikir B, Külük MC, Unal K, Goka S, et al. Correlation between total vitamin D levels and psychotic psychopathology in patients with schizophrenia: therapeutic implications for add-on vitamin D augmentation. Therapeutic Advances in Psychopharmacology. 2014;4(6):268-75.
27. 27. Serafini G, Pompili M, Elena SM, Stefani H, Palermo M, Coryell W et al. The role of inflammatory cytokines in suicidal behavior: a systematic review. Eur Neuropsychopharmacol. 2013;23(12):1672-86.
28. 28. Chesney E, Goodwin GM, Fazel S. Risks of all cause and intihare mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153-60.
29. 29. Sagınc H, Kugu N, Akyuz G, Dogan O. Investigation of suicide history in inpatients. Anadolu Psikiyatri Derg. 2000;1:83-88.
30. 30. Jaddou HY, Batieha AM, Khader YS, et al. Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey. Eur Arch Psychiatry Clin Neurosci. 2012;262:321–7.
31. 31. Kjaergaard M, Joakimsen R, Jorde R. Low serum 25-hydroxyvitamin D levels are associated with depression in an adult Norwegian population. Psychiatry Res. 2011;190:221–5.
32. 32. Yavuz YC, Biyik, Z, Ozkul D, Abusoglu S, Eryavuz D, Dag M, et al. Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender. Clin Exp Nephrol. 2020;24:63–72.
33. 33. Zhao G, Ford ES, Li C, Balluz LS. No associations between serum concentrations of 25-hydroxyvitamin D and parathyroid hormone and depression among US adults. Br J Nutr. 2010;104:1696–702.
34. 34. Pan A, Lu L, Franco OH, Yu Z, Li H, Lin X. Association between depressive symptoms and 25-hydroxyvitamin D in middle-aged and elderly Chinese. J Affect Disord. 2009;118:240–3.
35. 35. Park J, Yang JC, Park TW, Chung SK. Is serum 25-hydroxyvitamin D associated with depressive symptoms and suicidal ideation in Korean adults? The International Journal of Psychiatry in Medicine. 2016;51(1):31–46.
36. 36. Umhau JC, George DT, Heaney RP, Lewis MD, Ursano RJ, Heilig M et al. Low vitamin D status and suicide: a casecontrol study of active duty military service members. PLoS One. 2013;8(1):e51543.
37. 37. Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ. Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. Journal of Chemical Neuroanatomy. 2005;29(1):21-30.
38. 38. Prufer K, Veenstra TD, Jirikowski GF, Kumar R. Distribution of 1,25-dihydroxyvitamin D3 receptor immuno reactivity in the rat brain and spinal cord. Journal of Chemical Neuroanatomy. 1999;16(2):135-45.
39. 39. Eyles D, Brown J, Mackay-Sim A, McGrath J, Feron F. Vitamin D3 and brain development.Neuroscience. 2003;118:641–53.
40. 40. Lawrie S, Abukmeil S. Brain abnormality in schizophrenia. A systematic and quantitative review of volumetric magnetic resonance imaging studies. Br J Psychiatry. 1998;172:110–20.
41. 41. Selemon L, Rajkowska G, Goldman-Rakic P. Abnormally high neuronal density in the schizophrenic cortex. A morphometric analysis of prefrontal area 9 and occipital area 17. Arch Gen Psychiatry. 1995;52:805–20.
42. 42. Lansdowne AT, Provost SC. Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl). 1998;135:319-23.
43. 43. Sanders KM, Stuart AL, Williamson EJ, Jacka FN, Dodd S, Nicholson G, et al. Annual high-dose vitamin D3 and mental well-being: randomised controlled trial. British Journal of Psychiatry. 2011;198:357-64.
44. 44. Motsingera S, Lazovicha D, MacLehose RF, Torkelson CJ, Robien K. Vitamin D intake and mental health-related quality of life in older women: The Iowa Women’s Health Study. Maturitas. 2012;71:267–73.
45. 45. Awad AG. Neurobiological Issues in Autism. Can J Psychiatry. 1984;29(7):609-13.
46. 46. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, Schlatter J, Lahortiga F, Majem LS, et al. Association of the Mediterranean dietary pattern with the incidence of depression. Arch Gen Psychiatry. 2009;66(10):1090–8.
47. 47. Jacka FN, Pasco JA, Mykletun A, Williams LJ, Hodge AM, O'Reilly SL, et al. Association of Western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167(3):305–11.