Progressnotes - October/November 2012
- About MUSC Health
Could something as simple as a daily supplement of fish oil help prevent suicide in veterans?
If so, that would be welcome news for the military. The rate of suicides in veterans is almost double that in the civilian population (41 suicides in men and 12 in women per 100,000 veterans vs 23 in men and 6 in women per 100,000 civilians). Since the beginning of Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom, suicide rates among veterans have more than doubled.1
To help evaluate fish oil’s efficacy in preventing suicide, the Military Operational Medicine Joint Program Committee (JPC-5) awarded $10 million dollars to MUSC, the Ralph H. Johnson VA Medical Center, and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to conduct a 3-year, prospective randomized controlled trial testing whether increased intake of omega-3 polyunsaturated fatty acids (PUFAs) can reduce depression and suicidality in 350 at-risk veterans. Omega-3 PUFAs cannot be manufactured or stored long term by the body and so must be obtained from dietary sources, such as salmon, tuna, herring, sardines, and mackerel.
Participating veterans will be asked to drink two “smoothies” per day; half of the veterans will receive smoothies containing SmartFish Nutrifriend (SmartFish, Oslo, Norway), a supplement rich in the omega-3 PUFAs docosahexaenoic acid (DHA) and eicosapentaenoic acid (EHA). Blood samples will be obtained at follow-up. Veterans in both control and experimental groups will participate in well-validated cognitive and psychological assessments, which will provide an ongoing barometer of their mood, anxiety and performance on simple cognitive and perceptual tasks.
According to Bernadette Marriott, PhD (pictured above), a professor in the Clinical Neuroscience Division of the Institute of Psychiatry at MUSC, who will be leading the study, “If increasing the omega-3 fatty acid intakes is effective in reducing the risk of suicidality in this population of veterans, then these results can also be directly translated to active-duty military populations,” meaning that seafood could be more regularly featured in mess halls and meals ready to eat or that fish oil supplements could be provided to all members of the armed forces. Ronald Acierno, PhD, and Hugh Myrick, M.D., who both hold joint appointments at MUSC and the VA, are coinvestigators on the grant.
A number of the participating veterans will also be recruited into one of two substudies. One, led by Therese K. Killeen, PhD, will examine whether an increased intake of omega-3 PUFAs helps curb alcohol abuse, which is often associated with suicide. The second, headed by Mark George, PhD, will use functional magnetic resonance imaging to document any changes in brain function after increased intake of omega-3 PUFAs. Participating veterans will be asked to perform decision-making tasks during magnetic resonance imaging to evaluate whether increased levels of omega-3 PUFAs correlate with less risky decision making.
Research by the NIAAA’s Joseph R. Hibbeln, M.D., a coprincipal investigator on the grant, has long suggested a link between low levels of omega-3 PUFAs and a risk for suicide, particularly impulsive suicide. In an important article that provided the basis for the current study, Hibbeln compared plasma samples from 800 veterans who had committed suicide with 800 age- and sex-matched controls, finding significantly lower levels of omega-3 PUFAs in those who committed suicide.2
The project will be managed by the Congressionally Directed Medical Research Programs (CDMRP).
¹ Tarabay J. Suicide rivals the battlefield in toll on U.S. military. National Public Radio. June 17, 2010. Available at http://www.npr.org/templates/story/story. php?storyId=127860466. Accessed November 14, 2012.
² Lewis MD, Hibbeln JR, Johnson JE, et al. Suicide deaths of active-duty US military and omega-3 fatty acid status: a case-control comparison. J Clin Psychiatry. 2011;72(12):1585-90.