title: Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels.
abstract: OBJECTIVE
  Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (< or =4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity.
  
  
  METHODS
  Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990-1991. These levels were remeasured in 1993-1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire.
  
  
  RESULTS
  Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score > or =15 or > or =17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups.
  
  
  CONCLUSIONS
  Men with a lower cholesterol level (< or =4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.
authors.affiliation: Department of Epidemiology, Erasmus University Medical School, Rotterdam, The Netherlands.
authors.forename: P H
authors.initials: PH
authors.lastname: Steegmans
authors.forename: A W
authors.initials: AW
authors.lastname: Hoes
authors.forename: A A
authors.initials: AA
authors.lastname: Bak
authors.forename: E
authors.initials: E
authors.lastname: van der Does
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D000786:Anger; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood*; D003863:Depression / Q000097:blood* / Q000453:epidemiology*; D006791:Hostility; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000517:prevention & control
chemical_list: D014280:Triglycerides; D002784:Cholesterol