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Gomes-da-Costa S, Solé E, Williams E, Giménez A, Garriga M, Pacchiarotti I, Vázquez M, Cavero M, Blanch J, Pérez V, Palao D, Vieta E, Verdolini N. The impact of the Catalonia Suicide Risk Code (CSRC) in a tertiary hospital: Reduction in hospitalizations and emergency room visits for any reason but not for suicide attempt. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:68-75. [PMID: 34111603 DOI: 10.1016/j.rpsm.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Suicide attempts represent a public health concern. The objective of this study is to describe the clinical characteristics of patients visiting an emergency room for a suicide attempt and included in a suicide prevention program, the Catalonia Suicide Risk Code (CSRC), particularly focusing on the follow-up evaluations. MATERIALS AND METHODS The CSRC program is divided in 3 phases: (1) alert and activation, (2) proactive telephone and face-to-face follow-up and (3) comprehensive preventive health monitoring. This is the analysis of the sample of patients attempting or intending suicide who were seen at a tertiary hospital in Barcelona, and their 1-year follow-up outcome. RESULTS Three hundred and sixty-five patients were included. In 15% of the cases, there was no previous psychiatric history but in the majority of cases, a previous psychiatric diagnosis was present. The most common type of suicide attempt was by drug overdose (84%). Up to 66.6% of the patients attended the scheduled follow-up visit in the CSRC program. A significant reduction in the proportion of patients visiting the emergency room for any reason (but not specifically for a suicide attempt) and being hospitalized in the first semester in comparison with the second six months after the CSRC activation (30.1% versus 19.9%, p=0.006; 14.1% versus 5.8%, p=0.002) was observed. CONCLUSIONS The clinical risk factors and the findings of the CSRC helped in the characterization of suicide attempters. The CSRC may contribute to reduce hospitalizations and the use of mental health care resources, at least in the short-term.
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Affiliation(s)
- Susana Gomes-da-Costa
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Eva Solé
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain; Perinatal Mental Health Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Evelyn Williams
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Anna Giménez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Mireia Vázquez
- Psychiatry Emergency Service, Hospital Clinic, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Myriam Cavero
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
| | - Jordi Blanch
- Psychiatry and Psychology Department, Hospital Clinic, University of Barcelona, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain; Chair of the Mental Health and Addictions Program, Department of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Víctor Pérez
- Institute of Neuropsychiatry and Addictions, Department of Psychiatry, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), CIBERSAM, Autonomous University of Barcelona, Barcelona, Catalonia, Spain
| | - Diego Palao
- Department of Mental Health, Parc Taulí-University Hospital of Sabadell, Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain.
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Institute of Neuroscience, Barcelona, Catalonia, Spain
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Sher L, Challman KN, Smith EC, New AS, Perez-Rodriguez MM, McClure MM, Goodman M, Kahn RS, Hazlett EA. Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation. Psychiatry Res 2023; 322:115132. [PMID: 36841053 DOI: 10.1016/j.psychres.2023.115132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
This study compared demographic and clinical features in a sample of 384 participants: healthy controls (HC; n = 166) and individuals with schizotypal personality disorder (SPD) with (n = 50) and without (n = 168) suicidal ideation (SI) to examine specific risk factors for suicidality in SPD. Compared to the non-SI group, the SI group showed significantly greater severity of depression, aggression, impulsivity, affective lability, schizotypal features, poorer social adjustment, and had fewer social contacts. Individuals in the SI group were also more likely to have a history of a suicide attempt and comorbid borderline personality disorder in comparison to the non-SI group. Logistic regression analysis indicated that severity of depression and the number of social contacts drove the difference between the SI and non-SI groups. Compared with both SPD subgroups, the HC group was significantly less depressed, aggressive, impulsive, affectively labile, had fewer schizotypal features, was better socially adjusted, and had more social contacts. This study indicates that overall, the SI group is a more severely impaired group of individuals with SPD compared to the non-SI group. Better educating medical professionals about the diagnosis and management of SPD and its associations with suicidality is warranted.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Katelyn N Challman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emma C Smith
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Antonia S New
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - René S Kahn
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Harris LM, Huang X, Funsch KM, Fox KR, Ribeiro JD. Efficacy of interventions for suicide and self-injury in children and adolescents: a meta-analysis. Sci Rep 2022; 12:12313. [PMID: 35853962 PMCID: PMC9296501 DOI: 10.1038/s41598-022-16567-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Despite increased numbers of children and adolescents seeking and receiving mental health treatment, rates of self-injurious thoughts and behaviors (SITBs) in youth are rising. In the hopes of aiding ongoing efforts to alleviate the burden of SITBs in this vulnerable population, the present study summarizes current knowledge on the efficacy of SITB interventions in children and adolescents. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing treatment effects on SITBs in child and adolescent populations. A total of 112 articles comprising 558 effect sizes were included in analyses. Nearly all interventions produced nonsignificant reductions in SITBs. For binary SITB outcomes, a nonsignificant treatment effect was detected, with an RR of 1.06 (95% CIs [0.99, 1.14]). For continuous SITB outcomes, analyses also yielded a nonsignificant treatment effect (g = - 0.04 [- 0.12, 0.05]). These patterns were largely consistent across SITB outcomes, regardless of intervention type, treatment components, sample and study characteristics, and publication year. Our findings highlight opportunities for improving SITB intervention development and implementation in child and adolescent populations. The most efficacious interventions are likely to directly target the causes of SITBs; therefore, future research is needed to identify the causal processes underlying the onset and maintenance of SITBs in youth.
