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Fatemian H, Moslemi H, Hosseini Y, Moshfeghinia R. C-reactive protein (CRP) level in depressed patients with suicidal behavior: A systematic review and meta-analysis. J Affect Disord 2024; 366:423-433. [PMID: 39187188 DOI: 10.1016/j.jad.2024.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/30/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Suicidal behavior necessitates prompt diagnosis due to its severe consequences. C-reactive protein (CRP) levels may offer insights into its pathophysiology and aid in risk assessment, potentially enhancing preventive interventions and treatment strategies. The aim of this study is to assess the CRP levels in depressed patients with and without suicidal behavior. METHODS Our systematic review was registered in Prospero (#CRD42024518477). We searched five databases (PubMed, Scopus, PsycINFO, Web of Science, and CINAHL Complete) for records in English from inception to February 2024. We included observational studies that measured CRP in depressed patients with and without suicidal behavior. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of the included studies. We employed a random-effects model, and the statistical analysis was conducted using Stata software version 17. RESULTS Initial 632 articles narrowed to 15 for systematic review. Fifteen studies with 3652 participants included. Fourteen studies involving 3387 depressed patients, 1269 with suicidal behavior, analyzed CRP levels. Suicidal patients exhibited higher CRP levels (SMD: 0.80 [0.37, 1.23]). Analysis of seven studies with 465 participants, including 200 depressed patients with suicidal behavior and 265 healthy controls, showed higher CRP levels in depressed patients (SMD: 1.58 [0.97, 2.19]). CONCLUSION In summary, our systematic review and meta-analysis of CRP levels in suicidal patients revealed that those with suicidal behavior exhibited higher CRP levels, suggesting possible implications for treatment approaches.
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Affiliation(s)
- Hossein Fatemian
- Medical doctor, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Moslemi
- Department of Science and Technology Studies, AJA University of Command and Staff, Tehran, Iran
| | - Yasaman Hosseini
- Cognitive Neuroscience Research Center, AJA University of Medical Sciences, Tehran, Iran.
| | - Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Research Center for Psychiatry and Behavior Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Strumila R, Lengvenyte A, Zdanavicius L, Badaras R, Dlugauskas E, Lesinskiene S, Matiekus E, Marcinkevicius M, Venceviciene L, Utkus A, Kaminskas A, Petrenas T, Songailiene J, Vitkus D, Ambrozaityte L. Higher levels of plasma Adrenocorticotropic hormone (ACTH) are associated with lower suicidal ideation in depressed patients compared to controls and suicide attempters, independently from depression severity. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100235. [PMID: 38737407 PMCID: PMC11087924 DOI: 10.1016/j.cpnec.2024.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Suicidal ideation, an important risk factor for suicide attempts, has an unclear neurobiological basis and is potentially linked to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and immune-inflammatory systems. While inflammatory markers have been associated with suicide attempts and, to a lower extent suicidal ideation, the data on the role of a stress-response system is less robust, with most studies carried out with cortisol showing inconsistent results. The present study extends on the previous studies implicating stress-response and immune-inflammatory systems in suicidal thoughts and behaviours, focusing on the associations of several stress-response (adrenocorticotropic hormone (ACTH), cortisol, and dehydroepiandrosterone (DHEA)) and immune-inflammatory (C-reactive protein (CRP),interle ukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-alpha)) with suicidal ideation severity in recent suicide attempters, patients with major depressive disorder, and non-psychiatric controls. Methods This observational study included 156 adults from three Vilnius hospitals, recruited into one of the three groups in equal parts: recent suicide attempters, patients with major depressive disorder in current depressive episode, and non-psychiatric controls. Measures included the Hamilton Depression Rating Scale (HDRS-17) and the Beck Scale for Suicide Ideation/Suicide Severity Index (BSS/SSI), alongside sociodemographic data, alcohol, tobacco use, and morning blood samples, measuring plasma ACTH, cortisol, DHEA, CRP, and IL-6. Data were analysed with non-parametric tests, Kendall's tau correlation, and multivariate linear regression adjusted for confounders. Results We found a negative correlation between the plasma ACTH levels and suicidal ideation severity (tau = -0.130, p = 0.033), which was driven by the patients with major depressive disorder (tau = -0.237, p = 0.031). Suicidal ideation severity was also negatively correlated with TNF-alpha (tau = -0.231; p < 0.001), positively correlated with IL-6 (tau = 0.154, p = 0.015), and CRP levels (tau = 0.153, p = 0.015), but no differences were observed in group-stratified analyses. The association between plasma ACTH levels and suicidal ideation severity in patients with major depressive disorder remained robust to adjustment for major confounders (adjusted for age, sex, education years, body mass index, smoking status, plasma CRP and PEth concentration (measuring chronic alcohol exposure), and antidepressant use) in the linear regression model (t = -2.71, p = 0.011), as well as additionally adjusting for depression severity (t = -2.99, p = 0.006). Discussion The present study shows an association between plasma ACTH levels and suicidal ideation severity in patients with major depressive disorder, robust to adjustment for antidepressant use and depression severity. This finding highlights the potential role of ACTH, in elucidating the effects of stress and mental health disorders. Our findings underscore the importance of the HPA axis in the diagnosis and treatment of suicidal ideation in major depressive disorder and invite further research on interventions targeting this pathway.
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Affiliation(s)
- Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aiste Lengvenyte
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Linas Zdanavicius
- Centre for Toxicology, Clinic of Anaesthesiology, Reanimatology and Critical Care Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robertas Badaras
- Centre for Toxicology, Clinic of Anaesthesiology, Reanimatology and Critical Care Medicine, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Edgaras Dlugauskas
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sigita Lesinskiene
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Lina Venceviciene
- Centre for Family Medicine, Vilnius University Hospital Santaros Klinikos, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius, Lithuania
| | - Andrius Kaminskas
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius, Lithuania
| | - Tomas Petrenas
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius, Lithuania
| | - Jurgita Songailiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius, Lithuania
| | - Dalius Vitkus
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Laima Ambrozaityte
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius, Lithuania
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Alacreu-Crespo A, Sebti E, Moret RM, Courtet P. From Social Stress and Isolation to Autonomic Nervous System Dysregulation in Suicidal Behavior. Curr Psychiatry Rep 2024; 26:312-322. [PMID: 38717659 PMCID: PMC11147891 DOI: 10.1007/s11920-024-01503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE OF REVIEW In this narrative review we wanted to describe the relationship of autonomic nervous system activity with social environment and suicidal spectrum behaviors. RECENT FINDINGS Patients with suicidal ideation/suicide attempt have higher sympathetic nervous system (SNS) and lower parasympathetic nervous system (PNS) activity in resting conditions and during acute stress tasks compared with patients without suicidal ideation/suicide attempt. Death by suicide and violent suicide attempt also are related to SNS hyperactivation. Similarly, a SNS/PNS imbalance has been observed in people with childhood trauma, stressful life events or feelings of loneliness and isolation. Social support seems to increase PNS control and resilience. Due to the importance of the social context and stressful life events in suicidal behavior, SNS/PNS imbalance could act as a mediator in this relationship and be a source of relevant biomarkers. Childhood trauma and stressful life events may impair the autonomic nervous system response in suicidal patients. Loneliness, isolation and social support may act as moderators in acute stress situations.
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Affiliation(s)
- Adrián Alacreu-Crespo
- Department of Psychology and Sociology, University of Zaragoza, C/Atarazana 4, Aragon, Teruel, 44003, Spain.
