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Serum Lipids and Suicidal Risk among Patients with Schizophrenia Spectrum Disorders: Systematic Review and Meta-Analysis.

OBJECTIVE: A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders.

METHODS: We undertook a systematic search of multiple databases for studies that ascertained an association between serum lipids and suicidality in adult patients with schizophrenia spectrum disorders (18-65 years) from database inception to 2nd September 2020. Qualitative analysis was done using National Institute of Health (NIH) scales. The Standard Mean Difference (SMD) and 95% confidence intervals (CI) were calculated for each study and standardized relative to the study. Adjusted p-value, Z-test, and heterogeneity were calculated, as well as testing for publication bias.

RESULTS: Of 1262 records identified, 17 studies (n= 3113) were included in our systematic review, while 11 studies were included in the meta-analysis. The majority of studies (11) rated fair on qualitative analysis. Data from seven studies (n= 1597) revealed a medium effect size for an association between low total cholesterol and suicide attempts (SMD -0.560; 95% CI - 0.949 - 0.170; p =0.005). People with history of suicide attempt had a mean cholesterol value 0.56 SD lower than the mean in those without suicide attempts. There were differences in how a suicide attempt was defined and there was high heterogeneity (I2 = 83.3%). No significant association was found between any of the serum lipid parameters and suicide ideation. Funnel-plot analysis suggested small study effects with publication bias.

CONCLUSIONS: Suicide attempts in people with schizophrenia spectrum disorders is associated with low mean total cholesterol levels.

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