Top

BMC Psychiatry

Published in:

Open Access 01-12-2014 | Research article

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

Authors: Ole Grønli, Jan Magnus Kvamme, Rolf Jorde, Rolf Wynn

Published in: BMC Psychiatry | Issue 1/2014

Abstract

Background

Previous studies have found an association between psychiatric disorders and vitamin D deficiency, but most studies have focused on depression. This study aimed to establish the prevalence of vitamin D deficiency in elderly patients with a wider range of psychiatric diagnoses.

Method

The study included elderly patients (>64 years) referred to a psychiatric hospital in Northern Norway and a control group from a population survey in the same area. An assessment of psychiatric and cognitive symptoms and diagnoses was conducted using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini Mental State Examination, the Clockdrawing Test, and the Mini International Neuropsychiatric Interview (MINI+), as well as clinical interviews and a review of medical records. The patients’ mean level of 25-hydroxyvitamin D (25(OH)D) and the prevalence of vitamin D deficiency were compared with those of a control group, and a comparison of vitamin D deficiency across different diagnostic groups was also made. Vitamin D deficiency was defined as 25(OH)D <50 nmol/L (<20 ng/ml).

Results

The mean levels of 25(OH)D in the patient group (n = 95) and the control group (n = 104) were 40.5 nmol/L and 65.9 nmol/L (p < 0.001), respectively. A high prevalence of vitamin D deficiency was found in the patient group compared with the control group (71.6% and 20.0%, respectively; p < 0.001). After adjusting for age, gender, season, body mass index, and smoking, vitamin D deficiency was still associated with patient status (OR: 12.95, CI (95%): 6.03-27.83, p < 0.001). No significant differences in the prevalence of vitamin D deficiency were found between patients with different categories of psychiatric diagnoses, such as depression, bipolar disorders, psychosis, and dementia.

Conclusion

Vitamin D deficiency is very common among psychogeriatric patients, independent of diagnostic category. Even though the role of vitamin D in psychiatric disorders is still not clear, we suggest screening for vitamin D deficiency in this patient group due to the importance of vitamin D for overall health.

Available only for authorised users

Sedrani SH: Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region. Ann Nutr Metab. 1984, 28 (3): 181-185. 10.1159/000176801.CrossRefPubMed

McGrath JJ, Kimlin MG, Saha S, Eyles DW, Parisi AV: Vitamin D insufficiency in south-east Queensland. Med J Aust. 2001, 174 (3): 150-151.PubMed

Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, Sawhney RC, Saluja B, Ganie MA, Singh S: Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr. 2005, 82 (2): 477-482.PubMed

Mai XM, Chen Y, Camargo CA, Langhammer A: Cross-sectional and prospective cohort study of serum 25-hydroxyvitamin D level and obesity in adults: the HUNT study. Am J Epidemiol. 2012, 175 (10): 1029-1036. 10.1093/aje/kwr456.CrossRefPubMed

Holick MF, Chen TC: Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008, 87 (4): 1080S-6S.PubMed

Holick MF: Vitamin D deficiency. N Engl J Med. 2007, 357 (3): 266-281. 10.1056/NEJMra070553.CrossRefPubMed

Webb AR, Kline L, Holick MF: Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988, 67 (2): 373-378. 10.1210/jcem-67-2-373.CrossRefPubMed

Holick MF, Matsuoka LY, Wortsman J: Age, vitamin D, and solar ultraviolet. Lancet. 1989, 2 (8671): 1104-1105.CrossRefPubMed

Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001, 22 (4): 477-501. 10.1210/edrv.22.4.0437.CrossRefPubMed

10.

Wicherts IS, van Schoor NM, Boeke AJ, Visser M, Deeg DJ, Smit J, Knol DL, Lips P: Vitamin D status predicts physical performance and its decline in older persons. J Clin Endocrinol Metab. 2007, 92 (6): 2058-2065. 10.1210/jc.2006-1525.CrossRefPubMed

11.

Institute of Medicine: Dietary reference intakes for calcium and vitamin D. 2011, Washington, DC: The National Academies Press

12.

Wilkins CH, Sheline YI, Roe CM, Birge SJ, Morris JC: Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. Am J Geriatr Psychiatry. 2006, 14 (12): 1032-1040. 10.1097/01.JGP.0000240986.74642.7c.CrossRefPubMed

13.