- FondaMental Foundation, Créteil, France.
| | - Emma Sebti
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Rosa María Moret
- Department of Psychology and Sociology, University of Zaragoza, C/Atarazana 4, Aragon, Teruel, 44003, Spain
| | - Philippe Courtet
- FondaMental Foundation, Créteil, France
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Pethő B, Kovács MÁ, Simon D, Tóth T, Hajnal AS, Csulak T, Hebling D, Albert N, Varga E, Herold M, Osváth P, Vörös V, Tényi T, Herold R. Investigation of peripheral inflammatory biomarkers in association with suicide risk in major depressive disorder. Front Psychiatry 2024; 15:1321354. [PMID: 38347880 PMCID: PMC10859515 DOI: 10.3389/fpsyt.2024.1321354] [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: 10/13/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Suicide is the most severe complication of major depressive disorder (MDD). Novel research assumes the role of immunological dysregulation in the background - several studies have reported alterations in the number of inflammatory cells related to both MDD and suicidality. There are currently no objective, routinely measured parameters to indicate suicidal vulnerability. However, altered inflammatory cell numbers and ratios have been proposed as potential biomarkers of suicide risk (SR). The present research aims to examine changes of these values related to increased SR in MDD as an assumed inflammatory state. We investigated laboratory parameters of psychiatric in-patients diagnosed with MDD (n = 101) retrospectively. Individuals with recent suicide attempt (SA) (n = 22) and with past SA (n = 19) represented the high SR group. MDD patients with no history of SA (n = 60) composed the intermediate SR group. We compared the number of neutrophil granulocytes, monocytes, lymphocytes, platelets, white blood cell count (WBC), neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red blood cell distribution width (RDW) and erythrocyte sedimentation rate (ESR). Furthermore, we evaluated alterations of these parameters related to antidepressant (AD) and antipsychotic (AP) treatment, which have been proved to have anti-inflammatory effects. We found a significant increase in neutrophil granulocyte count, NLR, monocyte count, MLR, WBC and ESR in patients with recent SA compared to patients with no history of SA. Moreover, there was a significant elevation in monocyte count, MLR, ESR and RDW in patients with high SR compared to patients with intermediate SR. AD treatment resulted in a significant decrease in neutrophil granulocyte count and NLR, however, it did not affect monocyte count and MLR. Assuming immunological mechanisms in the background of MDD and suicidality, our findings support the role of NLR as a biomarker of acute SR, though its alterations may be masked by possible anti-inflammatory effects of AD treatment in the long term. However, MLR, a marker exhibiting changes which are not attenuated by pharmacotherapy, may be a possible indicator of both acute and long-term suicidal vulnerability.
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Affiliation(s)
- Borbála Pethő
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Áron Kovács
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Diána Simon
- Department of Immunology and Biotechnology, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Tünde Tóth
- Department of Anatomy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - András Sándor Hajnal
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Tímea Csulak
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Dóra Hebling
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Albert
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Eszter Varga
- Department of Pediatrics, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Márton Herold
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Osváth
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Viktor Vörös
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Tényi
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
| | - Róbert Herold
- Department of Psychiatry and Psychotherapy, Clinical Center, Medical School, University of Pécs, Pécs, Hungary
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Su Y, Ye C, Xin Q, Si T. Major depressive disorder with suicidal ideation or behavior in Chinese population: A scoping review of current evidence on disease assessment, burden, treatment and risk factors. J Affect Disord 2023; 340:732-742. [PMID: 37619652 DOI: 10.1016/j.jad.2023.08.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Identifying and managing major depressive disorder (MDD) patients with suicidal ideation or behavior (MDSI) is critical for reducing the disease burden. This scoping review aims to map the existing evidence related to MDSI in the Chinese population. METHOD A scoping review was conducted to summarize the published evidence regarding epidemiology or disease burden, evaluation, diagnosis, management, and prognosis of MDSI. The search strategy imposed restriction on English or Chinese publications between 1 January 2011 and 28 February 2022. RESULTS Of the 14,005 identified records, 133 met the eligibility criteria and were included for analysis. The included studies were characterized as high heterogeneity in evaluation of suicidal ideation or behavior. Compared with MDD patients without suicidal ideation or behavior, MDSI patients were more likely to suffer from psychological and somatic symptoms, social function impairment, and lower quality of life. Younger age, female gender, longer disease course, and comorbid psychological or physical symptoms were consistently found to be risk factors of suicidal ideation or behavior. Relevant research gaps remain regarding comprehensive evaluation of standard clinical diagnosis, disease burden, social-cultural risk factors, and effectiveness of interventions targeting MDSI. Studies with large sample size, representative population are warranted to provide high-quality evidence. CONCLUSIONS MDD patients with suicidal ideation or behavior should be prioritized in treatment and resource allocation. Heterogeneity exists in the definition and evaluation of MDSI in different studies. To better inform clinical practice, it is imperative to establish a unified standard for evaluation and diagnosis of suicidal ideation or behavior among MDD population.
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Affiliation(s)
- Yun'Ai Su
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Qin Xin
- Xi'an Janssen Pharmaceutical Ltd, Beijing, China
| | - Tianmei Si
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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MacNeil S, Renaud J, Gouin JP. Respiratory sinus arrhythmia, negative social interactions, and fluctuations in unmet interpersonal needs: A daily diary study. Suicide Life Threat Behav 2023; 53:597-612. [PMID: 37208985 DOI: 10.1111/sltb.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/04/2023] [Accepted: 04/22/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION This study examined daily fluctuations in the unmet interpersonal needs of thwarted belongingness and perceived burdensomeness in response to daily negative social interactions, as well as the moderating role of respiratory sinus arrhythmia (RSA) across adolescents at lower and higher risk for suicidal ideation. METHODS Fifty five adolescents with major depressive disorder (MDD, i.e., higher-risk group) and without MDD (i.e., lower-risk group) completed measures of resting RSA, and daily measures of negative social interactions, perceived burdensomeness, and loneliness, as a proxy for thwarted belongingness, for 10 consecutive days. Within-person analyses examined the association between daily negative social interactions and unmet interpersonal needs, and the moderating roles of RSA and higher-risk group status. Between-person analyses also examined the association between RSA and unmet interpersonal needs across groups. RESULTS At the within-person level, participants reported more unmet interpersonal needs on days when they reported more negative social interactions. At the between-person level, higher RSA was associated with decreased loneliness in both groups, and decreased burdensomeness among the higher-risk group. CONCLUSIONS Negative social interactions are associated with daily unmet interpersonal needs. Higher RSA may serve as a protective factor mitigating risk for unmet interpersonal needs, particularly burdensomeness, among adolescents at higher risk for suicidal ideation.
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Affiliation(s)
- Sasha MacNeil
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Johanne Renaud
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Gonda X, Serafini G, Dome P. Fight the Fire: Association of Cytokine Genomic Markers and Suicidal Behavior May Pave the Way for Future Therapies. J Pers Med 2023; 13:1078. [PMID: 37511694 PMCID: PMC10381806 DOI: 10.3390/jpm13071078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
The fight against suicide is highly challenging as it may be one of the most complex and, at the same time, most threatening among all psychiatric phenomena. In spite of its huge impact, and despite advances in neurobiology research, understanding and predicting suicide remains a major challenge for both researchers and clinicians. To be able to identify those patients who are likely to engage in suicidal behaviors and identify suicide risk in a reliable and timely manner, we need more specific, novel biological and genetic markers/indicators to develop better screening and diagnostic methods, and in the next step to utilize these molecules as intervention targets. One such potential novel approach is offered by our increasing understanding of the involvement of neuroinflammation based on multiple observations of increased proinflammatory states underlying various psychiatric disorders, including suicidal behavior. The present paper overviews our existing understanding of the association between suicide and inflammation, including peripheral and central biomarkers, genetic and genomic markers, and our current knowledge of intervention in suicide risk using treatments influencing inflammation; also overviewing the next steps to be taken and obstacles to be overcome before we can utilize cytokines in the treatment of suicidal behavior.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1085 Budapest, Hungary
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, 1085 Budapest, Hungary
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, 443079 Samara, Russia
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16126 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1085 Budapest, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, 1135 Budapest, Hungary
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Kim JM, Kim JW, Kim YJ, Kang HJ, Kim SW, Kim JT, Park MS, Kim JC, Ahn Y, Jeong MH, Stewart R. Associations of systemic inflammation and social support with suicidal ideation in patients with acute coronary syndrome and stroke. J Affect Disord 2023; 323:101-107. [PMID: 36436762 DOI: 10.1016/j.jad.2022.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to investigate associations of serum high-sensitivity C-reactive protein (hsCRP) and social support (SS) levels with suicidal ideation (SI), and to evaluate potential modifying effects of SS on the associations between serum hsCRP levels and SI in two longitudinal cohorts with cardio-/cerebrovascular diseases. METHODS 1152 acute coronary syndrome (ACS) and 423 stroke patients were recruited at baseline within 2 weeks of disease onset, and evaluated for: i) serum hsCRP levels; ii) SS by the Social Support Scale and Social Undermining Scale; iii) SI by the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale; and iv) covariates including socio-demographics, depression, vascular risk factors, and index disease severity. At 12-month follow-up, SI was re-evaluated. Logistic regression models were used to adjust for potential covariates. RESULTS In the ACS cohort, higher serum hsCRP and lower SS levels were significantly associated with SI at baseline; and only lower SS levels were significantly associated with SI at follow-up. In the stroke cohort, lower SS levels were significantly associated with SI at baseline; but no other association was found. Associations of serum hsCRP levels with SI at both baseline and follow-up were only significant at higher SS levels with significant interaction terms in both cohorts. LIMITATIONS This study evaluated SI, but not suicide attempts or death; it also used a single-center design. CONCLUSIONS By considering SS evaluations with routine serum hsCRP levels in cardio-/cerebrovascular disease, clinical prediction of SI both at acute and chronic phases of the diseases might be improved.
