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Nonlinear Association Between NHHR and Suicide Attempts in First-Episode Untreated Depression With a Threshold Effect
Xiaofang Shang1, Diwen Shen2, Ya-Nan Sun3
1Department of Psychiatry, Nanjing Medical University Affiliated Brain Hospital, Nanjing, 210029, China, c-nbh.com.
Depression and Anxiety
|May 13, 2026
Summary
The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is nonlinearly linked to suicide attempts (SAs) in first-episode untreated major depressive disorder (MDD) patients. A threshold of NHHR=5.76 indicates a significant increase in SA risk.
Area of Science:
- Neuroscience
- Biochemistry
- Psychiatry
Background:
- Major Depressive Disorder (MDD) is a leading cause of disability worldwide.
- Suicide attempts (SAs) are a critical concern in MDD patients.
- Lipid profiles, including the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR), are increasingly studied in relation to psychiatric disorders.
Purpose of the Study:
- To investigate the relationship between NHHR and SAs in first-episode untreated (FEU) MDD patients.
- To explore potential nonlinear associations and identify a threshold effect.
Main Methods:
- A cross-sectional study included 1718 FEU MDD patients.
- NHHR was calculated from fasting lipid profiles.
- Multivariable logistic regression and restricted cubic splines were used to analyze the dose-response relationship.
Main Results:
- SA prevalence was 20.1% in the study population.
- SA risk increased progressively with higher NHHR tertiles (p < 0.001).
- A nonlinear threshold effect was identified at NHHR = 5.76, with increased SA likelihood below this level (OR=1.27).
Conclusions:
- NHHR is independently and nonlinearly associated with SAs in FEU MDD patients.
- A clinically significant threshold for NHHR was determined to be 5.76.
- NHHR can serve as a practical tool for early suicide risk stratification in clinical settings.
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