Higher prevalence of depressive symptoms in middle-aged men with low serumcholesterol levels

Objective: Investigators from several studies have reported a positive rela tionship between low cholesterol levels and death due to violent causes (eg , suicide and accidents), possibly mediated by depressive symptoms, aggress ion or hostility, or impulsivity. We set out to establish whether middle-ag ed men with chronically low cholesterol levels (less than or equal to 4.5 m mol/liter) have a higher risk of having depressive symptoms, according to s cores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar compariso n was also made for measures of anger, hostility, and impulsivity. Methods: Cholesterol measurements were obtained as part of a population-based chole sterol screening study in 1990-1991. These levels were remeasured in 1993-1 994. Only those whose cholesterol level remained in the same range were inc luded in the study. Depressive symptoms were assessed by using the Beck Dep ression 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 Impulsivi ty Questionnaire. Results: Men with chronically low cholesterol levels show ed a consistently higher risk of having depressive symptoms (Beck Depressio n Inventory score greater than or equal to 15 or greater than or equal to 1 7) than the reference group, even after adjusting for age, energy intake, a lcohol use, and presence of chronic diseases. No differences in anger, host ility, and impulsivity were observed between the two groups. Conclusions: M en with a lower cholesterol level (less than or equal to 4.5 mmol/liter) ha ve 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 ongoi ng debate on the putative association between low cholesterol levels and vi olent death.