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Affiliation(s)
- Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ye-Jin Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Medical School, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Medical School, Republic of Korea
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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Holmgren JG, Morrow A, Coffee AK, Nahod PM, Santora SH, Schwartz B, Stiegmann RA, Zanetti CA. Utilizing digital predictive biomarkers to identify Veteran suicide risk. Front Digit Health 2022; 4:913590. [PMID: 36329831 PMCID: PMC9624222 DOI: 10.3389/fdgth.2022.913590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Veteran suicide is one of the most complex and pressing health issues in the United States. According to the 2020 National Veteran Suicide Prevention Annual Report, since 2018 an average of 17.2 Veterans died by suicide each day. Veteran suicide risk screening is currently limited to suicide hotlines, patient reporting, patient visits, and family or friend reporting. As a result of these limitations, innovative approaches in suicide screening are increasingly garnering attention. An essential feature of these innovative methods includes better incorporation of risk factors that might indicate higher risk for tracking suicidal ideation based on personal behavior. Digital technologies create a means through which measuring these risk factors more reliably, with higher fidelity, and more frequently throughout daily life is possible, with the capacity to identify potentially telling behavior patterns. In this review, digital predictive biomarkers are discussed as they pertain to suicide risk, such as sleep vital signs, sleep disturbance, sleep quality, and speech pattern recognition. Various digital predictive biomarkers are reviewed and evaluated as well as their potential utility in predicting and diagnosing Veteran suicidal ideation in real time. In the future, these digital biomarkers could be combined to generate further suicide screening for diagnosis and severity assessments, allowing healthcare providers and healthcare teams to intervene more optimally.
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Affiliation(s)
- Jackson G. Holmgren
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States,Correspondence: Jackson G. Holmgren
| | - Adelene Morrow
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Ali K. Coffee
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, United States
| | - Paige M. Nahod
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Samantha H. Santora
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Brian Schwartz
- Department of Medical Humanities, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States
| | - Regan A. Stiegmann
- Department of Tracks and Special Programs, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States,Flight Medicine, US Air Force Academy, Colorado Springs, CO, United States
| | - Cole A. Zanetti
- Department of Tracks and Special Programs, Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States,Chief Health Informatics Officer, Ralph H Johnson VA Health System, Charleston, SC, United States
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Koyama Y, Fujiwara T, Doi S, Isumi A, Morita A, Matsuyama Y, Tani Y, Nawa N, Mashiko H, Yagi J. Heart rate variability in 2014 predicted delayed onset of internalizing problems in 2015 among children affected by the 2011 Great East Japan Earthquake. J Psychiatr Res 2022; 151:642-648. [PMID: 35661521 DOI: 10.1016/j.jpsychires.2022.05.039] [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: 06/15/2021] [Revised: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Experience of natural disaster was related to an increased risk of long-term child internalizing problems. Initial traumatic experiences are hypothesized to work as disaster-related stresses and sensitize neural circuitry, leading to heightened reactivity to subsequent stressful experiences, which in turn results in delayed onset of internalizing problems. However, empirical evidence is lacking. Thus, we aimed to examine the association between heart rate variability (HRV) and internalizing problems among children exposed to the disaster. The Great East Japan Earthquake Follow-up for Children (GEJE-FC) study followed children aged 4-6 years old and their siblings and parents from three affected prefectures (Miyagi, Fukushima, and Iwate) and one unaffected prefecture (Mie) in Japan over four periods: from August 2012 to June 2013 (= T1), August 2013 to April 2014 (= T2), July 2014 to December 2014 (= T3), and August 2015 to December 2015 (= T4) (n = 155). HRV was assessed at T2 and T3 as a biomarker of autonomic nervous system activity. Child internalizing problems were assessed by caregivers at T3 and T4, using the Child Behavior Checklist. HRV measurements at T2 were not associated with child internalizing problems at T3. However, HRV in low frequency domains at T3 showed an inverse association with child internalizing problems at T4 (B = -1.72, 95% CI = -3.12 to -0.31). The findings indicated that later exacerbation of internalizing problems could be predicted by dysfunction of autonomic nervous system measured by HRV.
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Affiliation(s)
- Yuna Koyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan; Japan Society of the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Ayako Morita
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yusuke Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hirobumi Mashiko
- Fukushima Rehabilitation Center for Children, 1 Hikarigaoka, Fukushima, 960-1247, Japan
| | - Junko Yagi
- Department of Neuropsychiatry, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-0023, Japan
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11
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Blood hormones and suicidal behaviour: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 139:104725. [PMID: 35690122 DOI: 10.1016/j.neubiorev.2022.104725] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/28/2022]
Abstract
This study was to evaluate the relationship between blood hormone levels and suicidal behaviour. We reviewed Web of Science, PubMed and Embase for literature published up to 10 April 2022. Studies were restricted to English-language articles. Studies measuring blood hormone levels in suicidal and non-suicidal subjects were eligible. Standardized mean differences (SMDs) were applied to evaluate group differences. Overall, 57 studies were eligible, of which 51 evaluated suicide attempts, and 9 assessed suicidal ideation. Random-effects meta-analysis indicated that levels of thyrotropin stimulating hormone (TSH) (SMD = 0.50; 95% CI, 0.27-0.72), leptin (SMD = -1.16; 95% CI, -1.94 to -0.38) and dehydroepiandrosterone sulfate (DHEAS) (SMD = -0.67; 95% CI, -1.13 to -0.21) were related to suicide attempts, whereas progesterone levels (SMD = 0.22; 95% CI, 0.03-0.41) were related to suicidal ideation. This analysis offers evidence linking abnormalities of blood hormones with suicidal behaviour, which may be essential for identifying individuals with suicide attempts and suicidal ideation. Large prospective studies are needed for further clarification of roles of hormones in suicidal behaviour.
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12
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Associations of three major physiological stress systems with suicidal ideation and suicide attempts in patients with a depressive and/or anxiety disorder. Brain Behav Immun 2022; 102:195-205. [PMID: 35202735 DOI: 10.1016/j.bbi.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND People with depressive and/or anxiety disorders are at increased risk of suicidal ideation and suicide attempts, but biological correlates signaling such risk remain unclear. Independent and cumulative dysregulations in physiological stress systems, in particular the hypothalamic-pituitaryadrenal axis (HPA-axis), immune-inflammatory system, and autonomous nervous system (ANS), may contribute to this risk. However, findings have either been heterogeneous or absent thus far. METHODS Associations between individual markers and cumulative indices of the HPA-axis (cortisol awakening response and evening cortisol), immune-inflammatory system (C-reactive protein, interleukin-6 (IL-6), and tumor necrosis factor-α), and the ANS (heart rate, respiratory sinus arrhythmia, and pre-ejection period) and the outcomes no suicide ideation with suicide attempt (SI-SA+), suicide ideation without suicide attempt (SI+SA-) and suicide ideation with suicide attempt (SI+SA+) were investigated in 1749 persons with depressive and/or anxiety disorders from the Netherlands Study of Depression and Anxiety (NESDA). RESULTS High levels of CRP and IL-6 were associated with SI-SA+ and SI+SA+ respectively when compared to non-suicidal patients after adjusting for confounders and multiple testing. Also, cumulative immune-inflammatory dysregulations were positively associated with SI+SA+, suggesting a dose-response effect. No significant associations were found between HPA-axis or ANS indicators and suicide-outcomes and between immune-inflammatory system markers or cumulative stress system dysregulations and SI+SA-. CONCLUSION Although stress system markers could not differentiate between SI+SA- and non-suicidal patients, findings indicate that dysregulations of individual and cumulative immune-inflammatory markers are associated with suicide attempts in depressive and/or anxiety patients. Thus, immune-inflammatory system dysregulation may be involved in the pathophysiology of suicidal behavior, supporting further examination of the effects of anti-inflammatory interventions on suicidality.
