{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:10:29Z","timestamp":1781179829081,"version":"3.54.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["SDR 02-237 and 98-004"],"award-info":[{"award-number":["SDR 02-237 and 98-004"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U S. Department of Veterans Affairs","doi-asserted-by":"crossref","award":["SDR 02-237 and 98-004"],"award-info":[{"award-number":["SDR 02-237 and 98-004"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The purpose of this study is to determine the associations between Vitamin D supplementation, 25(OH) blood serum levels, suicide attempts, and intentional self-harm in a population of veterans in the Department of Veterans Affairs (VA).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort study of US Veterans supplemented with Vitamin D. Veterans with any Vitamin D<jats:sub>3<\/jats:sub> (cholecalciferol) or Vitamin D<jats:sub>2<\/jats:sub> (ergocalciferol) fill between 2010 and 2018 were matched 1:1 to untreated control veterans having similar demographics and medical histories. Cox proportional hazards regression was used to estimate the time from the first Vitamin D<jats:sub>3<\/jats:sub> (cholecalciferol) or Vitamin D<jats:sub>2<\/jats:sub> (ergocalciferol) prescription fill to the first suicide attempt or intentional self-harm. Analyses were repeated in stratified samples to measure associations by race (Black or White), gender (male or female), blood levels (0\u201319 ng\/ml, 20\u201339 ng\/ml, and 40+ ng\/ml), and average daily dosage.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Vitamin D3 and D2 supplementation were associated with a 45% and 48% lower risk of suicide attempt and self-harm ((D<jats:sub>2<\/jats:sub> Hazard Ratio (HR) = 0.512, [95% CI, 0.457, 0.574]; D<jats:sub>3<\/jats:sub> HR = 0.552, [95% CI, 0.511, 0.597])). Supplemented black veterans and veterans with 0\u201319 ng\/ml vitamin D serum levels were at ~64% lower risk relative to controls (Black Veteran HR: 0.362 [95% CI: 0.298,0.440]; 0\u201319 ng\/ml HR: 0.359 [95% CI: 0.215,0.598]). Supplementation with higher vitamin D dosages was associated with greater risk reductions than lower dosages (Log Average Dosage HR: 0.837 [95% CI: 0.779,0.900]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Vitamin D supplementation was associated with a reduced risk of suicide attempt and self-harm in Veterans, especially in veterans with low blood serum levels and Black veterans.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0279166","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T18:28:04Z","timestamp":1675276084000},"page":"e0279166","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["The association between vitamin D serum levels, supplementation, and suicide attempts and intentional self-harm"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3325-7510","authenticated-orcid":true,"given":"Jill E.","family":"Lavigne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1724-6897","authenticated-orcid":true,"given":"Jason B.","family":"Gibbons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"pone.0279166.ref001","volume-title":"Vitamin D Fact Sheet for Health Professionals","author":"Office of Dietary Supplements NIoH"},{"issue":"14","key":"pone.0279166.ref002","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1001\/jama.2021.3069","article-title":"Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement","volume":"325","author":"Force USPST","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"pone.0279166.ref003","doi-asserted-by":"crossref","first-page":"e51543","DOI":"10.1371\/journal.pone.0051543","article-title":"Low vitamin D status and suicide: a case-control study of active duty military service members.","volume":"8","author":"JC Umhau","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"pone.0279166.ref004","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know","volume":"96","author":"AC Ross","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0279166.ref005","unstructured":"Office of Mental Health and Suicide Prevention DoVHA. National Veteran Suicide Prevention Annual Report. 2021."},{"issue":"6","key":"pone.0279166.ref006","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/YPG.0000000000000295","article-title":"Effects of vitamin D-related gene polymorphisms on attempted suicide","volume":"31","author":"YX Wei","year":"2021","journal-title":"Psychiatr Genet"},{"issue":"3","key":"pone.0279166.ref007","first-page":"224","article-title":"Biochemical predictors in presentations to the emergency department after a suicide attemp.","volume":"122","author":"I Yagci","year":"2021","journal-title":"Bratisl Lek Listy"},{"key":"pone.0279166.ref008","first-page":"e1897","article-title":"Evaluating the heterogeneous effect of a modifiable risk factor on suicide: The case of vitamin D deficiency.","author":"JR Zubizarreta","year":"2021","journal-title":"Int J Methods Psychiatr Res"},{"key":"pone.0279166.ref009","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jpsychires.2020.02.027","article-title":"Increased brain vitamin D receptor expression and decreased expression of cathelicidin antimicrobial peptide in individuals who died by suicide","volume":"125","author":"TT Postolache","year":"2020","journal-title":"J Psychiatr Res"},{"issue":"2","key":"pone.0279166.ref010","first-page":"106","article-title":"The association between low vitamin D levels and suicide attempts in adolescents.","volume":"32","author":"G. Gokalp","year":"2020","journal-title":"Ann Clin Psychiatry"},{"issue":"1","key":"pone.0279166.ref011","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1097\/MCG.0000000000001094","article-title":"Predictors of Suicidal Ideation Among IBD Outpatients.","volume":"53","author":"JG Hashash","year":"2019","journal-title":"J Clin Gastroenterol."