Association of Vitamin D with Suicide Behaviors: A Systematic Review and Meta-Analysis
Abstract
Objective: Research findings on the relationship between vitamin D and suicide are not consistent; therefore, the objective of the present paper is to assess the relationship between vitamin D and suicide behaviors using a systematic review and meta-analysis.
ethod: A search strategy was developed using keywords including “Vitamin D”, “Vitamin D deficiency”, “suicide” "attempted suicide", "completed suicide”, “Suicide, Attempted”, “Suicidal Ideation.” We searched databases including Scopus, Medline, Web of Science, and Google Scholar by July 7, 2022. We examined the titles, abstracts, and full texts of the articles to select eligible ones. To pool the results of the selected studies, we used the random-effect method and mean difference as the effect size. The quality of the articles was evaluated by the Newcastle-Ottawa Scale (NOS). Moreover, heterogeneity and bias of reporting were evaluated by the I2 statistic and Egger's and Begg's tests, respectively.
Results: Out of 149 studies retrieved in the databases, 11 studies were included in the final phase. Among these, the pooled findings of seven studies included in the meta-analysis phase showed that low levels of vitamin D are related to increased probability for suicide behaviors (P < 0.05). Moreover, subgroup analysis showed a significant relationship between vitamin D and suicide ideation and suicide attempt (P < 0.05). In addition, the I2 statistic indicated moderate heterogeneity (58%) and Egger's and Begg's tests did not show any evidence of publication bias (P > 0.05).
Conclusion: This study provides evidence in favor of the relationship between vitamin D and suicide behaviors. It suggests that insufficient levels of vitamin D play a role in suicidal behaviors. However, it should be noted that further and stronger evidence is needed to establish this role. Finally, incorporating vitamin D-rich foods into the diet or taking vitamin D supplements is recommended to reduce the risk of suicide.
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8. Brodsky BS, Mann JJ, Stanley B, Tin A, Oquendo M, Birmaher B, et al. Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide attempts. J Clin Psychiatry. 2008;69(4):584-96.
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10. Sudol K, Mann JJ. Biomarkers of Suicide Attempt Behavior: Towards a Biological Model of Risk. Curr Psychiatry Rep. 2017;19(6):31.
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12. Choi SB, Lee W, Yoon JH, Won JU, Kim DW. Risk factors of suicide attempt among people with suicidal ideation in South Korea: a cross-sectional study. BMC Public Health. 2017;17(1):579.
13. Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry. 2000;34(3):420-36.
14. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728-36.
15. Milner A, Sveticic J, De Leo D. Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries. Int J Soc Psychiatry. 2013;59(6):545-54.
16. Rund BR. Is schizophrenia a neurodegenerative disorder? Nord J Psychiatry. 2009;63(3):196-201.
17. Dilek A, Cander B, Dogan S, Bulut B, YAZICI R, TASLİDERE B. Relationship between suicidal patients and vitamin D: A prospective case-control study. JOSAM. 2020;4(9):766-70.
18. Grudet C, Wolkowitz OM, Mellon SH, Malm J, Reus VI, Brundin L, et al. Vitamin D and inflammation in major depressive disorder. J Affect Disord. 2020;267:33-41.
19. Vatandost S, Jahani M, Afshari A, Amiri MR, Heidarimoghadam R, Mohammadi Y. Prevalence of vitamin D deficiency in Iran: A systematic review and meta-analysis. Nutr Health. 2018;24(4):269-78.
20. Shah J, Gurbani S. Association of vitamin D deficiency and mood disorders: A systematic review. Vitam. D Defic. 2019.
21. Gokalp G. The association between low vitamin D levels and suicide attempts in adolescents. Ann Clin Psychiatry. 2020;32(2):106-13.
22. Boulkrane MS, Fedotova J, Kolodyaznaya V, Micale V, Drago F, van den Tol AJM, et al. Vitamin D and Depression in Women: A Mini-review. Curr Neuropharmacol. 2020;18(4):288-300.
23. Fond G, Faugere M, Faget-Agius C, Cermolacce M, Richieri R, Boyer L, et al. Hypovitaminosis D is associated with negative symptoms, suicide risk, agoraphobia, impaired functional remission, and antidepressant consumption in schizophrenia. Eur. Arch. Psychiatry Clin. 2019;269(8):879-86.