Milaneschi Y, Shardell M, Corsi AM, Vazzana R, Bandinelli S, Guralnik JM, Ferrucci L: Serum 25-hydroxyvitamin D and depressive symptoms in older women and men. J Clin Endocrinol Metab. 2010, 95 (7): 3225-3233. 10.1210/jc.2010-0347.CrossRefPubMedPubMedCentral

14.

Stewart R, Hirani V: Relationship between vitamin D levels and depressive symptoms in older residents from a national survey population. Psychosom Med. 2010, 72 (7): 608-612. 10.1097/PSY.0b013e3181e9bf15.CrossRefPubMed

15.

Lee DM, Tajar A, O’Neill TW, O’Connor DB, Bartfai G, Boonen S, Bouillon R, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Punab M, Silman AJ, Vanderschueren D, Wu FC, Pendleton N: EMAS study group: lower vitamin D levels are associated with depression among community-dwelling European men. J Psychopharmacol. 2011, 25 (10): 1320-1328. 10.1177/0269881110379287.CrossRefPubMed

16.

Kjaergaard M, Joakimsen R, Jorde R: Low serum 25-hydroxyvitamin D levels are associated with depression in an adult Norwegian population. Psychiatry Res. 2011, 190 (2–3): 221-225.CrossRefPubMed

17.

Zhao G, Ford ES, Li C, Balluz LS: No associations between serum concentrations of 25-hydroxyvitamin D and parathyroid hormone and depression among US adults. Br J Nutr. 2010, 104 (11): 1696-1702. 10.1017/S0007114510002588.CrossRefPubMed

18.

Anglin RE, Samaan Z, Walter SD, McDonald SD: Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013, 202: 100-107. 10.1192/bjp.bp.111.106666.CrossRefPubMed

19.

Lansdowne AT, Provost SC: Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl). 1998, 135 (4): 319-323. 10.1007/s002130050517.CrossRef

20.

Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K: Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008, 264 (6): 599-609. 10.1111/j.1365-2796.2008.02008.x.CrossRefPubMed

21.

Kjaergaard M, Waterloo K, Wang CE, Almas B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R: Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case–control study and randomised clinical trial. Br J Psychiatry. 2012, 201 (5): 360-368. 10.1192/bjp.bp.111.104349.CrossRefPubMed

22.

Khoraminya N, Tehrani-Doost M, Jazayeri S, Hosseini A, Djazayery A: Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust N Z J Psychiatry. 2013, 47 (3): 271-275. 10.1177/0004867412465022.CrossRefPubMed

23.

Buell JS, Scott TM, Dawson-Hughes B, Dallal GE, Rosenberg IH, Folstein MF, Tucker KL: Vitamin D is associated with cognitive function in elders receiving home health services. J Gerontol A Biol Sci Med Sci. 2009, 64 (8): 888-895.CrossRefPubMed

24.

Annweiler C, Schott AM, Allali G, Bridenbaugh SA, Kressig RW, Allain P, Herrmann FR, Beauchet O: Association of vitamin D deficiency with cognitive impairment in older women: cross-sectional study. Neurology. 2010, 74 (1): 27-32. 10.1212/WNL.0b013e3181beecd3.CrossRefPubMed

25.

Llewellyn DJ, Lang IA, Langa KM, Melzer D: Vitamin D and cognitive impairment in the elderly U.S. population. J Gerontol A Biol Sci Med Sci. 2011, 66 (1): 59-65.CrossRefPubMed

26.

Berg AO, Melle I, Torjesen PA, Lien L, Hauff E, Andreassen OA: A 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. 10.4088/JCP.09m05299yel.CrossRefPubMed

27.

Hedelin M, Lof M, Olsson M, Lewander T, Nilsson B, Hultman CM, Weiderpass E: Dietary 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: 38-10.1186/1471-244X-10-38. 244X-10-38CrossRefPubMedPubMedCentral

28.

Itzhaky D, Amital D, Gorden K, Bogomolni A, Arnson Y, Amital H: Low serum vitamin D concentrations in patients with schizophrenia. Isr Med Assoc J. 2012, 14 (2): 88-92.PubMed

29.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The mini-international neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 (20): 22-33. quiz 34–57PubMed

30.

Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979, 134: 382-389. 10.1192/bjp.134.4.382.CrossRefPubMed

31.

Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed

32.

