BMJ Press Releases, Saturday 14 September 1996
Volume 313 No 7058

EMBARGOED 00.01 HRS 13 SEPTEMBER 1996

STUDIES EXAMINE POSSIBLE LINK BETWEEN CHOLESTEROL CONCENTRATIONS AND DEPRESSION OR SUICIDE

[Serum cholesterol concentration and death from suicide in men: Paris prospective study I]
[Rapid decrease of serum cholesterol concentration and postpartum depression]
[Editorial. Lowered serum cholesterol and low mood. The link remains unproved]
[Commentary: Having too much evidence (depression, suicide and low serum cholesterol]

Two papers in this week's BMJ add to the debate on the relation between cholesterol concentrations and depression, accidents or suicide which has been the subject of other published studies.

Reducing serum cholesterol is considered desirable particularly for those with high concentrations of serum cholesterol and a history of atherosclerotic disease. Atherosclerotic heart disease involving the coronary arteries is the most common single cause of death in the UK.

Zureik et al studied 6393 working Frenchmen, aged 43-52, who had undergone annual repeat measurements of serum cholesterol concentration, and followed them up for up to 17 years. They discovered that 32 of them had committed suicide and that the risk of suicide was higher in men with low average serum cholesterol concentrations and in those whose cholesterol concentration declined over time.

Ploeckinger et al studied 20 pregnant women, average age 25 and without significant marital, health, mental or socio-economic problems, because of the known effect of "maternity blues" after birth. "We postulated that the sudden fall in blood lipids (fats) after delivery could serve as a "natural model to test the association between serum lipids and mood," say the authors who found " a signficant correlation between decrease in cholesterol and depressive symptoms after delivery that remained even after adjustment for progesterone concentration".

Both studies, however, conclude that despite their results they cannot rule out other factors may have influenced the outcome. This, says an accompanying editorial by S Lori Brown, is significant because previous studies have shown that the association between low serum cholesterol and depression an be explained by other confounders such as poor health. "It is not outlandish to suggest that men who are ill may be depressed and that this has influenced their appetite and hence cholesterol concentrations," she says.

A commentary from Malcolm Law, accompanying the paper by Zureik et al, points out that the issue has already been examined in three randomised, placebo, controlled trials of statins (a drug that can reduce deaths in patients with coronary artery disease). These trials found that depression was no more common among those having treatment. Contact:

Dr Mahmoud Zureik Research fellow

National Institute of Health and Medical Research
Paris
France

Tel: 00 331 4395 9567/72
Fax: 00 331 4543 4269

Dr Barbara Ploeckinger Clinical assistant

Universitatsklinik fur Frauenheilkunde
Vienna
Austria

Tel: 00 43 1 40400 2994
Fax: 00 43 1 40400 2995

S Lori Brown Senior research scientist officer

Center for Devices and Radiological Health
1350 Piccard Drive
Rockville, MD 20850
USA

Malcolm Law Reader

Wolfson Institute of Preventive Medicine
Dept. of Environmental and Preventive Medicine
St Bartholomew's and Royal London School of Medicine
London

Tel: 0171 982 6268/9
Fax: 0171 982 6270
e-mail: n.j.wald@mds.qmw.ac.uk

GP CARE AS EFFECTIVE AS HOSPITALS FOR WOMEN WITH BREAST CANCER

[Routine follow up of breast cancer in primary care: randomised trial]

Women with breast cancer can be followed up just as well in general practice as in hospitals, according to the results of a randomised trial published in this week's BMJ.

Routine follow up after treatment for breast cancer usually entails visits to hospital outpatients for physical examination, blood tests and mammography. But a study of 296 women in England found that those followed up by GPs were diagnosed just as quickly if they had a recurrence as those followed up in hospital.

The women receiving GP care were no more anxious or in worse health than those seen in hospital. The authors point out that most recurrences of breast cancer are picked up by the women themselves in the intervals between appointments.

Contact:

Dr Eva Grunfeld

c/o Ottawa Regional Cancer Centre
501 Smyth Road
Ottawa
Ontario
Canada

Tel: 001 613 247 6877
Fax: 001 613 737 6782

LOCAL HEALTH COMMISSIONS SHOULD BE GIVEN DISCRETION IN DEPRIVATION PAYMENTS TO GPs

[Deprivation payments to general practitioners: limitations of census data]

Local health commissions should be given local discretion in allocating deprivation payments to general practices because of the innaccuracies and limitations of census data which is currently used, says a paper in this week's BMJ.

GPs, who are self employed within the NHS, can receive deprivation payments which are intended to take into account social deprivation in their practice population. The authors say there are problems with the census data from which deprivation payments have been calculated since June 1995. Problems include undernumeration, under counting of homeless people and refugees and errors in the way the census data was collected. They say that some GPs in the UK have been disadvantaged as a result of these problems.

Contact:

Dr F Azeem Majeed Lecturer in public health medicine

Dept of Public Health Sciences
St. George's Hospital Medical School
London SW17 ORE

Tel: 0181 725 2797
Fax: 0181 725 3584
Email: a.majeed@sghms.ac.uk

FAILURE TO ALLOCATE DEPRIVATION PAYMENTS ADEQUATELY TO GPs COULD THREATEN NHS PRIMARY CARE COVER FOR THE MOST DISADVANTAGED

[Editorial. Deprivation payments revisited (again). Equity remains a problem with current method of allocation]

An accompanying editorial points out that with increasing emphasis on primary care, rising workload in general practice and an emerging manpower crisis, destablising influences such as unpredictable shifts in income should be avoided. "Unfortunately, continuing to allocate deprivation payments to practices on the basis of geographical wards has resulted in large shifts of resources," the authors say.

"Only about nine per cent of patients attract deprivation payments; therefore only a minority of general practitioners receive them. However, deprivation payments have made an important contribution towards lower, and therefore sustainable, list sizes in inner city practices since the new contract. Failing to allocate payments to practices that deserve them risks continuing erosion of financial viability and a net exodus of doctors, The loss of primary care cover for our most disadvantaged populations would be a disaster for the NHS."

Contact:

Prof. Richard Hobbs Dept of General Practice

Medical School
Birmingham B15 2TT

Tel: 0121 414 3760/3766
Fax: 0121 414 6571
E-mail: general-practice@bham.ac.uk

EMBARGO: 00.01 HRS FRIDAY 13 SEPTEMBER 1996

Issued on behalf of the authors by: Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP
Telephone: 0171 383 6254, (between 08.30 - 18.00), (After 6pm & at weekends): 01895 239687, 0171 727 2897, 0181 674 6294, 0171 727 2897, 01491 651405

PLEASE STATE THE BMJ AS THE SOURCE OF ALL ARTICLES USED

Access jobs at BMJ Careers
Whats new online at Student BMJ