24. Gokalp G. The association between low vitamin D levels and suicide attempts in adolescents. Ann Clin Psychiatry. 2020;32(2):106-13
25. Park JI, Yang JC, Won Park T, Chung SK. Is serum 25-hydroxyvitamin D associated with depressive symptoms and suicidal ideation in Korean adults? International journal of psychiatry in medicine. 2016;51(1):31-46.
26. Kim SY, Jeon SW, Lim WJ, Oh KS, Shin DW, Cho SJ, et al. Vitamin D deficiency and suicidal ideation: A cross-sectional study of 157,211 healthy adults. J Psychosom Res. 2020;134:110125.
27. Darvishi N, Farhadi M, Haghtalab T, Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015;10(5):e0126870.
28. Poorolajal J, Moradi L, Mohammadi Y, Cheraghi Z, Gohari-Ensaf F. Risk factors for stomach cancer: a systematic review and meta-analysis. Epidemiol Health. 2020;42:e2020004.
29. Postolache TT, Akram F, Lee EE, Lowry CA, Stiller JW, Brenner LA, et al. Increased brain vitamin D receptor expression and decreased expression of cathelicidin antimicrobial peptide in individuals who died by suicide. J Psychiatr Res. 2020;125:75-84.
30. Nerhus M, Berg AO, Kvitland LR, Dieset I, Hope S, Dahl SR, et al. Low vitamin D is associated with negative and depressive symptoms in psychotic disorders. Schizophr Res. 2016;178(1-3):44-9.
31. Grudet C, Wolkowitz OM, Mellon SH, Malm J, Reus VI, Brundin L, et al. Vitamin D and inflammation in major depressive disorder. J Affect Disord. 2020;267:33-41.
32. Hashash JG, Vachon A, Rivers CR, Regueiro MD, Binion DG, Altman L, et al. Predictors of Suicidal Ideation Among IBD Outpatients. Journal of Clinical Gastroenterology. 2019;53(1):E41-E5.
33. Grudet C, Malm J, Westrin A, Brundin L. Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology. 2014;50:210-9.
34. Brundin L, Bryleva EY, Thirtamara Rajamani K. Role of Inflammation in Suicide: From Mechanisms to Treatment. Neuropsychopharmacology. 2017;42(1):271-83.
35. Aghajafari F, Letourneau N, Mahinpey N, Cosic N, Giesbrecht G. Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review. Nutrients. 2018;10(4).
36. Abedi P, Bovayri M, Fakhri A, Jahanfar S. The Relationship Between Vitamin D and Postpartum Depression in Reproductive-Aged Iranian Women. J Med Life. 2018;11(4):286-92.
37. Fernando C. A Review of the Association Between Vitamin D and Postpartum Depression. 2019.
38. Wang J, Liu N, Sun W, Chen D, Zhao J, Zhang W. Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies. Arch Gynecol Obstet. 2018;298(6):1045-59.
39. Stefanowski B, Antosik-Wójcińska AZ, Święcicki Ł. The effect of vitamin D3 deficiency on the severity of depressive symptoms. Overview of current research. Psychiatr Pol. 2017;51(3):437-54.
40. Amini S, Jafarirad S, Amani R. Postpartum depression and vitamin D: A systematic review. Crit Rev Food Sci Nutr. 2019;59(9):1514-20.
41. Tariq MM, Streeten EA, Smith HA, Sleemi A, Khabazghazvini B, Vaswani D, et al. Vitamin D: a potential role in reducing suicide risk? Int J Adolesc Med Health. 2011;23(3):157-65.
42. Cippitelli M, Santoni A. Vitamin D3: a transcriptional modulator of the interferon-gamma gene. Eur J Immunol. 1998;28(10):3017-30.
43. Orrù B, Szekeres-Bartho J, Bizzarri M, Spiga AM, Unfer V. Inhibitory effects of Vitamin D on inflammation and IL-6 release. A further support for COVID-19 management? Eur Rev Med Pharmacol Sci. 2020;24(15):8187-93.