Shulman KI: Clock-drawing: is it the ideal cognitive screening test?. Int J Geriatr Psychiatry. 2000, 15 (6): 548-561. 10.1002/1099-1166(200006)15:6<548::AID-GPS242>3.0.CO;2-U.CrossRefPubMed

33.

Alexopoulos GS, Abrams RC, Young RC, Shamoian CA: Cornell scale for depression in Dementia. Biol Psychiatry. 1988, 23 (3): 271-284. 10.1016/0006-3223(88)90038-8.CrossRefPubMed

34.

Grimnes G, Almaas B, Eggen AE, Emaus N, Figenschau Y, Hopstock LA, Hutchinson MS, Methlie P, Mihailova A, Sneve M, Torjesen P, Wilsgaard T, Jorde R: Effect of smoking on the serum levels of 25-hydroxyvitamin D depends on the assay employed. Eur J Endocrinol. 2010, 163 (2): 339-348. 10.1530/EJE-10-0150.CrossRefPubMed

35.

Pedersen R, Hofmann B, Mangset M: Patient autonomy and informed consent in clinical practice. Tidsskr Nor Laegeforen. 2007, 127 (12): 1644-1647.PubMed

36.

van der Wielen RP, Lowik MR, van den Berg H, de Groot LC, Haller J, Moreiras O, van Staveren WA: Serum vitamin D concentrations among elderly people in Europe. Lancet. 1995, 346 (8969): 207-210. 10.1016/S0140-6736(95)91266-5.CrossRefPubMed

37.

Lapid MI, Drake MT, Geske JR, Mundis CB, Hegard TL, Kung S, Frye MA: Hypovitaminosis D in psychogeriatric inpatients. J Nutr Health Aging. 2013, 17 (3): 231-234. 10.1007/s12603-012-0383-7.CrossRefPubMed

38.

Schneider B, Weber B, Frensch A, Stein J, Fritz J: Vitamin D in schizophrenia, major depression and alcoholism. J Neural Transm. 2000, 107 (7): 839-842. 10.1007/s007020070063.CrossRefPubMed

39.

Humble MB, Gustafsson S, Bejerot S: Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis. J Steroid Biochem Mol Biol. 2010, 121 (1–2): 467-470.CrossRefPubMed

40.

Stern RA, Robinson B, Thorner AR, Arruda JE, Prohaska ML, Prange AJ: A survey study of neuropsychiatric complaints in patients with graves’ disease. J Neuropsychiatry Clin Neurosci. 1996, 8 (2): 181-185.CrossRefPubMed

41.

Chan AK, Duh QY, Katz MH, Siperstein AE, Clark OH: Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy: a case–control study. Ann Surg. 1995, 222 (3): 402-12. 10.1097/00000658-199509000-00017. discussion 412–4CrossRefPubMedPubMedCentral

42.

Lachner C, Steinle NI, Regenold WT: The neuropsychiatry of vitamin B12 deficiency in elderly patients. J Neuropsychiatry Clin Neurosci. 2012, 24 (1): 5-15.CrossRefPubMed

43.

Eyles DW, Smith S, Kinobe R, Hewison M, McGrath JJ: Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neuroanat. 2005, 29 (1): 21-30. 10.1016/j.jchemneu.2004.08.006.CrossRefPubMed

44.

Eyles DW, Burne TH, McGrath JJ: Vitamin D, effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol. 2013, 34 (1): 47-64. 10.1016/j.yfrne.2012.07.001.CrossRefPubMed

45.

Carlsson A: A half-century of neurotransmitter research: impact on neurology and psychiatry (Nobel lecture). Chembiochem. 2001, 2 (7–8): 484-493.CrossRefPubMed

46.

Groves NJ, Kesby JP, Eyles DW, McGrath JJ, Mackay-Sim A, Burne TH: Adult vitamin D deficiency leads to behavioural and brain neurochemical alterations in C57BL/6 J and BALB/c mice. Behav Brain Res. 2013, 241: 120-131.CrossRefPubMed

47.

Lewis DA, Moghaddam B: Cognitive dysfunction in schizophrenia: convergence of gamma-aminobutyric acid and glutamate alterations. Arch Neurol. 2006, 63 (10): 1372-1376. 10.1001/archneur.63.10.1372.CrossRefPubMed

48.

Riaza Bermudo-Soriano C, Perez-Rodriguez MM, Vaquero-Lorenzo C, Baca-Garcia E: New perspectives in glutamate and anxiety. Pharmacol Biochem Behav. 2012, 100 (4): 752-774. 10.1016/j.pbb.2011.04.010.CrossRefPubMed

49.

