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Tio ES, Misztal MC, Felsky D. Evidence for the biopsychosocial model of suicide: a review of whole person modeling studies using machine learning. Front Psychiatry 2024; 14:1294666. [PMID: 38274429 PMCID: PMC10808719 DOI: 10.3389/fpsyt.2023.1294666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Background Traditional approaches to modeling suicide-related thoughts and behaviors focus on few data types from often-siloed disciplines. While psychosocial aspects of risk for these phenotypes are frequently studied, there is a lack of research assessing their impact in the context of biological factors, which are important in determining an individual's fulsome risk profile. To directly test this biopsychosocial model of suicide and identify the relative importance of predictive measures when considered together, a transdisciplinary, multivariate approach is needed. Here, we systematically review the emerging literature on large-scale studies using machine learning to integrate measures of psychological, social, and biological factors simultaneously in the study of suicide. Methods We conducted a systematic review of studies that used machine learning to model suicide-related outcomes in human populations including at least one predictor from each of biological, psychological, and sociological data domains. Electronic databases MEDLINE, EMBASE, PsychINFO, PubMed, and Web of Science were searched for reports published between August 2013 and August 30, 2023. We evaluated populations studied, features emerging most consistently as risk or resilience factors, methods used, and strength of evidence for or against the biopsychosocial model of suicide. Results Out of 518 full-text articles screened, we identified a total of 20 studies meeting our inclusion criteria, including eight studies conducted in general population samples and 12 in clinical populations. Common important features identified included depressive and anxious symptoms, comorbid psychiatric disorders, social behaviors, lifestyle factors such as exercise, alcohol intake, smoking exposure, and marital and vocational status, and biological factors such as hypothalamic-pituitary-thyroid axis activity markers, sleep-related measures, and selected genetic markers. A minority of studies conducted iterative modeling testing each data type for contribution to model performance, instead of reporting basic measures of relative feature importance. Conclusion Studies combining biopsychosocial measures to predict suicide-related phenotypes are beginning to proliferate. This literature provides some early empirical evidence for the biopsychosocial model of suicide, though it is marred by harmonization challenges. For future studies, more specific definitions of suicide-related outcomes, inclusion of a greater breadth of biological data, and more diversity in study populations will be needed.
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Affiliation(s)
- Earvin S. Tio
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melissa C. Misztal
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel Felsky
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Casten LG, Thomas TR, Doobay AF, Foley-Nicpon M, Kramer S, Nickl-Jockschat T, Abel T, Assouline S, Michaelson JJ. The combination of autism and exceptional cognitive ability is associated with suicidal ideation. Neurobiol Learn Mem 2023; 197:107698. [PMID: 36450307 PMCID: PMC10088461 DOI: 10.1016/j.nlm.2022.107698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 10/04/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022]
Abstract
Autism with co-occurring exceptional cognitive ability is often accompanied by severe internalizing symptoms and feelings of inadequacy. Whether cognitive ability also translates into greater risk for suicidal ideation is unclear. To investigate this urgent question, we examined two samples of high-ability autistic individuals for factors that were predictive of suicidal ideation. In the first sample (N = 1,074 individuals seen at a clinic specializing in gifted/talented youth), we observed a striking excess of parent-reported suicidal ideation in autistic individuals with IQ ≥ 120 (Odds Ratio = 5.9, p=0.0007). In a separate sample of SPARK participants, we confirmed higher rates of suicidal thoughts compared to non-autistic children from the ABCD cohort (combined N = 16,049, Odds Ratio = 6.8, p<2.2e-16), and further that autistic children with suicidal thoughts had significantly higher cognitive ability (p<2.2e-16) than those without. Elevated polygenic scores (PGS) for cognitive performance were associated with increased suicidal thoughts (N = 1,983, Z=2.16,p=0.03), with PGS for educational attainment trending in the same direction (Z=1.4,p=0.17). Notably, similar results were found in parents of these autistic youth, where higher PGS for educational attainment was associated with increasing thoughts of suicide (N = 736, Z=2.28,p=0.02). Taken together, these results suggest that on a phenotypic and genetic level, increasing cognitive ability is an unexpected risk factor for suicidal ideation in individuals diagnosed with, or at risk for autism.