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Affiliation(s)
- Lauren M Harris
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA.
| | - Xieyining Huang
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
| | - Kensie M Funsch
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kathryn R Fox
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306, USA
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4
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Sher L, Bierer LM, Flory J, Makotkine I, Yehuda R. Brain-derived neurotrophic factor in war veterans with or without a history of suicide attempt. J Affect Disord 2022; 308:160-165. [PMID: 35427710 DOI: 10.1016/j.jad.2022.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) plays a central role in brain development and plasticity and has been demonstrated to be altered in neuropsychiatric diseases and suicidal behavior. We examined whether there is a difference with regard to plasma BDNF levels between veterans who made or did not make a suicide attempt post-deployment. METHODS Combat veterans who made or did not make post-deployment suicide attempts were interviewed using Mini-International Neuropsychiatric Interview, the Montgomery-Åsberg Depression Rating Scale, the Barratt Impulsivity Scale (BIS) and the Scale for Suicidal Ideation (SSI). Reaction to the most recent suicide attempt was evaluated using item 16 of the Suicide Intent Scale. Plasma BDNF levels were determined by the BDNF ELISA kit. RESULTS Controlling for age and body-mass index (BMI), BDNF levels were higher among suicide attempters than non-attempters. We observed a positive correlation between BDNF levels and SSI scores among non-attempters but not among attempters. BDNF levels positively correlated with BIS scores among suicide attempters but not among non-attempters. Suicide attempters who regretted that they made a suicide attempt had significantly higher BDNF levels in comparison to attempters who did not regret their attempts, controlling or not controlling for age and BMI. LIMITATIONS A modest sample size is a shortcoming of our study. CONCLUSIONS Our study demonstrates that BDNF may be involved in the pathophysiology of suicidal behavior in combat veterans. Given the relative ease of measuring plasma BDNF levels, it may be appropriate to consider adding such assessments to studies of suicidal behavior.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janine Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sher L, Bierer LM, Makotkine I, Yehuda R. The effect of oral dexamethasone administration on testosterone levels in combat veterans with or without a history of suicide attempt. J Psychiatr Res 2021; 143:499-503. [PMID: 33243458 DOI: 10.1016/j.jpsychires.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Combat exposure has been linked to increased risk of suicidal ideation, suicide attempts, and death by suicide, and suicidality has been linked with altered testosterone levels. In this study, we examined morning baseline free and total testosterone levels and the effect of dexamethasone administration on testosterone levels in male combat veterans with or without a history of suicide attempt. Demographic and clinical parameters of the study participants were assessed and recorded. Blood samples were collected between 8:00 and 8:30 a.m. on the day prior to and following dexamethasone (0.5 mg) ingestion. Suicide attempters had higher schedule for suicidal ideation (SSI) scores in comparison to non-attempters. Baseline free and total testosterone levels were lower in suicide attempters compared to non-attempters. In the whole sample, both baseline free and total testosterone levels negatively correlated with SSI scores. Free testosterone levels decreased after dexamethasone administration among non-attempters but not among attempters. Free testosterone post-dexamethasone levels positively correlated with aggression scores among non-attempters but not among suicide attempters. Our findings indicate that there are substantial differences in the testosterone regulation between combat veterans with or without a history of suicide attempt. Studies of the relation between the testosterone function and suicidal behavior among combat veterans may lead to improvement in detection of suicidality and finding new pharmacological targets for prevention of suicide among veterans.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Golay P, Ostertag L, Costanza A, Van der Vaeren B, Dorogi Y, Saillant S, Michaud L. Patients with first versus multiple episodes of self-harm: how do their profiles differ? Ann Gen Psychiatry 2021; 20:30. [PMID: 33985548 PMCID: PMC8120773 DOI: 10.1186/s12991-021-00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.