Mohler H: The GABA system in anxiety and depression and its therapeutic potential. Neuropharmacology. 2012, 62 (1): 42-53. 10.1016/j.neuropharm.2011.08.040.CrossRefPubMed

50.

Szakacs R, Janka Z, Kalman J: The “blue” side of glutamatergic neurotransmission: NMDA receptor antagonists as possible novel therapeutics for major depression. Neuropsychopharmacol Hung. 2012, 14 (1): 29-40.PubMed

51.

Coyle JT: Substance use disorders and Schizophrenia: a question of shared glutamatergic mechanisms. Neurotox Res. 2006, 10 (3–4): 221-233.CrossRefPubMed

52.

Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW: Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008, 65 (5): 508-512. 10.1001/archpsyc.65.5.508.CrossRefPubMed

53.

Jorde R, Waterloo K, Saleh F, Haug E, Svartberg J: Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels: the Tromso study. J Neurol. 2006, 253 (4): 464-470. 10.1007/s00415-005-0027-5.CrossRefPubMed

54.

Gronli O, Wynn R: Normocalcemic hyperparathyroidism and treatment resistant depression. Psychosomatics. 2013, 54: 492-497.CrossRef

55.

Duque G, Close JJ, de Jager JP, Ebeling PR, Inderjeeth C, Lord S, McLachlan AJ, Reid IR, Troen BR, Sambrook PN: Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention. Med J Aust. 2010, 193 (3): 173-179.PubMed

56.

Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R: US preventive services task force: primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S preventive services task force. Ann Intern Med. 2010, 153 (12): 815-825. 10.7326/0003-4819-153-12-201012210-00008.CrossRefPubMed

57.

Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A: Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007, 370 (9588): 657-666. 10.1016/S0140-6736(07)61342-7.CrossRefPubMed

58.

Bischoff-Ferrari HA: Relevance of vitamin D in muscle health. Rev Endocr Metab Disord. 2012, 13 (1): 71-77. 10.1007/s11154-011-9200-6.CrossRefPubMed

59.

Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H: Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2009, 20 (2): 315-322. 10.1007/s00198-008-0662-7.CrossRefPubMed

60.

Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J: Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009, 339: b3692-10.1136/bmj.b3692.CrossRefPubMedPubMedCentral

61.

Tuohimaa P, Keisala T, Minasyan A, Cachat J, Kalueff A: Vitamin D, nervous system and aging. Psychoneuroendocrinology. 2009, 34 (Suppl 1): S278-86.CrossRefPubMed

62.

de Abreu DA F, Eyles D, Feron F: Vitamin D, a neuro-immunomodulator: implications for neurodegenerative and autoimmune diseases. Psychoneuroendocrinology. 2009, 34 (1): S265-77.CrossRef

63.

Hutchinson MS, Grimnes G, Joakimsen RM, Figenschau Y, Jorde R: Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromso study. Eur J Endocrinol. 2010, 162 (5): 935-942. 10.1530/EJE-09-1041.CrossRefPubMed

64.

Autier P, Boniol M, Pizot C, Mullie P: Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol. 2014, 2 (1): 76-89. 10.1016/S2213-8587(13)70165-7.CrossRefPubMed

65.

Hansen V, Jacobsen BK, Arnesen E: Prevalence of serious psychiatric morbidity in attenders and nonattenders to a health survey of a general population : the Tromso health study. Am J Epidemiol. 2001, 154 (10): 891-894. 10.1093/aje/154.10.891.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/134/prepub

Title: Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis
Authors: Ole Grønli
Jan Magnus Kvamme
Rolf Jorde
Rolf Wynn
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/1471-244X-14-134

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Vitamin D deficiency is common in psychogeriatric patients, independent of diagnosis

Abstract

Background

Method

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders

Differentiating ADHD from oral language difficulties in children: role of movements and effects of stimulant medication

“Clozapine makes me quite drowsy, so when I wake up in the morning those first cups of coffee are really handy”: an exploratory qualitative study of excessive caffeine consumption among individuals with schizophrenia

Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study

Mental health disparities between Roma and non-Roma children in Romania and Bulgaria

Mobile phone text message reminders of antipsychotic medication: is it time and who should receive them? A cross-sectional trust-wide survey of psychiatric inpatients