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Affiliation(s)
- Lucas G Casten
- Department of Psychiatry, University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Taylor R Thomas
- Department of Psychiatry, University of Iowa, United States; Interdisciplinary Graduate Program in Genetics, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Alissa F Doobay
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Megan Foley-Nicpon
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Sydney Kramer
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States; Department of Neuroscience and Pharmacology, University of Iowa, United States
| | - Ted Abel
- Iowa Neuroscience Institute, University of Iowa, United States; Department of Neuroscience and Pharmacology, University of Iowa, United States
| | - Susan Assouline
- Belin-Blank Center, University of Iowa, United States; Department of Psychological and Quantitative Foundations, University of Iowa, United States
| | - Jacob J Michaelson
- Department of Psychiatry, University of Iowa, United States; Iowa Neuroscience Institute, University of Iowa, United States.
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Li QS, Shabalin AA, DiBlasi E, Gopal S, Canuso CM, Palotie A, Drevets WC, Docherty AR, Coon H. Genome-wide association study meta-analysis of suicide death and suicidal behavior. Mol Psychiatry 2023; 28:891-900. [PMID: 36253440 PMCID: PMC9908547 DOI: 10.1038/s41380-022-01828-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
Suicide is a worldwide health crisis. We aimed to identify genetic risk variants associated with suicide death and suicidal behavior. Meta-analysis for suicide death was performed using 3765 cases from Utah and matching 6572 controls of European ancestry. Meta-analysis for suicidal behavior using data across five cohorts (n = 8315 cases and 256,478 psychiatric or populational controls of European ancestry) was also performed. One locus in neuroligin 1 (NLGN1) passing the genome-wide significance threshold for suicide death was identified (top SNP rs73182688, with p = 5.48 × 10-8 before and p = 4.55 × 10-8 after mtCOJO analysis conditioning on MDD to remove genetic effects on suicide mediated by MDD). Conditioning on suicidal attempts did not significantly change the association strength (p = 6.02 × 10-8), suggesting suicide death specificity. NLGN1 encodes a member of a family of neuronal cell surface proteins. Members of this family act as splice site-specific ligands for beta-neurexins and may be involved in synaptogenesis. The NRXN-NLGN pathway was previously implicated in suicide, autism, and schizophrenia. We additionally identified ROBO2 and ZNF28 associations with suicidal behavior in the meta-analysis across five cohorts in gene-based association analysis using MAGMA. Lastly, we replicated two loci including variants near SOX5 and LOC101928519 associated with suicidal attempts identified in the ISGC and MVP meta-analysis using the independent FinnGen samples. Suicide death and suicidal behavior showed positive genetic correlations with depression, schizophrenia, pain, and suicidal attempt, and negative genetic correlation with educational attainment. These correlations remained significant after conditioning on depression, suggesting pleiotropic effects among these traits. Bidirectional generalized summary-data-based Mendelian randomization analysis suggests that genetic risk for the suicidal attempt and suicide death are both bi-directionally causal for MDD.
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Affiliation(s)
- Qingqin S. Li
- grid.497530.c0000 0004 0389 4927Neuroscience, Janssen Research & Development, Titusville, NJ 08560 USA ,grid.497530.c0000 0004 0389 4927R&D Data Science, Janssen Research & Development, Titusville, NJ 08560 USA
| | - Andrey A. Shabalin
- grid.223827.e0000 0001 2193 0096Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112 USA
| | - Emily DiBlasi
- grid.223827.e0000 0001 2193 0096Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112 USA
| | - Srihari Gopal
- grid.497530.c0000 0004 0389 4927Neuroscience, Janssen Research & Development, Titusville, NJ 08560 USA ,grid.418961.30000 0004 0472 2713Present Address: Regeneron Pharmaceuticals Inc, Tarrytown, NY 10591 USA
| | - Carla M. Canuso
- grid.497530.c0000 0004 0389 4927Neuroscience, Janssen Research & Development, Titusville, NJ 08560 USA
| | | | - Aarno Palotie
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Wayne C. Drevets
- grid.497530.c0000 0004 0389 4927Neuroscience, Janssen Research & Development, San Diego, CA 92121 USA
| | - Anna R. Docherty
- grid.223827.e0000 0001 2193 0096Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112 USA ,grid.224260.00000 0004 0458 8737Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Hilary Coon
- grid.223827.e0000 0001 2193 0096Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112 USA