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13
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Buchmann A, Ritter C, Müller ST, Haynes M, Ghisleni C, Tuura R, Hasler G. Associations between heart rate variability, peripheral inflammatory markers and major depressive disorder. J Affect Disord 2022; 304:93-101. [PMID: 35196535 DOI: 10.1016/j.jad.2022.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Measures for the irregularity of the heartbeat, for example respiratory sinus arrhythmia, have been implicated as a measure for restorative functions of the vegetative nervous system. METHODS In the current observational study, we investigated 265 subjects, 70 of whom had a lifetime history of major depression, with a plethysmographic heartbeat monitor, blood sampling, as well as a range of psychiatric questionnaires. RESULTS Subjects with a history of MDE had significantly reduced respiratory sinus arrhythmia (RSA) as compared to never-depressed controls; in the whole sample, higher RSA went with lower anxiety/fear variables, especially in subscores related to cardiac symptoms as well as being afraid of dying. A reduced RSA was also associated with an increased concentration of cytokines (TNFa, IL1a, IL6, IFNg) and thyroid-stimulating hormone in the serum, pointing to a possible triangular relationship between immune system, vegetative nervous system, and emotional dysregulation. LIMITATIONS We used a plethysmographic device for the measurement of heartbeat instead of an electrocardiogram, and had a single time point only. CONCLUSIONS This data corroborate the idea that a disequilibrium of the vegetative nervous, especially if accompanied by a dysregulation system in immune function, can increase the risk for depression. Conversely, vagal stimulation and anti-inflammatory treatments may support the treatment with antidepressants.
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Affiliation(s)
- Andreas Buchmann
- Psychiatric University Hospital, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Unit of Psychiatry Research, University of Fribourg, Chemin du Cardinal-Journet 3, 1752 Villars-sur-Glâne, Fribourg, Switzerland; Center of MR-Research, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Christopher Ritter
- Psychiatric University Hospital, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Unit of Psychiatry Research, University of Fribourg, Chemin du Cardinal-Journet 3, 1752 Villars-sur-Glâne, Fribourg, Switzerland; Center of MR-Research, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Sabrina Theresia Müller
- Psychiatric University Hospital, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Melanie Haynes
- Psychiatric University Hospital, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Carmen Ghisleni
- Center of MR-Research, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ruth Tuura
- Center of MR-Research, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Gregor Hasler
- Unit of Psychiatry Research, University of Fribourg, Chemin du Cardinal-Journet 3, 1752 Villars-sur-Glâne, Fribourg, Switzerland
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14
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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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15
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Vasupanrajit A, Jirakran K, Tunvirachaisakul C, Solmi M, Maes M. Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: a systematic review and meta-analysis. Mol Psychiatry 2022; 27:1350-1361. [PMID: 34997194 DOI: 10.1038/s41380-021-01407-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
A meta-analysis showed a significant association between activated immune-inflammatory and nitro-oxidative (IO&NS) pathways and suicide attempts (SA). There is no data on whether recent suicidal ideation (SI) is accompanied by activated IO&NS pathways and whether there are differences between recent SA and SI. The current study searched PubMed, Google Scholar, and Web of Science, for articles published from inception until May 10, 2021, and systematically reviewed and meta-analysed the association between recent SA/SI (<3 months) and IO&NS biomarkers. We included studies which compared psychiatric patients with and without SA and SI and controls (either healthy controls or patients without SA/SI) and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence intervals (CI). Our search included 59 studies comprising 4.034 SA/SI cases and 12.377 controls. Patients with SA/SI showed activated IO&NS pathways (SMD: 0.299; CI: 0.200; 0.397) when compared to controls. The immune profiles were more strongly associated with SA than with SI, particularly when compared to healthy controls, as evidenced by activated IO&NS (SMD: 0.796; CI: 0.503; 1.089), immune (SMD: 1.409; CI: 0.637; 1.462), inflammatory (SMD: 1.200; CI: 0.584; 1.816), and neurotoxic (SMD: 0.904; CI: 0.431; 1.378) pathways. The effects sizes of the IO&NS, immune and inflammatory profiles were significantly greater in SA than in SI. In conclusion: activated IO&NS pathways are associated with recent SA and SI, and inflammation, T helper-1 activation, nitro-oxidative stress, lowered neuroprotection, and increased neurotoxicity explain at least in part why psychiatric patients show increased suicidal behaviours, especially SA.
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Affiliation(s)
- Asara Vasupanrajit
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Ketsupar Jirakran
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Maximizing Thai Children's Developmental Potential Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chavit Tunvirachaisakul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Marco Solmi
- University of Ottawa, Psychiatry Department, Ottawa, ON, Canada.,The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,IMPACT Strategies Research Center, Deakin University, Geelong, VIC, Australia. .,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
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16
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Development of Autonomic Nervous System Assays as Point-of-Care Tests to Supplement Clinical Judgment in Risk Assessment for Suicidal Behavior: A Review. Curr Psychiatry Rep 2022; 24:11-21. [PMID: 35076889 DOI: 10.1007/s11920-022-01315-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW A biomarker point-of-care (POC) test that supplements the psychiatric interview and improves detection of patients at risk for suicide would be of value, and assays of autonomic nervous system (ANS) activity would satisfy the logistical requirements for a POC test. We performed a selective review of the available literature of ANS assays related to risk for suicide. RECENT FINDINGS We searched PubMed and Web of Science with the strategy: "suicide OR suicidal" AND "electrodermal OR heart rate variability OR pupillometry OR pupillography." The search produced 119 items, 21 of which provided original data regarding ANS methods and suicide. These 21 studies included 6 for electrodermal activity, 14 for heart rate variability, and 1 for the pupillary light reflex. The 21 papers showed associations between ANS assays and suicide risk in a direction suggesting underlying hyperarousal in patients at risk for suicide. ANS assays show promise for future development as POC tests to supplement clinical decision making in estimating risk for suicide.
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17
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Miola A, Dal Porto V, Tadmor T, Croatto G, Scocco P, Manchia M, Carvalho AF, Maes M, Vieta E, Sambataro F, Solmi M. Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:537-552. [PMID: 34292580 PMCID: PMC9290832 DOI: 10.1111/acps.13351] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/29/2021] [Accepted: 07/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Suicide is a leading cause of death worldwide. Identifying factors associated with suicidality (suicidal ideation [SI]/suicidal behavior) could increase our understanding of the pathophysiological underpinnings of suicide and improve its prevention. METHODS We conducted a systematic review (PubMed/PsycInfo/Cochrane databases, up to September 2020) and random-effect meta-analysis including observational studies comparing peripheral C-reactive protein (CRP) levels in suicidal versus non-suicidal patients affected by any psychiatric disorder and healthy controls (HC). Primary outcome was the CRP standardized mean difference (SMD) between patients with high suicidality versus those with absent or low suicidality. Secondary outcomes were SMD of CRP levels between those with suicide attempt versus no suicide attempt, as well as between those with (high) versus low or absent SI. Quality of included studies was measured with Newcastle-Ottawa scale. RESULTS Out of initial 550 references, 21 observational studies involving 7682 subjects (7445 with mood disorders or first-episode psychosis, 237 HC) were included. A significant association of CRP levels with suicidality (SMD 0.688, 95% CI 0.476-0.9, p < 0.001) emerged. CRP levels were higher in individuals with high SI (SMD 1.145, 95% CI 0.273-2.018, p = 0.010) and in those with suicide attempt (SMD 0.549, 95%CI 0.363-0.735, p < 0.001) than non-suicidal individuals (either patients or HC). Main analyses were confirmed in sensitivity analysis (removing HC), and after adjusting for publication bias. The cross-sectional design of included studies, and the high heterogeneity of diagnosis and treatment limit the generalizability of these results. Median quality of included studies was high. CONCLUSION CRP is associated with higher suicidality in patients with mental disorders. Large cohort studies longitudinally monitoring CRP levels are needed to explore its longitudinal association with suicidality.
