Psychology, 2010, 1: 17-21 doi:10.4236/psych.2010.11003 Published Online April 2010 (http://www.SciRP.org/journal/psych) Copyright © 2010 SciRes PSYCH 17 Beta Thalassemia Minor as a Risk Factor for Suicide and Violence: A Failure to Replicate Alireza Fotouhi Ghiam 2 , Alireza Hashemi 1 , Samira Taban 1 , Mohammad Reza Bordbar 1 , Mehran Karimi 1 1 Hematology Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran; 2 Mental Health University Institute, Douglas Hospital, McGill University, Montreal, Canada. Email: karimim@sums.ac.ir Received January 13 th , 2010; revised February 22 nd , 2010; accepted February 23 rd , 2010. ABSTRACT The aim of present study was to evaluate the association of thalassemia minor with suicide, impulsivity and aggression. The study group consisted of 293 suicidal subjects, 300 violent criminals and 300 control subjects. Thalassemia trait was slightly more common in criminals (7.3%) than in controls (6.67%), this difference was not statistically significant (p = 0.75). Similarly, carrier trait was observed more in suicidal subjects (8.87%) though this difference was not statis- tically significant (p = 0.3). Despite a plausible biological hypothesis, our study results do not support that thalassemia minor could be a risk factor for suicidal, impulsivity and aggressive behaviors. Keywords: Thalassemia Minor, Aggression, Suicide 1. Introduction Beta-thalassemia is among the most common genetic disor- ders worldwide. The clinical spectrum of β-thalassemia ranges from the severe transfusion-dependent β-thalassemia major to the asymptomatic β-thalassemia carriers [1]. Showing geographical differences in prevalence, het- erozygote β-thalassemia minor is frequent particularly in Mediterranean area and amongst people of Greek, Italian, Middle Eastern, Southeast Asian, Southern Chinese and African descent [2]. The significant clinical manifesta- tions and complications commonly associated with β-thalassemia major are not seen in β-thalassemia minor. That is, most affected individuals are asymptomatic or characterized clinically by mild anemia with persistent microcytosis that usually goes unnoticed [1,3]. Consid- ering the high prevalence of β-thalassemia minor in Iran (7-10 %), the National Thalassamia Program has been launched since 1997 for screening and genetic counseling in attempt to reduce the birth rate of β-thalassemia major [4-6]. Abnormal lipid profile has been repeatedly reported in all clinical phenotypes of β-thalassemia including thalas- semia major, thalassemia intermedia and thalassemia minor [7-11]. Patients with β-thalassemia trait have been found to have lower plasma concentrations of total cho- lesterol (TC) and low-density lipoprotein cholesterol (LDL-C), but unmodified plasma levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) [12,13]. The most suggested underlying mechanism for hypocholesterolemia observed in heterozygous β-thalasse- mia is the higher erythroid bone marrow activity with the enhanced cholesterol requirement [14]. To date, the clinical implications of this associated hypocholestro- lemia are still unknown. Over the past years, many epidemical and clinical studies have shown the substantial evidences for low serum cholesterol concentrations in people with suicidal, aggressive and violent behaviors meaning that low cho- lesterol level is significantly related to physical aggres- sion and violence towards self or others [15-23]. The severity of a suicide attempt as well as the degree of sui- cidal ideation was found to be inversely correlated with serum cholesterol levels. Low levels of cholesterol are associated with a more violent pattern of suicidal behav- ior [24,25]. There is also a report of low cholesterol lev- els in parasuicidal patients [24]. Impulsivity is closely associated with suicide and aggression or hostility [26]. The replication of these findings with different study designs across diverse populations has validated such associations. A reduced central serotonergic neurotrans- mission through decreased serotonergic (5HT) receptor function is a biochemical mechanism responsible for association between low cholesterol level and psycho- pathological processes involved in suicidal, aggressive