The association between low vitamin D levels and mental illness has been described in earlier research. The aim of our study was to examine the association between vitamin D levels with psychotic symptoms among hospitalized patients.
Methods
A total of 1,456 patient records from an academic psychiatric hospital were examined. Vitamin D levels were classified as normal (>30 ng/mL); insufficient (20 to 30 ng/mL); and deficient (<20 ng/mL). We then analyzed the association among vitamin D groups and symptoms of psychosis.
Results
The average vitamin D level in our sample was 23.59 ng/mL, with 76.2% of patients presenting with vitamin D levels <30 ng/mL. There was a significant association between vitamin D levels <20 ng/mL and symptoms of psychosis (P < .05). African /American patients had lower mean vitamin D levels than White patients (15.6 ± 0.2 ng/mL vs 25.8 ± 0.4 ng/mL, P < .001). There was no sex difference in vitamin D levels (females: 23.3 ± 11.5 ng/mL; males: 23.9 ±11.0 ng/mL).
Conclusions
Patients with vitamin D levels <30 ng/mL were 1.5 times more likely to have symptoms of psychosis. Patients who were African American, Hispanic, Asian, or biracial had lower vitamin D levels than patients who were White. Multivariate analysis found that after adjusting for age, sex, and race, the association between vitamin D and psychosis was not statistically significant. Possible explanations could include the known tendency to overdiagnose psychosis among individuals who are African American, referral bias, subgroup effect, or an epiphenomenon.
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References
1.
AnglinRESamaanZWalterSDVitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013; 202: 100–107. doi:10.1192/bjp.bp.111.106666
2.
MurriBMRespinoMMasottiMVitamin D and psychosis: mini meta-analysis. Schizophr Res. 150(1)235–239. doi:10.1016/j.schres.2013.07.017
3.
EskandariFMartinezPETorvikS; Premenopausal, Osteoporosis Women, Alendronate, Depression (POWER) Study Group. Low bone mass in premenopausal women with depression. Arch Intern Med. 2007;167(21)2329–2336. doi:10.1001/archinte.167.21.2329
4.
PolakMAHoughtonLAReederAISerum 25-hydroxyvitamin D concentrations and depressive symptoms among young adult men and women. Nutrients. 2014;6(11)4720–4730. doi:10.3390/nu6114720
5.
BoermanRCohenDSchultePFPrevalence of vitamin D deficiency in adult outpatients with bipolar disorder or schizophrenia. J Clin Psychopharmacol. 2016:36(6)588–592. doi:10.1097/JCP.0000000000000580
6.
BergAOMelleITorjesenPAA cross-sectional study of vitamin D deficiency among immigrants and Norwegians with psychosis compared to the general population. J Clin Psychiatry. 2010;71(12)1598–1604. doi:10.4088/JCP.09m05299yel
7.
ItzhakyDAmitalDGordenKLow serum vitamin D concentrations in patients with schizophrenia. Isr Med Assoc J. 2012;14(2)88–92.
8.
JovanovaOAartsNNoordamRVitamin D serum levels are cross-sectionally but not prospectively associated with late-life depression. Acta Psychiatr Scand. 2017;135(3)185–194. doi:10.1111/acps.12689
9.
KhoshbakhtYBidakiRSalehi-AbargoueiA.Vitamin D status and attention deficit hyperactivity disorder: a systematic review and meta- analysis of observational studies. Adv Nutr. 2018;9(1)9–20. doi:10.1093/advances/nmx002
10.
JiaFShanLWangBBench to bedside review: possible role of vitamin D in autism spectrum disorder. Psychiatry Res. 2018; 260: 360–365. doi:10.1016/j.psychres.2017.12.005
11.
JamilianHBagherzadehKNazeriZVitamin D parathyroid hormone, serum calcium and phosphorus in patients with schizophrenia and major depression. Int J Psychiatry Clin Pract. 2013;17(1)30–34. doi:10.3109/13651501.2012.667111
12.
RylanderMVerhulstS.Vitamin D insufficiency in psychiatric inpatients. J Psychiatr Pract. 2013;19(4)296–300. doi:10.1097/01.pra.0000432599.24761.c1
13.
IkonenHPalaniswamySNordströmTVitamin D status and correlates of low vitamin D in schizophrenia, other psychoses and non-psychotic depression - the Northern Finland Birth Cohort 1966 study. Psychiatry Res. 2019; 279: 186–194. doi:10.1016/j.psychres.2019.02.060
14.
GrahamKAKeefeRSLiebermanJARelationship of low vitamin D status with positive, negative and cognitive symptom domains in people with first-episode schizophrenia. Early Intervent Psychiatry. 2015;9(5)397–405. doi:10.1111/eip.12122
15.
NerhusMBergAOKvitlandLRLow vitamin D is associated with negative and depressive symptoms in psychotic disorders. Schizophr Res. 2016;178 (1-3):44–49. doi:10.1016/j.schres.2016.08.024
16.
PenckoferSByrnMAdamsWVitamin D supplementation improves mood in women with type 2 diabetes. J Diabetes Res. 2017; 2017: 8232863. doi:10.1155/2017/8232863
17.
YooTChoiWHongJHAssociation between vitamin D insufficiency and metabolic syndrome in patients with psychotic disorders. Psychiatry Invest. 2018;15(4)396–401. doi:10.30773/pi.2017.08.30
18.
CuiXGoochHPettyAVitamin D and the brain: genomic and non-genomic actions. Mol Cell Endocrinol. 2017; 453: 131–143. doi:10.1016/j.mce.2017.05.035
19.
EylesDWSmithSKinobeRDistribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat. 2005;29(1)21–30. doi:10.1016/j.jchemneu.2004.08.006
20.
IbiMSawadaHNakanishiMProtective effects of 1 alpha, 25-(OH)(2)D(3) against the neurotoxicity of glutamate and reactive oxygen species in mesencephalic culture. Neuropharmacology. 2001; 40(6)761–771. doi:10.1016/s0028-3908(01)00009-0
21.
de OliveiraLRC, MimuraLAN, de Campos Fraga-SilvaT F, Calcitriol prevents neuroinflammation and reduces blood-brain barrier disruption and local macrophage/microglia activation. Front Pharmacol. 2020; 11: 161. doi:10.3389/fphar.2020.00161.
22.
SmithMPFletcher-TurnerAYurekDMCalcitriol protection against dopamine loss induced by intracerebroventricular administration of 6-hydroxydopamine. Neurochem Res. 2006;31(4)533–539. doi:10.1007/s11064-006-9048-4
23.
EvansMAKimHALingYHVitamin D3 supplementation reduces subsequent brain injury and inflammation associated with ischemic stroke. Neuromol Med. 2018;20(1)147-159 doi:10.1007/s12017-018-8484-z
24.
GrovesNJMcGrathJJBurneTHJ. Vitamin D as a neurosteroid affecting the developing and adult brain. Annu Rev Nutr. 2014; 34: 117–141. doi:10.1146/annurev-nutr-071813-105557
25.
BerridgeMJ. Vitamin D and depression: cellular and regulatory mechanisms. Pharmacol Rev. 2017;69(2)80–92. doi:10.1124/pr.116.013227
26.
RingeJDKipshovenC.Vitamin D-insufficiency: an estimate of the situation in Germany. Dermato-Endocrinology. 2012;4(1)72–80. doi:10.4161/derm.19829
27.
SchwartzRCBlankenshipDM. Racial disparities in psychotic disorder diagnosis: a review of empirical literature. World Psychiatry. 2014;4(4)133–140. doi:10.5498/wjp.v4.i4.133
28.
PoweCEEvansMKWengerJVitamin D-binding protein and vitamin D status of black Americans and white Americans. N Eng J Med. 2013;369(21) 1991-2000. doi:10.1056/NEJMoa1306357
29.
GraciousBLFinucaneTLFriedman-CampbellMVitamin D deficiency and psychotic features in mentally ill adolescents: a cross-sectional study. BMC Psychiatr. 2012; 12: 38. doi:10.1186/1471-244X-12-38
30.
CuiXMcGrathJJBurneTHJVitamin D and schizophrenia: 20 years on. Mol Psychiatry. 2021;26(7)2708–2720. doi:10.1038/s41380-021-01025-0
31.
McGrathJBrownASt ClairD.Prevention and schizophrenia–the role of dietary factors. Schizophr Bull. 2011;37(2)272–283. doi:10.1093/schbul/sbq121
32.
EylesDWBurneTHJMcGrathJJ. Vitamin D effects on brain 31 development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinology. 2013;34(1)47–64. doi:10.1016/j.yfrne.2012.07.001
33.
FippsDCRaineyE.Psychotic features abated with vitamin D treatment in a patient with major depressive disorder. Case Rep Psychiatry. 2020:2046403. doi:10.1155/2020/2046403
34.
NerimanAHakanYOzgeU.The psychotropic effect of vitamin D supplementation on schizophrenia symptoms. BMC Psychiatry. 2021;21(1)309. doi:10.1186/s12888-021-03308-w
35.
ParttiKHeliövaaraMImpivaaraOSkeletal status in psychotic disorders: a population-based study. Psychosom Med. 2010;72(9)933–940. doi:10.1097/psy.0b013e3181f7abd3
36.
Rey-SánchezPLavado-GarcíaJMCanal-MacíasMLUltrasound bone mass in schizophrenic patients on antipsychotic therapy. Hum Psychopharmacol. 2009;24(1)49–54. doi:10.1002/hup.984
37.
YükselRNAltunsoyNTikirBCorrelation between total vitamin D levels and psychotic psychopathology in patients with schizophrenia: therapeutic implications for add-on vitamin D augmentation. Ther Adv Psychopharmacol. 2014;4(6)268–275. doi:10.1177/2045125314553612
38.
HedelinMLöfMOlssonMDietary intake of fish, omega-3, omega-6 polyunsaturated fatty acids and vitamin D and the prevalence of psychotic-like symptoms in a cohort of 33,000 women from the general population. BMC Psychiatry. 2010; 10: 38. doi:10.1186/1471-244X-10-38
39.
DoknicMMaricNPBritvicDBone remodeling, bone mass and weight gain in patients with stabilized schizophrenia in real-life conditions treated with long-acting injectable risperidone. Neuroendocrinology. 2011;94(3)246–254. doi:10.1159/000329391
40.
MenkesDBLancasterKGrantMVitamin D status of psychiatric inpatients in New Zealand's Waikato region. BMC Psychiatry. 2012; 12: 68. doi:10.1186/1471-244X-12-68
41.
HorgaGBernacerJDusiNCorrelations between ventricular enlargement and gray and white matter volumes of cortex, thalamus, striatum, and internal capsule in schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2011;261(7)467–476. doi:10.1007/s00406-011-0202-x
42.
GaughranFStringerDWojewodkaGEffect of vitamin D supplementation outcomes in people with early psychosis: the DFEND randomized clinical trial. JAMA Netw Open. 2021;4(12)e2140858. doi:10.1001/jamanetworkopen.2021.40858
