title: Association between suicidal behaviour and impaired glucose metabolism in depressive disorders.
abstract: BACKGROUND
  Disturbances in lipid metabolism have been linked to suicidal behaviour, but little is known about the association between suicide risk and abnormal glucose metabolism in depression. Hyperglycaemia and hyperinsulinaemia may increase the risk of depression and also the risk for suicide, we therefore studied associations between suicidal behaviour and disturbances in glucose metabolism in depressive patients who had been referred to depression nurse case managers.
  
  
  METHODS
  Patients aged 35 years and older (N = 448, mean age 51 years) who were experiencing a new depressive episode, who were referred to depression nurse case managers in 2008-2009 and who scored ≥10 on the Beck Depression Inventory were enrolled in this study. The study was conducted in municipalities within the Central Finland Hospital District (catchment area of 274 000 inhabitants) as part of the Finnish Depression and Metabolic Syndrome in Adults study. The patients' psychiatric diagnoses and suicidal behaviour were confirmed by the Mini-International Neuropsychiatric Interview. Blood samples, for glucose and lipid determinations, were drawn from participants after 12 h of fasting, which was followed by a 2-hour oral glucose tolerance test (OGTT) when blood was drawn at 0 and 2 h. Insulin resistance was measured by the Quantitative Insulin Sensitivity Check Index (QUICKI) method.
  
  
  RESULTS
  Suicidal ideation (49 %) and previous suicide attempts (16 %) were common in patients with major depressive disorder or dysthymia. Patients with depression and suicidal behaviour had higher blood glucose concentrations at baseline and at 2 hours in the OGTT. Glucose levels associated positively with the prevalence of suicidal behaviour, and the linearity was significant at baseline (p for linearity: 0.012, adjusted for age and sex) and for 2-hour OGTT glucose (p for linearity: 0.004, adjusted for age and sex). QUICKI levels associated with suicidal behavior (p for linearity across tertiles of QUICKI: 0.026). Total and LDL cholesterol and triglyceride levels were also higher in those patients with suicidal behaviour. Multivariate analysis revealed that blood glucose levels, BDI scores and antidepressive medications associated with suicidal behaviour.
  
  
  CONCLUSIONS
  Insulin resistance and disturbances in glucose and lipid metabolism may be more common in middle-aged depressive patients with suicidal behaviour.
authors.affiliation: Old Age Psychiatry, University of Helsinki, and Helsinki University Hospital, P.O. Box 22, FIN-00014, Helsinki, Finland. hannu.j.koponen@hus.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Koponen
authors.affiliation: Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland. hannu.kautiainen@medcare.fi.|Primary Health Care Unit, Central Hospital of Central Finland, Jyväskylä, Finland. hannu.kautiainen@medcare.fi.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: Public Utility Laboratory KESLAB, Central Finland Hospital District, Jyväskylä, Finland. esa.leppanen@eksote.fi.
authors.forename: Esa
authors.initials: E
authors.lastname: Leppänen
authors.affiliation: Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland. pekka.mantyselka@uef.fi.|Primary Health Care Unit, Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland. pekka.mantyselka@uef.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Mäntyselkä
authors.affiliation: Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland. mauno.vanhala@ksshp.fi.|Primary Health Care Unit, Central Hospital of Central Finland, Jyväskylä, Finland. mauno.vanhala@ksshp.fi.|Department of Health Sciences, University of Eastern Finland, Kuopio, Finland. mauno.vanhala@ksshp.fi.
authors.forename: Mauno
authors.initials: M
authors.lastname: Vanhala
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D004812:Epidemiologic Methods; D005260:Female; D005387:Finland; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D024821:Metabolic Syndrome / Q000523:psychology*; D008875:Middle Aged; D010555:Personality Inventory; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents