Publication: RELATIONSHIP BETWEEN SUICIDAL PATIENTS AND VITAMIN D
NTRODUCTION: When a person end their life consciously and intentionally, it is called suicide. Suicide is not a random and nonpurposeful movement, but it is a way of getting rid of the crisis or problem that cause a big trouble and can not be overcome (1,2).The person who committed suicide carries out this action with the thoughts of despair and the lack of people around to help. Suicide is related to ongoing stress factors and narrowing of options before the individual (1,2). The most commonly used method for suicide is multiple drug intake and suicide probability is high among people who have previously attempted suicide, people from families with suicidal individuals (3,4). One of the most investigated issues related to suicide is mental disorders. Numerous studies have reported high rates of mental disorders in individuals who attempt suicide or who die from suicide (5,6). In a study conducted on 100 people who had attempted suicide, 70% of them had depression, 15% had alcoholism, 3% had schizophrenia and 5% had other disorders (7). The most important of the sterols belonging to the vitamin D family is cholecalciferol (vitamin D3). Cholecalciferol is composed of 7- dehydrocholesterol in the skin with the effect of ultraviolet rays (8). The aim of this study was to investigate the vitamin D levels in patients admitted to our emergency department due to suicid intervention and to contribute to the treatment of clinical applications according to the results. METHOD: This study is conducted prospectively in patients presented with suicide in Istanbul Sağlık Bilimleri University Kanuni Sultan Suleyman Training and Research Hospital Emergency Medicine Clinic between 01.12.2018-01.02.2019 with the approval of Kanuni Sultan Süleyman Training and Research Hospital Ethics Committee by the protocol numbered 2018/11/47. The study included 59 individuals with suicidal attempt and 42 subjects with control group. Blood taken from the patients was taken as disposable 10 ml, vacuumed, nonanticoagulanted, in biochemistry tubes for 5-7 ml and centrifuged at 2500 rpm for 10 minutes and their serum was separated within half an hour. Separated serums were stored at -80°C until examined. Each serum was only dissolved once on the day of the study. All variables were tested for conformity to normal distribution, Kolmogorov Smirnov test and compliance with parametric test criteria. The data obtained by the study carried out within the scope of clinical research are statistically nonparametric. For this reason, Mann Whitney U tests were used for statistical evaluations based on categorical (nominal or ordinal) and binary variables. Spearman rank correlation in non-parametric data and Pearson correlation in parametric data were used as correlation methods. FINDINGS: A total of 59 patients and 42 control groups were included in our study. 70.3% (n = 71) of the participants were female and 29.7% (n = 30) were male. The mean age of the participants was 30.7 and the minimum and maximum ages were 18 and 53 years. When the final results of the patients were evaluated; 50.8% (n = 31) were discharged with health, 29.5% (n = 18) were hospitalized and 7.1% (n = 12) were admitted to intensive care unit. When the presence of psychiatric disease was evaluated inthe patients with suicidal attempt, 42.3% (n = 25) had psychiatric disease and 57.6% (n = 34) did not have a diagnosis of psychiatric disease. In patients with suicidal interventions, a positive, high level relationship was detected with the presence of psychiatric disease (r: 0.860, p=0.000). Hastaların The relationship between vitamin D levels and the presence of psychiatric disease was statistically significant (r: 0.276, p = 0.005). Laboratory parameters of vitamin D minimum 4.4 maximum 33 values were found, the effect of vitamin D on suicidal interference is negative, a significant relationship is found (z:-3.630, p=0.000). ). When the relationship between vitamin D levels and previous suicide attempts was found to be significant (z: -2.260, p = 0.024) DISCUSSION: It has been reported that vitamin D has an important role in the treatment of many chronic diseases in recent years (9,10). The risk of suicide is different in every psychiatric disorder. Psychiatric disorder most commonly associated with increased risk of suicide is major depression (11,12,13). The identification of vitamin D receptors in brain regions affecting depression has strengthened the relationship between vitamin D and depression. In human and animal studies, vitamin D receptors and 1-α-hydroxylase enzyme are found in the brain and the role of vitamin D in central nervous system functions have been shown (14,15). According to the results of our study, vitamin D levels was detected low in cases with sucidal attempts. There is increasing evidence that there is a relationship between depressive symptoms and low serum/plasma 25 (OH) D levels. Cross-sectional studies and prospective data also support that low vitamin D levels are associated with an increased risk of depression (16,17). In a study showing that vitamin D deficiency and mood disorders were very common among the elderly, the quality of life of the elderly women with low vitamin D (<400 IU / day) was found to be lower than those with higher vitamin D. In order to improve the quality of life in the elderly, it was emphasized that the recommended daily intake of vitamin D (≥400 IU / day) is important (18). In our study, the relationship between the presence of psychiatric disease in patients with suicidal attempt is indirectly similar to other studies. Low vitamin D levels were found to be a factor in suicidal intervention. CONCLUSION: Suicidal intervention is a condition with high mortality and morbidity. According to the results of our study, considering the low level of vitamin D in patients with suicidal interventions and underlying psychiatric disorders, it was thought that D vitamin replacement can be taken into treatment protocols and suicidal interventions could be reduced.