},{"issue":"8","key":"pone.0279166.ref012","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00406-018-0932-0","article-title":"Hypovitaminosis D is associated with negative symptoms, suicide risk, agoraphobia, impaired functional remission, and antidepressant consumption in schizophrenia.","volume":"269","author":"G Fond","year":"2019","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"pone.0279166.ref013","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.psyneuen.2014.08.016","article-title":"Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood","volume":"50","author":"C Grudet","year":"2014","journal-title":"Psychoneuroendocrinology"},{"key":"pone.0279166.ref014","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1186\/1756-0500-7-528","article-title":"Vitamin D supplementation for treatment of seasonal affective symptoms in healthcare professionals: a double-blind randomised placebo-controlled trial.","volume":"7","author":"TB Frandsen","year":"2014","journal-title":"BMC Res Notes"},{"issue":"1","key":"pone.0279166.ref015","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s13104-019-4218-z","article-title":"Vitamin D3 supplementation and treatment outcomes in patients with depression (D3-vit-dep).","volume":"12","author":"JP Hansen","year":"2019","journal-title":"BMC Res Notes"},{"issue":"5","key":"pone.0279166.ref016","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1192\/bjp.bp.111.104349","article-title":"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.","volume":"201","author":"M Kjaergaard","year":"2012","journal-title":"Br J Psychiatry"},{"key":"pone.0279166.ref017","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jsbmb.2017.08.002","article-title":"Vitamin D and symptoms of depression in overweight or obese adults: A cross-sectional study and randomized placebo-controlled trial","volume":"177","author":"A Mousa","year":"2018","journal-title":"J Steroid Biochem Mol Biol"},{"key":"pone.0279166.ref018","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jpsychires.2017.07.021","article-title":"Vitamin D supplementation in bipolar depression: A double blind placebo controlled trial","volume":"95","author":"WK Marsh","year":"2017","journal-title":"J Psychiatr Res"},{"key":"pone.0279166.ref019","doi-asserted-by":"crossref","first-page":"8232863","DOI":"10.1155\/2017\/8232863","article-title":"Vitamin D Supplementation Improves Mood in Women with Type 2 Diabetes","volume":"2017","author":"S Penckofer","year":"2017","journal-title":"J Diabetes Res"},{"issue":"4","key":"pone.0279166.ref020","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1016\/j.dsx.2019.06.011","article-title":"Effects of vitamin D supplementation on depressive symptoms in type 2 diabetes mellitus patients: Randomized placebo-controlled double-blind clinical trial","volume":"13","author":"M Omidian","year":"2019","journal-title":"Diabetes Metab Syndr"},{"issue":"2","key":"pone.0279166.ref021","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3945\/jn.115.218883","article-title":"Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial","volume":"146","author":"Z Sepehrmanesh","year":"2016","journal-title":"J Nutr"},{"key":"pone.0279166.ref022","doi-asserted-by":"crossref","first-page":"110125","DOI":"10.1016\/j.jpsychores.2020.110125","article-title":"Vitamin D deficiency and suicidal ideation: A cross-sectional study of 157,211 healthy adults.","volume":"134","author":"SY Kim","year":"2020","journal-title":"J Psychosom Res"},{"issue":"2","key":"pone.0279166.ref023","first-page":"168","article-title":"The effect of vitamin D supplementation on sexual functioning and depressive symptoms in young women with low vitamin D status.","volume":"69","author":"R Krysiak","year":"2018","journal-title":"Endokrynol Pol"},{"key":"pone.0279166.ref024","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jsbmb.2017.10.025","article-title":"Dose ranging effects of vitamin D3 on the geriatric depression score: A clinical trial","volume":"178","author":"V Yalamanchili","year":"2018","journal-title":"J Steroid Biochem Mol 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Screening for Vitamin D Deficiency in Adults: An Evidence Review for the US Preventive Services Task Force. In: Quality AfHRa, ed. 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Kessler","year":"2020","journal-title":"Molecular Psychiatry"},{"issue":"5","key":"pone.0279166.ref033","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1001\/jama.2020.10224","article-title":"Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores: A Randomized Clinical Trial","volume":"324","author":"OI Okereke","year":"2020","journal-title":"JAMA"},{"key":"pone.0279166.ref034","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1017\/jns.2018.19","article-title":"No improvement in depressive symptoms by vitamin D supplementation: results from a randomised controlled trial","volume":"7","author":"R Jorde","year":"2018","journal-title":"J Nutr Sci"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279166","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T18:28:38Z","timestamp":1675276118000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279166"}},"subtitle":[],"editor":[{"given":"James D.","family":"Clelland","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0279166","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}