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Docherty A, Kious B, Brown T, Francis L, Stark L, Keeshin B, Botkin J, DiBlasi E, Gray D, Coon H. Ethical concerns relating to genetic risk scores for suicide. Am J Med Genet B Neuropsychiatr Genet 2021; 186:433-444. [PMID: 34472199 PMCID: PMC8692426 DOI: 10.1002/ajmg.b.32871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/02/2023]
Abstract
Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.
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Affiliation(s)
- Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Brent Kious
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Teneille Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Leslie Francis
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Louisa Stark
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Genetic Science Learning Center, University of Utah, Salt Lake City, UT USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT USA
| | - Jeffrey Botkin
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Doug Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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Djurdjinovic L, Peters JA. Special Issue Introduction: Dealing with Psychological and Social Complexity in Genetic Counseling. J Genet Couns 2017; 26:1-4. [PMID: 28271394 DOI: 10.1007/s10897-017-0080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | - June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, 9609 Medical Center Drive, # 6E548, Rockville, MD, 20850, USA
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