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Affiliation(s)
| | | | - Tal Tadmor
- Neurosciences DepartmentUniversity of PaduaPaduaItaly
| | | | | | - Mirko Manchia
- Unit of PsychiatryDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly,Unit of Clinical PsychiatryUniversity Hospital Agency of CagliariCagliariItaly,Department of PharmacologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Andre F. Carvalho
- IMPACT ‐ the Institute for Mental and Physical Health and Clinical TranslationSchool of MedicineBarwon HealthDeakin UniversityGeelongAustralia
| | - Michael Maes
- Department of PsychiatryFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkokThailand,School of MedicineIMPACT Strategic Research CentreDeakin UniversityGeelongVictoriaAustralia
| | - Eduard Vieta
- Bipolar and Depressive Disorders UnitHospital ClinicInstitute of NeuroscienceUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | | | - Marco Solmi
- Department of PsychiatryUniversity of OttawaOttawaOntarioCanada,Department of Mental HealthThe Ottawa HospitalOttawaOntarioCanada
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18
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Mann JJ. Can Knowledge of Genetic and Environmental Causal Factors of Fatal and Nonfatal Suicidal Behavior Be Translated Into Better Prevention? Am J Psychiatry 2021; 178:994-997. [PMID: 34734746 DOI: 10.1176/appi.ajp.2021.21090913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, andDepartment of Psychiatry, Columbia University, New York
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19
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Association between high-sensitivity C-reactive protein levels and depression: Moderation by age, sex, obesity, and aerobic physical activity. J Affect Disord 2021; 291:375-383. [PMID: 34091325 DOI: 10.1016/j.jad.2021.05.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/08/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low-grade systemic inflammation evidenced by elevated serum high-sensitivity C-reactive protein (hsCRP) levels can be a biomarker for depression. This study aimed to investigate the association between serum hsCRP levels and depressive symptoms and to explore the potential moderating effects of age, sex, body mass index (BMI), and aerobic physical activity on the association. METHODS Data of 10,702 adults (≥ 19 years) were obtained from the nationwide cross-sectional Korea National Health and Nutrition Examination Surveys of 2016 and 2018. Significant depressive symptoms were defined as ≥ 10 on the Patient Health Questionnaire-9, and high hsCRP level was defined as > 3.0 mg/L. RESULTS Adults with high hsCRP levels were more likely to have depressive symptoms (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.07-1.84) and suicidal ideation (OR: 1.39, 95% CI: 1.07-1.80) than those with low hsCRP levels. In the age- and sex-stratified analysis, high hsCRP levels were associated with depressive symptoms in the non-geriatric population (age ≤ 64 years) alone, with a higher OR in males than females. In subgroup analyses, the association between them was observed only among obese adults and adults without aerobic physical activity. LIMITATIONS Causal interpretation is limited due to the cross-sectional design. CONCLUSIONS Our results replicate previous findings of an association between high hsCRP levels and depressive symptoms in adults using a large nationally representative sample. The association between them was more prominent in the non-geriatric population, males, obese adults, and those without aerobic physical activity.
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Abstract
PURPOSE OF REVIEW The aim of this review was to analyze COVID-19 effect on the biological features of suicidal vulnerability and its interaction with suicide-related biological pathways. We carried out a narrative review of international publications on the interactions of COVID-19 with the biological bases of suicide. RECENT FINDINGS We hypothesize that SARS-CoV-2 interacts with multiple biological processes that underlie suicidal behavior, such as the renin-angiotensin system, nicotinic receptors, and central and systemic inflammation. Social distancing measures may also worsen subjective or objective social disconnection, thus increasing the risk of suicide. Interestingly, the drugs used to prevent suicide could be promising options to counteract brain damage caused by this coronavirus. SARS-CoV-2 interacts with multiple biological pathways involved in suicide and opens a new window for understanding the suicidal process. The development of suicide prevention treatments in the context of a pandemic may benefit from knowledge on these interactions.
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Affiliation(s)
- I Conejero
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France.
| | - B Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- FondaMental Foundation, Créteil, France
| | - Ph Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- FondaMental Foundation, Créteil, France
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21
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Choi KW, Jang EH, Kim AY, Kim H, Park MJ, Byun S, Fava M, Mischoulon D, Papakostas GI, Yu HY, Jeon HJ. Predictive inflammatory biomarkers for change in suicidal ideation in major depressive disorder and panic disorder: A 12-week follow-up study. J Psychiatr Res 2021; 133:73-81. [PMID: 33310645 DOI: 10.1016/j.jpsychires.2020.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
Previous studies have investigated the role of inflammatory markers in suicidality of patients with major depressive disorder (MDD) or panic disorder (PD). However, few studies have investigated associations between serum inflammatory cytokine levels and suicidality. We hypothesized that MDD and PD status might be significantly associated with serum inflammatory cytokines and that we could predict levels of improvement in suicide ideation intensity using serum inflammatory biomarkers in patients with MDD and PD. For this study, 41 patients with MDD, 52 patients with PD, and 59 healthy control (HC) subjects were enrolled. Psychological measurements and serum inflammatory markers such as interleukin (IL) -6, -10, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and C reactive protein (CRP) were examined. A total of five visits were completed during 12 weeks. After controlling for confounding factors, log-transformed IL-6 (ln_IL-6) at baseline (MDD: 0.297 ± 0.626; PD: 0.342 ± 0.723; HC: -0.121 ± 0.858; p = 0.007, >0.0017, 0.05/30) and mean ln_IL-6 (MDD: 0.395 ± 0.550, PD: 0.249 ± 0.544, HC: -0.139 ± 0.622, p = 0.002, >0.0017, 0.05/30) levels were trends towards significantly higher in patients with MDD and PD than in HC. In MDD patients, a higher level of basal ln_TNF-α was a significant predictor of ΔSSI (changes in SSI scores between baseline and week 12) even after controlling for changes of depression symptoms and baseline SSI scores (standardized β = 0.541, p = 0.002 < 0.0028, 0.05/18). In conclusion, we could predict ΔSSI using baseline inflammatory biomarkers for patients with MDD.
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Affiliation(s)
- Kwan Woo Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Jang
- Bio-Medical IT Convergence Research Division, Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Ah Young Kim
- Bio-Medical IT Convergence Research Division, Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Jin Park
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangwon Byun
- Department of Electronics Engineering, Incheon National University, Incheon, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - George I Papakostas
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Han Young Yu
- Bio-Medical IT Convergence Research Division, Electronics and Telecommunications Research Institute (ETRI), Daejeon, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Korean Psychological Autopsy Center (KPAC), Republic of Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, And Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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Lee D, Baek JH, Cho YJ, Hong KS. Association of Resting Heart Rate and Heart Rate Variability With Proximal Suicidal Risk in Patients With Diverse Psychiatric Diagnoses. Front Psychiatry 2021; 12:652340. [PMID: 33995148 PMCID: PMC8121144 DOI: 10.3389/fpsyt.2021.652340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Objectively measurable biomarkers have not been applied for suicide risk prediction. Resting heart rate (HR) and heart rate variability (HRV) showed potential as trans-diagnostic markers associated with suicide. This study aimed to investigate the associations of resting HR and HRV on proximal suicide risk in patients with diverse psychiatric diagnoses. This chart review study used the medical records of psychiatric patients who visited the outpatient clinic at an academic tertiary hospital. A total of 1,461 patients with diverse psychiatric diagnoses was included in the analysis. Proximal suicide risk was measured using the Mini-International Neuropsychiatric Interview (MINI) suicidal score. Linear regression analyses with the MINI suicidal score as a dependent variable and binary logistic regression analyses with moderate-to-high suicide risk (MINI suicidal risk score ≥6) as a dependent variable were conducted to explore the effects of resting HR and HRV parameters on acute suicide risk after adjusting for age, sex, presence of major depressive disorder (MDD) and bipolar disorder (BD), severity of depression and anxiety severity. We found that 55 (34.6%) patients in the MDD group, 40 (41.7%) in the BD group and 36 (3.9%) in the others group reported moderate-to-high suicide risk. Linear regression analysis revealed that both resting HR and root-mean-square of successive difference (RMSSD) had significant associations with the MINI suicidal score (P = 0.037 with HR, P = 0.003 with RMSSD). In logistic regression, only RMSSD showed a significant association with moderate-to-high suicide risk (P = 0.098 with HR, P = 0.019 with RMSSD), which remained significant in subgroup analysis with patients who reported any suicide-related symptom (MINI suicidal score >0; n = 472; P = 0.017 with HR, P = 0.012 with RMSSD). Our study findings suggest the potential for resting HR and RMSSD as biomarkers for proximal suicide risk prediction. Further research with longitudinal evaluation is needed to confirm our study findings.
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Affiliation(s)
- Dongbin Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hyun Baek
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yun Ji Cho
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Sue Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Chen X, Pu J, Liu Y, Tian L, Chen Y, Gui S, Xu S, Song X, Xie P. Increased C-reactive protein concentrations were associated with suicidal behavior in patients with depressive disorders: a meta-analysis. Psychiatry Res 2020; 292:113320. [PMID: 32717709 DOI: 10.1016/j.psychres.2020.113320] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/13/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
Abstract
Suicide is devastating with a high incidence in patients with depressive disorder (PDDs). Although some studies have explored underlying associations between C-reactive protein (CRP) levels and suicidal behavior in PDDs, consistent results have not been reached. Therefore, the aim of this meta-analysis was to explore the differences of peripheral blood CRP concentrations between suicidal and non-suicidal PDDs, and between suicidal PDDs and healthy controls (HCs). To this end, PubMed, Embase, and Web of science were searched for eligible studies, and pooled effect sizes from eligible studies were calculated by random-effect models. Furthermore, sensitivity and meta-regression analyses were performed to explain the causes of heterogeneity. Eventually, 7 studies with 2,108 participants were included. Our statistical results suggested that the concentrations of peripheral CRP may be significantly increased for suicidal PDDs, both compared with non-suicidal PDDs and HCs, respectively. The differences of detection methods may be linked with the sources of heterogeneity. In short, our findings showed both compared with non-suicidal PDDs and HCs, peripheral blood CRP levels may be significantly increased in suicidal PDDs, while more studies with large sample sizes are needed to validate our findings.
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Affiliation(s)
- Xiang Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yiyun Liu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lu Tian
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siwen Gui
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaohua Xu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemian Song
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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24
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Affiliation(s)
- J John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
| | - Mina M Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
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25
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Su YA, Lin JY, Liu Q, Lv XZ, Wang G, Wei J, Zhu G, Chen QL, Tian HJ, Zhang KR, Wang XY, Zhang N, Wang Y, Haroon E, Yu X, Si TM. Associations among serum markers of inflammation, life stress and suicide risk in patients with major depressive disorder. J Psychiatr Res 2020; 129:53-60. [PMID: 32570089 DOI: 10.1016/j.jpsychires.2020.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) are at high risk for suicide. As the worst outcome of MDD and common self-concealment in patients with suicide risk, studies of biomarkers may provide useful tools for suicide prevention and treatment. METHODS This study recruited 168 patients with MDD from the Objective Diagnostic Markers and Personalized Intervention in MDD patients (ODMPIM), including 50 patients with suicide risk. Based on previous evidence and hypothesis, 23 targeted serum biomarkers involving immune-inflammation, neurotrophins, hypothalamic-pituitary-adrenal (HPA) axis and metabolism, were measured. We used path analysis and principal components analysis (PCA) to clarify the associations among serum biomarkers, childhood adversities, adulthood life events, severity of depression and suicide risk. RESULTS We identified that patients with suicide risk had a higher level of inflammatory markers in serum than patients without suicide risk (P < 0.001), especially chemokine (C-X-C motif) ligand 1 (CXCL-1). After using the Bonferroni correction, there were no differences in biomarkers related to neurotrophins, HPA-axis and metabolism. In addition, a higher proportion of patients with suicide risk had adulthood adversity (assessed by Life Events Scale) (P = 0.003). Intriguingly, path analysis demonstrated that the association between adulthood adversity and suicide risk mainly depended on severity of depression and inflammatory index. CONCLUSION This study highlights the possible role of inflammation involved in suicide risk of MDD patients. Inflammatory markers have the potential for early identification and then reducing suicidal behaviors or becoming novel treatment targets in suicide risk management.
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Affiliation(s)
- Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing-Yu Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Zhen Lv
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Gang Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Wei
- Peking Union Medical College (PUMC), Beijing, China
| | - Gang Zhu
- The First Hospital of China Medical University, Shenyang, China
| | | | | | - Ke-Rang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xue-Yi Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Zhang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Wang
- The 984th Hospital of PLA, Beijing, China
| | - Ebrahim Haroon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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26
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Yang G, Xiao C, Li S, Yang N. The Effect and Mechanism of Adverse Childhood Experience on Suicide Ideation in Young Cancer Patients During Coronavirus Disease 2019 (COVID-19) Pandemic. Risk Manag Healthc Policy 2020; 13:1293-1300. [PMID: 32904621 PMCID: PMC7457626 DOI: 10.2147/rmhp.s266269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background and Aim Coronavirus disease 2019 (COVID-19) is currently prevalent worldwide. This research aimed to explore the effect of adverse childhood experience (ACE) on suicide ideation in young cancer patients during the COVID-19 pandemic. Self-reported questionnaires analyzed the mediating effects of sleep quality, anxiety symptoms, and inflammatory conditions between ACE and suicide ideation. Materials and Methods A total of 197 young cancer patients (age 18–40) completed questionnaires and a blood test. Correlation analysis and structural equation model were used to explore the relationships between ACE, sleep quality, anxiety symptom, serum C-reactive protein (CRP) levels and suicide ideation. The mediating roles of sleep quality, anxiety symptoms, and CRP levels on the influence of ACE on suicide ideation were explored. Results ACE was positively related to anxiety symptoms, CRP levels, and suicide ideation, and negatively related to sleep quality. Anxiety symptoms and CRP levels were positively related to suicide ideation, while sleep quality was negatively related to suicide ideation. Anxiety symptoms were positively related to CRP levels but negatively related to sleep quality. From these results, we found ACE affected suicide ideation directly and was mediated by roles sleep quality, anxiety symptom and CRP. Conclusion ACE not only directly affected suicide ideation but also affected suicide ideation through sleep quality, anxiety symptoms, and inflammatory conditions in young cancer patients during the COVID-19 pandemic. Therefore, targeted intervention and help for cancer patients from the perspective of ACE should be put into practice.
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Affiliation(s)
- Guoqing Yang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, People's Republic of China
| | - Chenchang Xiao
- City College, Wuhan University of Science and Technology, Wuhan, People's Republic of China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Ningxi Yang
- College of Humanities and Social Sciences, Harbin Engineering University, Harbin, People's Republic of China
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27
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Kang GE, Patriquin MA, Nguyen H, Oh H, Rufino KA, Storch EA, Schanzer B, Mathew SJ, Salas R, Najafi B. Objective measurement of sleep, heart rate, heart rate variability, and physical activity in suicidality: A systematic review. J Affect Disord 2020; 273:318-327. [PMID: 32421619 PMCID: PMC7306422 DOI: 10.1016/j.jad.2020.03.096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/27/2020] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Emerging literature suggests that the arousal and regulatory systems as measured by sleep-wakefulness, heart rate (HR) and heart rate variability (HRV) may be powerful objective warning signs of suicidality. However, there is no systematic literature review examining the association between objective measurements of these variables with suicide and suicidal behavior. METHODS A web-based, systematic literature search using PubMed and EMBASE was conducted for articles that measured sleep-wakefulness and HR/HRV quantitatively in association with suicide. Search results were limited to human subjects and articles published in peer-reviewed journals in English. There were no restrictions for age, sex, settings and durations of measurements, types of mental illnesses, or comorbidity. RESULTS Twenty-three studies were included in the current systematic review. Across the studies, consistent patterns of disturbed sleep-wakefulness such as greater sleep onset latency and lower sleep efficiency were related to suicide. In addition, higher HR and lower variance of R-R intervals was an indicator of risk of suicide. LIMITATIONS Studies that used different equipment for sleep studies (i.e., polysomnography, electroencephalogram, actigraphy) were combined, and potential differences in their findings due to the different equipment were not considered. CONCLUSIONS Findings provide initial evidence for consistent patterns of sleep-wakefulness and HR/HRV possibly associated with suicidality; however, more studies are needed in order to identify the precise objective variables (e.g., sleep onset latency, high-frequency HRV), as well as time-varying patterns in these variables, that are related to acute suicide risk.
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Affiliation(s)
- Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Michelle A Patriquin
- The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Hung Nguyen
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Hyuntaek Oh
- The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Katrina A Rufino
- The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Department of Social Sciences, University of Houston Downtown, Houston, TX, United States
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bella Schanzer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Sanjay J Mathew
- The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Ramiro Salas
- The Menninger Clinic, Houston, TX, United States; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
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Eddie D, Bentley KH, Bernard R, Yeung A, Nyer M, Pedrelli P, Mischoulon D, Winkelman JW. Major depressive disorder and insomnia: Exploring a hypothesis of a common neurological basis using waking and sleep-derived heart rate variability. J Psychiatr Res 2020; 123:89-94. [PMID: 32044591 PMCID: PMC7047553 DOI: 10.1016/j.jpsychires.2020.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/03/2020] [Accepted: 01/25/2020] [Indexed: 01/16/2023]
Abstract
It remains unclear whether neurobiological dysfunction observed in major depressive disorder (MDD) and insomnia is an expression of common or independent bases. The present investigation sought to explore differences in heart rate variability (HRV)-a widely utilized biomarker of neurobiological functioning-among individuals with MDD, insomnia, and healthy controls, while awake and during distinct sleep stages (REM, N2), with the goal of improving our understanding of shared neurobiological factors in depression and insomnia. Participants were 73 adults who underwent home polysomnography. All N2 and REM sleep epochs with a duration greater than or equal to 5 min were identified for HRV analysis. Additionally, a single waking epoch was defined for each participant. From waking to N2 sleep, and waking to REM sleep, changes in HRV indices indicated participants experienced reductions in sympathetic arousal and increases in parasympathetic arousal. Contrary to hypotheses, however, no between group differences were observed in HRV. Though the present findings do not support the hypotheses of a shard neurobiological pathway between MDD and insomnia, more work is warranted to advance our understanding of the neurobiological bases of these common, debilitating, and frequently co-occurring psychiatric conditions, to improve early detection and identify novel intervention targets for these disorders.