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Affiliation(s)
- Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Louise Ostertag
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Bénédicte Van der Vaeren
- Pole of Psychiatry and Psychotherapy, Liaison Psychiatry Service, Hospital Centre of Valais Romand, Sion, Switzerland
| | - Yves Dorogi
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Saillant
- Center for Psychiatric Emergencies and Liaison Psychiatry, Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Center, Neuchâtel, Switzerland
| | - Laurent Michaud
- Liaison Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Lasota D, Mirowska-Guzel D, Goniewicz K. Analysis of Suicide Methods and Substances Influencing the State of Consciousness of Their Victims in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4936. [PMID: 34066358 PMCID: PMC8124387 DOI: 10.3390/ijerph18094936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/06/2023]
Abstract
An integral part of the World Health Organization's (WHO) mental health action plan for 2013-2020 is suicide prevention, and a 10% reduction in the suicide rate. A key element of the preventive measures taken is, among other things, limiting access to means enabling and facilitating committing suicide. However, this requires detailed knowledge of community suicide patterns and preferences. Unfortunately, such information is not usually collected, and the recorded method of committing suicide is often imprecise and untrue, which means that such knowledge has limited application in presuicidal prophylaxis. The statistical data on suicides recorded as part of the Police Statistics in Poland during the years 2009-2019 was analyzed. The analysis included suicide deaths and suicide attempts, taking into account the suicide methods and substances influencing the state of consciousness of their victims. The number of suicides in Poland in the analyzed period tended to increase. The most common method of suicide was hanging, and alcohol was the substance influencing the state of consciousness of suicide victims. The statistics for 2017-2019 showed the presence of new methods of suicide, such as taking drugs other than hypnotics, intoxication with narcotic drugs, poisoning with designer drugs, suffocation and self-immolation, as well as new psychoactive substances affecting the state of consciousness of victims, i.e., drugs and narcotic drugs. The effectiveness of actions taken in Poland in the field of suicide prevention does not bring the desired effects, as evidenced by growing number of suicides. This low effectiveness is mainly due to the lack of a national suicide prevention strategy. The effectiveness of these activities may be improved by creating a uniform database of suicides, which is a source of reliable information which will allow the taking of actions aimed at limiting the availability of means enabling and facilitating the committing of suicide. The study aimed to analyze the types of suicide methods and substances influencing the state of consciousness of their victims in Poland in the years covered by the study.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02097 Warsaw, Poland;
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02097 Warsaw, Poland;
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08521 Dęblin, Poland;
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Agrawal J, Dwivedi Y. GABA A Receptor Subunit Transcriptional Regulation, Expression Organization, and Mediated Calmodulin Signaling in Prefrontal Cortex of Rats Showing Testosterone-Mediated Impulsive Behavior. Front Neurosci 2020; 14:600099. [PMID: 33240041 PMCID: PMC7677587 DOI: 10.3389/fnins.2020.600099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Testosterone can induce impulsivity, a behavioral impairment associated with various psychiatric illnesses. The molecular mechanisms associated with testosterone-induced impulsivity are unclear. Our earlier studies showed that supraphysiological doses of testosterone to rats induced impulsive behavior, impacted hypothalamic-pituitary-adrenal axis (HPA) and hypothalamic-pituitary-gonadal axis interactions, and altered α2A adrenergic receptors in prefrontal cortex (PFC). Owing to the importance of GABAergic system in impulsivity and memory, the present study examines whether testosterone-mediated impulsivity is associated with changes in the expression of Gamma-Aminobutyric Acid (GABA) A and B receptor subunit transcripts (Gabra1, Gabra2, Gabra2 transcript variant 2, Gabra3, Gabra4, Gabra5, Gabra6, Gabrb1, Gabrb2, Gabrb3, Gabrg1, Gabrg2, Gabrg3, Gabbr1, Gabbr2) in rat PFC, and whether testosterone influences GABAA receptor subunit organization. We studied GABA receptor functions by examining GABA receptor-mediated calcium/calmodulin-dependent kinase signaling genes (Calm1, Calm2, Calm3, Camk2a, Camk2b, Camk2g, Camk2d, Camk4) in the testosterone-induced impulsivity model. Rats were left untreated as controls (C), gonadectomized (GDX), or GDX and injected with supraphysiological doses of testosterone (T). Impulsive behavior was examined using the go/no-go paradigm. Gene expression was studied using qRT-PCR and GABAA subunit reorganization using cross correlation. Our findings show that expressions of select GABAA receptor subunits (Gabra3, Gabra5, Gabra6) were significantly upregulated in PFC of T group compared to GDX or C groups. GABAA receptor subunit organization was different in C, T, and GDX groups. Additionally, Camk4 expression was significantly downregulated in T compared to C group. Our findings suggest that specific GABAA receptor subunit expression, their reorganization, and Camk4-mediated functions may be associated with testosterone-mediated impulsivity.