2. Umhau JC, George DT, Heaney RP, Lewis MD, Ursano RJ, Heilig M, et al. Low vitamin D status and suicide: a case-control study of active duty military service members. PLoS One. 2013;8(1):e51543.
3. Murphy S, Xu J, Kochanek K. Arias E. mortality in the United States. NCHS Data Brief. 2017;2018(328):1-8.
4. Office of the Surgeon G, National Action Alliance for Suicide P. Publications and Reports of the Surgeon General. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington (DC): US Department of Health & Human Services (US); 2012.
5. Stone DM, Simon TR, Fowler KA, Kegler SR, Yuan K, Holland KM, et al. Vital Signs: Trends in State Suicide Rates - United States, 1999-2016 and Circumstances Contributing to Suicide - 27 States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(22):617-24.
6. Wasserman D. Suicide: an unnecessary death: OUP; 2016.
7. Brent DA, Melhem N. Familial transmission of suicidal behavior. Psychiatr Clin North Am. 2008;31(2):157-77.
8. Brodsky BS, Mann JJ, Stanley B, Tin A, Oquendo M, Birmaher B, et al. Familial transmission of suicidal behavior: factors mediating the relationship between childhood abuse and offspring suicide attempts. J Clin Psychiatry. 2008;69(4):584-96.
9. Turecki G, Ota VK, Belangero SI, Jackowski A, Kaufman J. Early life adversity, genomic plasticity, and psychopathology. LANCET PSYCHIAT. 2014;1(6):461-6.
10. Sudol K, Mann JJ. Biomarkers of Suicide Attempt Behavior: Towards a Biological Model of Risk. Curr Psychiatry Rep. 2017;19(6):31.
11. Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990;147(2):190-5.
12. Choi SB, Lee W, Yoon JH, Won JU, Kim DW. Risk factors of suicide attempt among people with suicidal ideation in South Korea: a cross-sectional study. BMC Public Health. 2017;17(1):579.
13. Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry. 2000;34(3):420-36.
14. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728-36.
15. Milner A, Sveticic J, De Leo D. Suicide in the absence of mental disorder? A review of psychological autopsy studies across countries. Int J Soc Psychiatry. 2013;59(6):545-54.
16. Rund BR. Is schizophrenia a neurodegenerative disorder? Nord J Psychiatry. 2009;63(3):196-201.
17. Dilek A, Cander B, Dogan S, Bulut B, YAZICI R, TASLİDERE B. Relationship between suicidal patients and vitamin D: A prospective case-control study. JOSAM. 2020;4(9):766-70.
18. Grudet C, Wolkowitz OM, Mellon SH, Malm J, Reus VI, Brundin L, et al. Vitamin D and inflammation in major depressive disorder. J Affect Disord. 2020;267:33-41.
19. Vatandost S, Jahani M, Afshari A, Amiri MR, Heidarimoghadam R, Mohammadi Y. Prevalence of vitamin D deficiency in Iran: A systematic review and meta-analysis. Nutr Health. 2018;24(4):269-78.
20. Shah J, Gurbani S. Association of vitamin D deficiency and mood disorders: A systematic review. Vitam. D Defic. 2019.
21. Gokalp G. The association between low vitamin D levels and suicide attempts in adolescents. Ann Clin Psychiatry. 2020;32(2):106-13.
22. Boulkrane MS, Fedotova J, Kolodyaznaya V, Micale V, Drago F, van den Tol AJM, et al. Vitamin D and Depression in Women: A Mini-review. Curr Neuropharmacol. 2020;18(4):288-300.
23. Fond G, Faugere M, Faget-Agius C, Cermolacce M, Richieri R, Boyer L, et al. Hypovitaminosis D is associated with negative symptoms, suicide risk, agoraphobia, impaired functional remission, and antidepressant consumption in schizophrenia. Eur. Arch. Psychiatry Clin. 2019;269(8):879-86.
24. Gokalp G. The association between low vitamin D levels and suicide attempts in adolescents. Ann Clin Psychiatry. 2020;32(2):106-13
25. Park JI, Yang JC, Won Park T, Chung SK. Is serum 25-hydroxyvitamin D associated with depressive symptoms and suicidal ideation in Korean adults? International journal of psychiatry in medicine. 2016;51(1):31-46.
26. Kim SY, Jeon SW, Lim WJ, Oh KS, Shin DW, Cho SJ, et al. Vitamin D deficiency and suicidal ideation: A cross-sectional study of 157,211 healthy adults. J Psychosom Res. 2020;134:110125.
27. Darvishi N, Farhadi M, Haghtalab T, Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015;10(5):e0126870.
28. Poorolajal J, Moradi L, Mohammadi Y, Cheraghi Z, Gohari-Ensaf F. Risk factors for stomach cancer: a systematic review and meta-analysis. Epidemiol Health. 2020;42:e2020004.
29. Postolache TT, Akram F, Lee EE, Lowry CA, Stiller JW, Brenner LA, et al. Increased brain vitamin D receptor expression and decreased expression of cathelicidin antimicrobial peptide in individuals who died by suicide. J Psychiatr Res. 2020;125:75-84.
30. Nerhus M, Berg AO, Kvitland LR, Dieset I, Hope S, Dahl SR, et al. Low vitamin D is associated with negative and depressive symptoms in psychotic disorders. Schizophr Res. 2016;178(1-3):44-9.
31. Grudet C, Wolkowitz OM, Mellon SH, Malm J, Reus VI, Brundin L, et al. Vitamin D and inflammation in major depressive disorder. J Affect Disord. 2020;267:33-41.
32. Hashash JG, Vachon A, Rivers CR, Regueiro MD, Binion DG, Altman L, et al. Predictors of Suicidal Ideation Among IBD Outpatients. Journal of Clinical Gastroenterology. 2019;53(1):E41-E5.
33. Grudet C, Malm J, Westrin A, Brundin L. Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology. 2014;50:210-9.
34. Brundin L, Bryleva EY, Thirtamara Rajamani K. Role of Inflammation in Suicide: From Mechanisms to Treatment. Neuropsychopharmacology. 2017;42(1):271-83.
35. Aghajafari F, Letourneau N, Mahinpey N, Cosic N, Giesbrecht G. Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review. Nutrients. 2018;10(4).
36. Abedi P, Bovayri M, Fakhri A, Jahanfar S. The Relationship Between Vitamin D and Postpartum Depression in Reproductive-Aged Iranian Women. J Med Life. 2018;11(4):286-92.
37. Fernando C. A Review of the Association Between Vitamin D and Postpartum Depression. 2019.
38. Wang J, Liu N, Sun W, Chen D, Zhao J, Zhang W. Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies. Arch Gynecol Obstet. 2018;298(6):1045-59.
39. Stefanowski B, Antosik-Wójcińska AZ, Święcicki Ł. The effect of vitamin D3 deficiency on the severity of depressive symptoms. Overview of current research. Psychiatr Pol. 2017;51(3):437-54.
40. Amini S, Jafarirad S, Amani R. Postpartum depression and vitamin D: A systematic review. Crit Rev Food Sci Nutr. 2019;59(9):1514-20.
41. Tariq MM, Streeten EA, Smith HA, Sleemi A, Khabazghazvini B, Vaswani D, et al. Vitamin D: a potential role in reducing suicide risk? Int J Adolesc Med Health. 2011;23(3):157-65.
42. Cippitelli M, Santoni A. Vitamin D3: a transcriptional modulator of the interferon-gamma gene. Eur J Immunol. 1998;28(10):3017-30.
43. Orrù B, Szekeres-Bartho J, Bizzarri M, Spiga AM, Unfer V. Inhibitory effects of Vitamin D on inflammation and IL-6 release. A further support for COVID-19 management? Eur Rev Med Pharmacol Sci. 2020;24(15):8187-93.
| Files | ||
| Issue | Vol 18 No 4 (2023) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v18i4.13635 | |
| Keywords | ||
| Mortality from Suicide Suicide Attempt Suicide Ideation Systematic Review Vitamin D | ||
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How to Cite
1.
Mohammadi Y, Ansari N, Daneshi-Maskooni M, Amiri MR. Association of Vitamin D with Suicide Behaviors: A Systematic Review and Meta-Analysis. Iran J Psychiatry. 2023;18(4):484-492.
