An association between low serum cholesterol levels and an increased risk of suicide has been made by Canadian researchers in a report in Epidemiology.

Larry Ellison and Howard Morrison of Health Canada in Ottawa used data from the Canadian National Mortality Database to determine the 'mortality experience' of 11,554 participants. The researchers identified 27 deaths due to suicide.

Ellison and Morrison report that as cholesterol levels decreased in the subjects, their risk of committing suicide increased. Those in the lowest quartile of serum cholesterol concentration (<4.27 mmol/liter) had more than six times the risk of committing suicide compared with those in the highest quartile (>5.77 mmol/liter). The risk ratios for suicide were 6.39 in the lowest quartile, 2.95 in the second quartile, and 1.94 in the third quartile. Furthermore, these risks were still apparent after excluding patients with clinical depression or those who were unemployed.

'A number of mechanisms have been proposed to explain the suicide/serum total cholesterol association,' the authors say. Low serum total cholesterol concentration might alter the metabolism of serotonin, leading to depression. Alternatively, increased levels of the cytokine interleukin-2 could result in decreased levels of both serum total cholesterol and melatonin, leading to depression and an increased risk of suicide.

Ellison and Morrison conclude:'Whether low cholesterol promotes depression, ultimately leading to suicide, or is a consequence of it remains to be determined. This is an increasingly important question, given the ability of new pharmacotherapies to lower serum total cholesterol dramatically.'

Epidemiology 2001; 12: 168?172

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