Do children with mental disorders have higher prevalence of hypovitaminosis D?
Mini Zhang1, Keith Cheng1, Robert Rope2, Elizabeth Martin3, Ajit Jetmalani1
Inadequate vitamin D level is associated with various adverse medical outcomes. There is a growing concern that insufficient vitamin D may play a role in the development of psychiatric symptoms. This study aims to answer the question: do children with mental disorders have a higher prevalence of hypovitaminosis D?
A retrospective chart review examined 25 hydroxyvitamin D (25(OH)D) levels in youth ages 7 to 17 (n=67) at two Oregon psychiatric residential facilities. Vitamin D deficiency is defined as <20 ng/ml and insufficiency as <30 ng/ml. Diagnoses were organized into six categories. 25(OH)D levels were compared across genders and diagnostic groups using a two-sample t-test and ANOVA, respectively. Statistical differences in prevalence across diagnostic categories were calculated using a Pearson chi-square test.
Using the data from Saintonge’s NHANES III study on healthy US children for comparison,
- 21% of our cohorts were found to be vitamin D deficient and 64% insufficient,
- in contrast to 14% and 48%, respectively.
While our results are not statistically significant, mainly because of small sample size, the overall mean 25(OH)D level in our cohort was insufficient (27.59 ± 9.35 ng/ml), compared to a sufficient mean value of 32.1 ng/ml in the general population. No statistical significant difference was found in the prevalence across diagnostic categories. This study found that children with psychiatric disorders might have a higher prevalence of hypovitaminosis D than the general pediatric population. Although a causal relationship between hypovitaminosis D and psychiatric disorders cannot be derived based on the study design, our study provides initial descriptive data on the prevalence of hypovitaminosis D in children with psychiatric disorders, which has not been previously reported to our knowledge. Prospective studies with a larger sample size and controlled variables would allow more precise analysis of the relationship between hypovitaminosis D and childhood mental disorders.
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Anxiety disorder
• Anxiety Post traumatic stress disorder
• Obsessive compulsive disorder
• Post traumatic stress disorder
Autism spectrum disorders (ASD)
• Autism
• Asperger’s syndrome
• Pervasive developmental disorder
Disruptive disorders
• Attention deficit/hyperactive disorder (ADD/ADHD)
• Conduct disorder
• Disruptive disorder not otherwise specified (NOS)
• Intermittent explosive disorder
• Oppositional defiant disorder
Mood disorders
• Bipolar disorder I and II
• Cyclothymia
• Major depression
Psychotic disorders
• Psychotic disorder NOS
• Schizoaffective disorder
• Schizophrenia
Other disorders
• Acculturation problem
• Cognitive disorder
• Eating disorder
• Enuresis
• Language/communication disorder
• Learning disorder
• Relational problem
• Sleep disorder
• Substance abuse and dependence
Methods
A retrospective chart review was conducted at two residential psychiatric treatment programs in Oregon, USA, (latitude 45°N). There were 67 patients aged from 7 to 17 years, whose serum 25(OH)D levels were measured between October 2009 and 2010. Patients had one to four co-morbid psychiatric diagnoses. There were no exclusion criteria. Given the retrospective nature and lack of identifiable health data used in the study, no institutional review board approval was needed.
Deficiency was defined as <20 ng/ml, based on the AAP recommended value. Insufficiency was defined as <30 ng/ ml, by the local laboratory standard used in Oregon. For the 14 patients who had multiple 25(OH)D levels recorded, we used the lowest 25(OH)D level in our analyses. We felt this method was justified clinically if any period with this degree of hypovitaminosis D during childhood is correlated to developmental differences. The diagnoses were organized into six categories shown in Table 1. For patients with multiple diagnoses, their 25(OH)D level was counted individually in each diagnostic category to calculate the mean and prevalence.
25(OH)D levels were compared across genders and diagnostic groups using a two-sample t-test and ANOVA, respectively. Statistical differences in prevalence across diagnostic groups were calculated using a Pearson chi-square test. The analysis was performed using STATA IC (version 11) from StataCorp LP, College Station, Texas.
Discussion
Beyond its importance in endocrine function, there is growing awareness of the role that vitamin D plays in brain function. However, the prevalence of hypovitaminosis D in children with mental illnesses is uncertain. This study found that children with serious psychiatric disorders may have a higher prevalence of hypovitaminosis D and a lower mean 25(OH)D level, compared to the general US population10. Although no statistical significance can be concluded, it is noteworthy that psychotic disorders had the highest prevalence of hypovitaminosis D among the specific diagnostic categories, which supports previous studies 2,3,7. We suggest using a cut-off value of 20 ng/ml for clinical interventions, as recommended by the AAP and IOM10. Clinicians should discuss the costs and benefits of treatment with patients when levels are between 20 and 30 ng/ml.
The primary limitation of this study was its small sample size. Due to its retrospective design, we were limited by the availability of 25(OH)D studies without specific clinical indications. Other limitations include not controlling for the length of inpatient stay, ethnicity, age, nutritional status, sun exposure, or skin pigmentation. For the patients with multiple diagnoses, their 25(OH)D was counted in each diagnostic category, which might overestimate the prevalence of hypovi-taminosis D. The study utilized the lowest level of 25(OH)D for patients with multiple measurements, which might result in lower mean level and higher prevalence. Although a causal relationship between hypovitaminosis D and psychiatric disorders cannot be derived based on the study design, our study provides important initial descriptive data on the prevalence of hypovitaminosis D in a pediatric population with psychiatric disorders which has not, to our knowledge, been previously reported.
Conclusion
As research continues on the impact of vitamin D in medicine, its implication for psychiatric disorders may be clarified. While no robust statistical conclusions can be made mainly due to small sample size, this study provides initial data suggesting that children with mental illnesses might have lower vitamin D levels and a higher prevalence of hypovitaminosis D than the general population.
Given the high prevalence of hypovitaminosis D and its profound impact on overall health, clinicians should have a higher suspicion of hypovitaminosis D in the pediatric psychiatric population.
Important future steps include the design of a larger prospective study with more controlled variables would allow more precise analysis to establish the prevalence of hypovitaminosis D, as well as to infer any correlation between hypovitaminosis D and childhood mental illness. Preventative and ameliorative measures might subsequently be instigated to assess causation and afiSect the development and treatment of certain mental disorders.
See also VitaminDWiki
- Mental Illness and Vitamin D
- Mental health problems cut in half when have adequate level of vitamin D – Jan 2013
- Hypothesis: Some Mental Illness could be treated or prevented with vitamin D
- Bipolar Disorder may be related to cellular, not blood Vitamin D
- 99 percent of psychiatric population had less than 30 ng of vitamin D – June 2013
- Fewest Google searches for Mental Health when there is lots of vitamin D from the sun – May 2013
- Seach VitaminDWiki for ("mental health" OR "mental illness") 1880 items as of Feb 2014