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Affiliation(s)
- David Eddie
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Kate H Bentley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Richard Bernard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Albert Yeung
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Maren Nyer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - John W Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
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29
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Miller BJ, Parker CB, Rapaport MH, Buckley PF, McCall WV. Insomnia and suicidal ideation in nonaffective psychosis. Sleep 2020; 42:5165662. [PMID: 30407600 DOI: 10.1093/sleep/zsy215] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses. Methods We recruited 108 inpatients and outpatients age 18-65 between July 2010 and July 2016 with DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, or schizophreniform disorder). We investigated relationships between current insomnia (Insomnia Severity Index [ISI]), suicidal ideation over the past week, and lifetime history of suicide attempt (Beck Scale for Suicide Ideation [BSS]) in regression analyses. Results After controlling for potential confounders, insomnia was a significant indicator of suicidal ideation (β = 0.27, p = 0.032). Insomnia was also a significant indicator of a high BSS score (≥16; OR = 1.14, 95% CI: 1.01-1.28, p = 0.029). Furthermore, participants with severe insomnia were almost 15 times more likely to have a lifetime history suicide attempt than participants without current insomnia (OR = 14.8, 95% CI: 1.4-157, p = 0.025). Insomnia was also an indicator of greater PANSS total (β = 0.33, p = 0.001), positive subscale (β = 0.32, p = 0.002), and general subscale (β = 0.40, p < 0.001) scores. Conclusions Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Carmen B Parker
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter F Buckley
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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30
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Feature of Heart Rate Variability and Metabolic Mechanism in Female College Students with Depression. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5246350. [PMID: 32190670 PMCID: PMC7064846 DOI: 10.1155/2020/5246350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 01/19/2023]
Abstract
Purpose To explore the effects of depression on cardiac autonomic nerve function and related metabolic pathways, the heart rate variability (HRV) and urinary differential metabolites were detected on the college students with depression. Methods 12 female freshmen with depression were filtered by the Beck Depression Inventory (BDI-II) and Self-rating Depression Scale (SDS). By wearing an HRV monitoring system, time domain indexes and frequency domain indexes were measured over 24 hours. Liquid chromatography–mass spectrometry (LC-MS) was used to detect their urinary differential metabolites. Differential metabolites were identified by principal component analysis (PCA) and orthogonal projections to latent structures discriminant analysis (OPLS-DA). The metabolic pathways related to these differential metabolites were analyzed by the MetPA database. Results Stress time was significantly increased, and recovery time was markedly decreased in the depression group compared with the control group (p < 0.001). Standard deviation of the normal-to-normal R interval (SDNN), root mean square of the beat-to-beat differences (RMSSD), high frequency (HF), and low frequency (LF) were decreased significantly (p < 0.001). Standard deviation of the normal-to-normal R interval (SDNN), root mean square of the beat-to-beat differences (RMSSD), high frequency (HF), and low frequency (LF) were decreased significantly ( Conclusion Some autonomic nervous system disruption, high stress, and poor fatigue recovery were confirmed in college students with depression. The metabolic mechanism involved the disruption of coenzyme Q biosynthesis, glycine-serine-threonine metabolism, tyrosine metabolism, pyrimidine metabolism, and steroid metabolism under daily stress.
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Velasco Á, Rodríguez-Revuelta J, Olié E, Abad I, Fernández-Peláez A, Cazals A, Guillaume S, de la Fuente-Tomás L, Jiménez-Treviño L, Gutiérrez L, García-Portilla P, Bobes J, Courtet P, Sáiz PA. Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior. Eur Psychiatry 2020; 63:e14. [PMID: 32093807 PMCID: PMC7315873 DOI: 10.1192/j.eurpsy.2019.20] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/28/2019] [Accepted: 12/15/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have emerged as important peripheral inflammatory biomarkers. Recent data suggest a possible role of the immune system in the pathophysiology of suicidal behavior (SB). The aim of this study is to evaluate the association among NLR, MLR, and PLR and SB in patients with major depressive disorder (MDD), and to test its validity as a biomarker for suicidality. METHODS We evaluated 538 patients with MDD (mean age [standard deviation] = 43.87 [14.36] years; females: 68.8%). A logistic regression model was estimated to determine the independent factors associated with suicide risk in patients with and without a history of suicide attempt (SA). RESULTS Three hundred ninety-three patients (74.7%) had a personal history of SA. Patients with a previous SA were more frequently female (71.9% vs. 59.6%; p = 0.007), significantly younger (41.20 vs. 51.77 years; p < 0.001), had lower depression severity at enrolment (15.58 vs. 18.42; p < 0.000), and significantly higher mean NLR and PLR ratios (2.27 vs. 1.68, p = 0.001; 127.90 vs. 109.97, p = 0.007, respectively). In the final logistic regression model, after controlling for age, sex, and depression severity, NLR was significantly associated with SB (β = 0.489, p = 0.000; odds ratio [95% confidence intervals] = 1.631 [1.266-2.102]). We propose a cut-off value of NLR = 1.30 (sensitivity = 75% and specificity = 35%). CONCLUSIONS Our data suggest that NLR may be a valuable, reproducible, easily accessible, and cost-effective strategy to determine suicide risk in MDD.
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Affiliation(s)
- Ángela Velasco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Julia Rodríguez-Revuelta
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier—Inserm U1061, University of Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Iciar Abad
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | | | - Aurélie Cazals
- Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier—Inserm U1061, University of Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier—Inserm U1061, University of Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Lorena de la Fuente-Tomás
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Luis Jiménez-Treviño
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Laura Gutiérrez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier—Inserm U1061, University of Montpellier, Montpellier, France
- Fondation FondaMental, Créteil, France
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Mental Health Services of Principado de Asturias (SESPA), Oviedo, Spain
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Oh KY, Van Dam NT, Doucette JT, Murrough JW. Effects of chronic physical disease and systemic inflammation on suicide risk in patients with depression: a hospital-based case-control study. Psychol Med 2020; 50:29-37. [PMID: 30606276 DOI: 10.1017/s0033291718003902] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Few studies have examined the concurrent effects of physical disease and systemic inflammation on suicide risk in patients with depression. The authors investigated the independent contributions of chronic physical disease and systemic inflammation as indexed by C-reactive protein (CRP), on risk of suicide attempt. METHODS In this case-control study, 1468 cases of suicide attempters and 14 373 controls, both aged 18-65 years with a diagnosis of depression during 2011-2015, were identified from the hospital-wide database. Regression models were implemented to identify separate effects of physical diseases and systemic inflammation indexed by CRP, on risk of suicide attempt. RESULTS Compared with having no physical disease, having one, two, and three or more physical diseases was associated with a 3.6-, 6.4-, and 14.9-fold increase in odds of making a suicide attempt, respectively, after adjusting for age, sex, and race/ethnicity. In a sub-sample of cases and controls with available CRP values, patients with high CRP (>3 mg/L) had 1.9 times the odds of suicide attempt compared with patients with low CRP (<1 mg/L). This association was no longer significant when controlling for the effect of physical disease. CONCLUSIONS The presence of physical disease is an important risk factor for suicide attempt among patients with depression. Systemic inflammation is likewise associated with increased risk for suicide attempt, however, this association appears to be accounted for by the presence of physical disease among patients receiving care in a medical center setting. Healthcare providers should consider the risk of suicide attempt in depressed patients burdened with multiple comorbidities.
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Affiliation(s)
- Kyu Young Oh
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nicholas T Van Dam
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - John T Doucette
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Chesin M, Cascardi M, Tsang W, Smith S. Blunted Arousal in Response to Psychological Stress is Associated with Current Suicide Ideation. Arch Suicide Res 2020; 24:S381-S390. [PMID: 30955451 DOI: 10.1080/13811118.2019.1592041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to test the association between arousal in response to psychological stress, as measured by standardized maximum decrease in high-frequency heart rate variability (HF HRV) during a stressful laboratory task, and current suicide ideation (SI). 81 emerging adult college students completed a stressful laboratory task consisting of the computerized Stroop and Cyberball while having their heart activity recorded. Spectral analysis and Fast Fourier transformations were used to decompose and transform the recording into the high (0.15 Hz-0.4 Hz) frequency component. After the task, participants completed the Beck Scale for Suicide Ideation to measure current SI, the Beck Depression Inventory-II to assess depressive symptom severity, and a brief medical history. Multivariate negative binomial regression analysis showed that the negative association between SI and arousal in response to psychological stress remained statistically significant when suicide attempt history, depressive symptom severity, female gender, and current smoking behavior were controlled. Identification of potential biomarkers for SI is important for suicide behavior prevention given limits to self-report SI assessment. Our results suggest arousal in response to psychological stress merits further consideration as a biomarker for current SI.
