Study Showed Most Effect in Veterans with Low Levels, Black Race
CANANDAIGUA, NY – Supplementation with Vitamin D appeared to be associated with a reduced risk of suicide attempt and self-harm in veterans, especially those who are Black and have low blood serum levels, according to a VA-funded study.
Researchers from the VA’s Center of Excellence for Suicide Prevention in Canandaigua, NY, and colleagues sought to determine any possible links among Vitamin D supplementation, 25(OH) blood serum levels, suicide attempts, and intentional self-harm in a population of veterans being treated at the VHA.
Included in the retrospective cohort study were veterans using Vitamin D supplements. Those taking Vitamin D3 (cholecalciferol) or Vitamin D2 (ergocalciferol) between 2010 and 2018 were matched 1:1 to untreated control veterans having similar demographics and medical histories. Analyses looked at associations by race (Black or white), gender (male or female), blood levels (0–19 ng/ml, 20–39 ng/ml, and 40+ ng/ml), and average daily dosage.
“Vitamin D3 and D2 supplementation were associated with a 45% and 48% lower risk of suicide attempt and self-harm ((D2 Hazard Ratio (HR) = 0.512, [95% CI, 0.457, 0.574]; D3 HR = 0.552, [95% CI, 0.511, 0.597])),” the researchers reported in PLOS One. “Supplemented black veterans and veterans with 0–19 ng/ml vitamin D serum levels were at ~64% lower risk relative to controls (Black Veteran HR: 0.362 [95% CI: 0.298,0.440]; 0–19 ng/ml HR: 0.359 [95% CI: 0.215,0.598]). Supplementation with higher vitamin D dosages was associated with greater risk reductions than lower dosages (Log Average Dosage HR: 0.837 [95% CI: 0.779,0.900]).”
According to background information in the article, serum vitamin D, which comes from skin exposure to the sun or dietary Vitamin D and includes supplements D2 and D3., is important for bone health, immune function, and absorption of other micronutrients. The authors report that Vitamin D insufficiency and deficiency are prevalent in the United States in general, as well as specifically in the military community.
“More than 30% of US military members have been shown to have 25-hydroxyvitamin D [25(OH)] levels below 20ng/ml, which is considered deficient,” the researchers explained. “ Vitamin deficiency is particularly prevalent among servicemembers of color and males. Servicemembers and veterans also have elevated suicide attempt and suicide rates.”
The study team advised that increasing evidence has identified associations between suicidal behavior or depressive symptoms and low levels of serum 25-hydroxyvitamin D (serum Vitamin D). “Vitamin D deficiency has previously been associated with symptoms similar to depression, including fatigue, mood changes (e.g., hopelessness and sadness), suicidal thoughts, anxiety, changes in appetite and weight, insomnia, and forgetfulness,” according to the report. “In addition, low Vitamin D serum levels have been associated with other mental and physical disorders with high rates of comorbid depression, including obesity, schizophrenia, and seasonal affective disorder.”
Researchers pointed out that only vitamin D3 (cholecalciferol) demonstrated a dose-response effect in deficient veterans, with more significant reductions in suicide attempt and self-harm risk at higher doses of vitamin D3 (cholecalciferol) supplementation. “This finding is consistent with the pharmacology of the two D vitamins,” they explained. “When supplements are comprised of plant-based ingredients (D2, ergocalciferol) rather than from animal-based ingredients (D3, cholecalciferol), the inactive vitamin D storage form (25-hydroxyvitamin D2) has a shorter half-life. Cholecalciferol (D3) has been shown to increase serum 25(OH)D more efficiently than ergocalciferol (D2).”
The authors added that higher doses of vitamin D are more likely to achieve and maintain serum levels than low-dose prescriptions. That, they said, might explain the association between treatment intensity and suicide attempts and self-harm. “Moreover, those with the lowest blood levels may benefit the most from supplementation. The dose-response finding combined with more significant risk reductions in veterans with the lowest blood serum levels adds confidence to our primary finding of a general decrease in suicide attempt and self-harm risk for veterans receiving Vitamin D supplementation. However, additional research is required to determine the association between suicidal and self-harm behavior risk once sufficient vitamin D levels are obtained,” the researchers added.
- Lavigne JE, Gibbons JB. The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm. PLoS One. 2023 Feb 1;18(2):e0279166. doi: 10.1371/journal.pone.0279166. PMID: 36724169; PMCID: PMC9891532.