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Orri M, Macalli M, Galera C, Tzourio C. Association of parental death and illness with offspring suicidal ideation: cross-sectional study in a large cohort of university students. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2251-2260. [PMID: 35794467 DOI: 10.1007/s00127-022-02329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate the association of parental death and illness with suicidal ideation using a large sample of university students and (2) test whether associations were moderated by perceived family support. METHODS We used data from N = 15,008 French university students enrolled in the i-Share cohort (mean age, 20.5 years; 77% women). Students self-reported information on parental death, including the cause, parental illness (cardiovascular, stroke, cancer, depression/anxiety, alcohol abuse), and perceived family support during childhood/adolescence. Twelve-month suicidal ideation was self-reported and categorized into no, occasional, and frequent ideation. RESULTS Occasional and frequent suicidal ideation were, respectively, reported by 2692 (17.5%) and 699 (4.6%) students. After adjustment for age, gender, and parental education, we found associations between parental death and risk of occasional and frequent suicidal ideation (respectively, RR = 1.98 [1.81-2.17] and RR = 2.73 [2.30-3.24]). Parental deaths from illness, accidents, and suicides had the strongest associations. We also found associations for parental depression/anxiety (occasional, RR = 1.98 [1.81-2.17]; frequent, RR = 2.73 [2.30-3.24]), alcohol use problems (occasional, RR = 1.71 [1.5-1.94]; frequent, RR = 2.33 [1.89-2.87]), and cardiovascular diseases (occasional, RR = 1.22 [1.06-1.40]; frequent, RR = 1.83 [1.47-2.27]). For participants who experienced parental death and stroke, associations with occasional and frequent suicidal ideation (respectively) increased as perceived family support increased (Psinteraction ≤ 0.005). CONCLUSIONS Students who experienced parental death and common parental illnesses were at risk of reporting suicidal ideation, especially if their family were perceived as an important source of support. As information on parental death or illness can be routinely collected during health visits, attention should be paid to students reporting such experiences.
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Affiliation(s)
- Massimiliano Orri
- Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, 6875 Boulevard LaSalle, Montréal, QC, H4H 1R3, Canada. .,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.
| | - Melissa Macalli
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
| | - Cedric Galera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France.,Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France.,Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, CHU Bordeaux, F-33000, U1219, Bordeaux, France
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Johnston JN, Campbell D, Caruncho HJ, Henter ID, Ballard ED, Zarate CA. Suicide Biomarkers to Predict Risk, Classify Diagnostic Subtypes, and Identify Novel Therapeutic Targets: 5 Years of Promising Research. Int J Neuropsychopharmacol 2022; 25:197-214. [PMID: 34865007 PMCID: PMC8929755 DOI: 10.1093/ijnp/pyab083] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/02/2021] [Accepted: 11/30/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Suicide is a global health crisis. However, no objective biomarkers of suicide risk currently exist, and self-reported data can be unreliable, which limits prediction, diagnostic, and treatment efforts. Reliable biomarkers that can differentiate between diagnostic subgroups, predict worsening symptoms, or suggest novel therapeutic targets would be extremely valuable for patients, researchers, and clinicians. METHODS MEDLINE was searched for reports published between 2016 and 2021 using search terms (suicid*) AND (biomarker*) OR (indicat*). Reports that compared biomarkers between suicidal ideation, suicide attempt, death from suicide, or any suicide subgroup against other neuropsychiatric disorders were included. Studies exclusively comparing suicidal behavior or death from suicide with healthy controls were not included to ensure that biomarkers were specific to suicide and not other psychopathology. RESULTS This review summarizes the last 5 years of research into suicide-associated biomarkers and provides a comprehensive guide for promising and novel biomarkers that encompass varying presentations of suicidal ideation, suicide attempt, and death by suicide. The serotonergic system, inflammation, hypothalamic-pituitary-adrenal axis, lipids, and endocannabinoids emerged as the most promising diagnostic, predictive, and therapeutic indicators. CONCLUSIONS The utility of diagnostic and predictive biomarkers is evident, particularly for suicide prevention. While larger-scale studies and further in-depth research are required, the last 5 years of research has uncovered essential biomarkers that could ultimately improve predictive strategies, aid diagnostics, and help develop future therapeutic targets.
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Affiliation(s)
- Jenessa N Johnston
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Darcy Campbell
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Hector J Caruncho
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland,USA
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6
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[Suicide, a separate entity in psychiatry]. Soins Psychiatr 2021; 42:12-16. [PMID: 34144752 DOI: 10.1016/j.spsy.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Since ancient times, the subject of suicide has been recurrently discussed in societies. Whether it is a selfish or altruistic act, the ethical debate has always been intense. Today, the suicidal act is at the center of the public debate with the subject of euthanasia and assisted suicide. Philosophers, theologians, sociologists, doctors and jurists share their thoughts on this subject, which is still considered "taboo". Between suicide, suicidal ideas or suicidal crisis, the stakeholders are involved in the field of prevention and are mobilizing to propose innovative treatments.
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