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Affiliation(s)
- Megan Chesin
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Michele Cascardi
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - William Tsang
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
| | - Samantha Smith
- Department of Psychology, William Paterson University, Wayne, New Jersey, USA
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Lengvenyte A, Conejero I, Courtet P, Olié E. Biological bases of suicidal behaviours: A narrative review. Eur J Neurosci 2019; 53:330-351. [PMID: 31793103 DOI: 10.1111/ejn.14635] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ismael Conejero
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France.,Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
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Brakel K, Aceves AR, Aceves M, Hierholzer A, Nguyen QN, Hook MA. Depression-like behavior corresponds with cardiac changes in a rodent model of spinal cord injury. Exp Neurol 2019; 320:112969. [PMID: 31158357 DOI: 10.1016/j.expneurol.2019.112969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
Abstract
In previous studies we have shown that approximately 1/3 of male Sprague Dawley rats develop symptoms of depression following a spinal cord injury (SCI). Using established behavioral tests to measure depression in rodents, we found that after SCI, subjects characterized as depressed had decreased sucrose preference, open field activity, social exploration, and burrowing behavior. As some of these tests of depression could be affected by the compromised motor function inherent to the SCI condition, the current study examined whether non-subjective, physiological differences in heart rate and heart rate variability were also associated with depression, as seen in humans. Male Sprague Dawley rats were implanted with radiotelemetry devices and either received a moderate contusion injury or remained intact. The implanted telemetry devices recorded home cage activity, body temperature, heart rate, and heart rate variability for 5 min/h throughout a 30-day post-injury assessment period. Depression behavior was evaluated using a battery of tests conducted on days 9-10 and 19-20 post-injury. Locomotor recovery and pain reactivity were also examined. Hierarchical clustering, based on the behavioral scores collected on the tests of depression, revealed that 28% of the SCI subjects displayed symptoms of depression, relative to the remaining 72% of SCI subjects. The subjects characterized as depressed had significantly lower social interaction and burrowing activity than the group that was not depressed. Interestingly, the subjects behaviorally characterized as depressed also had significantly lower heart rate variability than the not-depressed intact group. There was no difference between not-depressed SCI and intact rats on this measure. Therefore, in addition to behavior, depressed and not-depressed rats differ on measures of physiological function that are associated with depression in humans. These physiological differences further validate the rodent model of depression after SCI.
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Affiliation(s)
- Kiralyn Brakel
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States.
| | - Alejandro R Aceves
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Miriam Aceves
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States
| | - Ashton Hierholzer
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Quynh-Nhu Nguyen
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Michelle A Hook
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States
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Ohlsson L, Gustafsson A, Lavant E, Suneson K, Brundin L, Westrin Å, Ljunggren L, Lindqvist D. Leaky gut biomarkers in depression and suicidal behavior. Acta Psychiatr Scand 2019; 139:185-193. [PMID: 30347427 PMCID: PMC6587489 DOI: 10.1111/acps.12978] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Inflammation is associated with major depressive disorder (MDD) and suicidal behavior. According to the 'leaky gut hypothesis', increased intestinal permeability may contribute to this relationship via bacterial translocation across enterocytes. We measured plasma levels of gut permeability markers, in patients with a recent suicide attempt (rSA), MDD subjects with no history of a suicide attempt (nsMDD), and healthy controls (HC), and related these markers to symptom severity and inflammation. METHOD We enrolled rSA (n = 54), nsMDD (n = 13), and HC (n = 17). Zonulin, intestinal fatty acid binding protein (I-FABP), soluble CD14, and interleukin-6 (IL-6) were quantified in plasma. Montgomery-Åsberg Depression Rating Scale (MADRS) and Suicide Assessment Scale (SUAS) were used for symptom assessments. RESULTS The rSA group displayed higher I-FABP and lower zonulin levels compared with both the nsMDD and the HC groups (all P < 0.001). IL-6 correlated positively with I-FABP (r = 0.24, P < 0.05) and negatively with zonulin (r = -0.25, P < 0.05). In all subjects, I-FABP levels correlated positively with MADRS (r = 0.25, P < 0.05) and SUAS scores (r = 0.38, P < 0.001), and the latter correlation was significant also in the nsMDD group (r = 0.60, P < 0.05). CONCLUSION The 'leaky gut hypothesis' may improve our understanding of the link between inflammation and suicidal behavior. These findings should be considered preliminary until replicated in larger cohorts.
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Affiliation(s)
- L. Ohlsson
- Department of Biomedical ScienceMalmo UniversityMalmöSweden
| | - A. Gustafsson
- Department of Biomedical ScienceMalmo UniversityMalmöSweden
| | - E. Lavant
- Department of Biomedical ScienceMalmo UniversityMalmöSweden
| | - K. Suneson
- Faculty of MedicineDepartment of Clinical Sciences Lund, PsychiatryLund UniversityLundSweden
| | - L. Brundin
- Center for Neurodegenerative ScienceVan Andel Research InstituteGrand RapidsMIUSA
| | - Å. Westrin
- Faculty of MedicineDepartment of Clinical Sciences Lund, PsychiatryLund UniversityLundSweden
| | - L. Ljunggren
- Department of Biomedical ScienceMalmo UniversityMalmöSweden
| | - D. Lindqvist
- Faculty of MedicineDepartment of Clinical Sciences Lund, PsychiatryLund UniversityLundSweden
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Malhi GS, Das P, Outhred T, Irwin L, Morris G, Hamilton A, Lynch K, Mannie Z. Understanding suicide: Focusing on its mechanisms through a lithium lens. J Affect Disord 2018; 241:338-347. [PMID: 30142593 DOI: 10.1016/j.jad.2018.08.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current intervention strategies have been slow in reducing suicide rates, particularly in mood disorders. Thus, for intervention and prevention, a new approach is necessary. Investigating the effects of a medication known for its anti-suicidal properties on neurobiological and neurocognitive substrates of suicidal thinking may provide a deeper and more meaningful understanding of suicide. METHOD A literature search of recognised databases was conducted to examine the intersection of suicide, mood disorders, and the mechanisms of lithium. RESULTS This review synthesises the extant evidence of putative suicide biomarkers and endophenotypes and melds these with known actions of lithium to provide a comprehensive picture of processes underlying suicide. Specifically, the central importance of glycogen synthase kinase-3β (GSK3β) is discussed in detail because it modulates multiple systems that have been repeatedly implicated in suicide, and which lithium also exerts effects on. LIMITATIONS Suicide also occurs outside of mood disorders but we limited our discussion to mood because of our focus on lithium and extending our existing model of suicidal thinking and behaviour that is contextualised within mood disorders. CONCLUSIONS Focusing on the neurobiological mechanisms underpinning suicidal thinking and behaviours through a lithium lens identifies important targets for assessment and intervention. The use of objective measures is critical and using these within a framework that integrates findings from different perspectives and domains of research is likely to yield replicable and validated markers that can be employed both clinically and for further investigation of this complex phenomenon.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia.
| | - Pritha Das
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Lauren Irwin
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Grace Morris
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Katie Lynch
- NSW Health and Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia; Center for Neural Science, New York University, New York, NY 10003, USA
| | - Zola Mannie
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW Australia; Sydney Medical School Northern, University of Sydney, NSW Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
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Adolph D, Teismann T, Forkmann T, Wannemüller A, Margraf J. High frequency heart rate variability: Evidence for a transdiagnostic association with suicide ideation. Biol Psychol 2018; 138:165-171. [PMID: 30253232 DOI: 10.1016/j.biopsycho.2018.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/12/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
Low levels of high frequency heart rate variability (HF-HRV) have been shown to be associated with suicidal ideation and behavior in students and depressed patients. The goal of the present study was to examine associations between suicide ideation and resting HF-HRV as well as HF-HRV reactivity in a diagnostically heterogeneous sample of adult outpatients with or without concurrent suicide ideation. Participants were N = 85 outpatients (67.1% female; age: M = 38.8, SD = 13.72). HF-HRV reactivity was assessed using a sad film induction method. Associations between resting HF-HRV, HF-HRV reactivity and suicide ideation were analyzed using linear regression modeling - controlling for depression, anxiety and stress. HF-HRV reactivity towards the sad film, but not low resting HF-HRV baseline, was predictive of higher scores on suicidal ideation within the whole sample. In women, lower resting as well as perturbed HF-HRV reactivity was associated with higher scores on suicidal ideation. Results suggest that suicide ideators have a reduced capacity to regulate their response to stress.
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Affiliation(s)
- Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-Universität, Bochum, Germany.
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität, Bochum, Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Germany
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr-Universität, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität, Bochum, Germany
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