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Affiliation(s)
- Juhee Agrawal
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States
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9
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Sher L. Suicide research and prevention during and after the COVID-19 pandemic. Acta Psychiatr Scand 2020; 142:353-354. [PMID: 33164212 DOI: 10.1111/acps.13248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, New York City, NY, USA.,Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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10
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Neuropeptide Y plasma levels and suicidal behavior in combat veterans. Eur Neuropsychopharmacol 2020; 40:31-37. [PMID: 32593562 DOI: 10.1016/j.euroneuro.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/01/2020] [Accepted: 06/09/2020] [Indexed: 01/27/2023]
Abstract
War veterans are at increased risk of suicide that may be related to deployment and/or post-deployment stressors and to adjustment-related factors. The aim of this study was to examine whether levels of plasma neuropeptide Y (NPY) might distinguish combat veterans who have made a post-deployment suicide attempt from those who have never made a suicide attempt. We focused on NPY because of prior findings linking NPY with the neurobiology of resilience, stress-related and other disorders, and suicidal behavior. Demographic and clinical parameters of suicide attempters and non-attempters were assessed and plasma NPY was determined by radioimmunoassay. NPY levels were higher among attempters in comparison to non-attempters, controlling for sex and body-mass index. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores than non-attempters. There was a positive correlation between NPY levels and SSI scores among non-attempters but not among attempters. Likewise, NPY levels positively correlated with Brown-Goodwin Aggression Scale scores among suicide attempters but not among non-attempters. This is the first demonstration of altered plasma NPY levels in association with suicide attempt history and suicidal ideation in veterans. Our findings suggest that clinical differences between combat veterans with or without a history of suicide attempt may have a neurobiological origin.
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Gupta G, Deval R, Mishra A, Upadhyay S, Singh PK, Rao VR. Re-testing reported significant SNPs related to suicide in a historical high -risk isolated population from north east India. Hereditas 2020; 157:31. [PMID: 32680568 PMCID: PMC7368720 DOI: 10.1186/s41065-020-00144-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background Genetic diathesis of suicide is supported by family and twin studies. Few candidate gene pathways are known, but does not explain fully the complexity of suicide genetic risk. Recent investigations opting for Genome-Wide Association Studies (GWAS) resulted in finding additional targets, but replication remained a challenge. In this respect small isolated population approach in several complex disease phenotypes is found encouraging. The present study is an attempt to re-test some of the reported significant SNPs for suicide among a small historical high- risk isolated population from Northeast India. Methods Two hundred ten cases (inclusive of depressed, suicide attempter and depressed + suicide attempter) and 249 controls were considered in the present study which were evaluated for the psychiatric parameters. Sixteen reported significant SNPs for suicide behaviour were re-tested using association approach under various genetic models. Networking by GeneMANIA tool was used for function prediction of the associated genes. Results Seven SNPs (of 6 genes) remained significant in different genetic models. On networking genes with significant SNPs IL7, RHEB, CTNN3, KCNIP4, ARFGEF3 are found in interaction with already known candidate gene pathways while SNP rs1109089 (RHEB) gained further support from earlier expression studies. NUGGC gene is in complete isolation. Conclusions Small population approach in replicating significant SNPs is useful in complex phenotypes like suicide. This study explored the region-specific demographics of India by identifying vulnerable population for suicide via genetic association analysis in bringing into academic and administrative forum, the importance of suicide as a disease and its biological basis.
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Affiliation(s)
- Gaurav Gupta
- Department of Biotechnology, Invertis University, Bareilly (U.P), India.,Department of Genetics, Osmania University, Hyderabad, 500007, India
| | - Ravi Deval
- Department of Biotechnology, Invertis University, Bareilly (U.P), India
| | - Anshuman Mishra
- VBRI Innovation Centre, New Delhi, India.,Institute of Advanced Materials (IAAM), 59053, Ulrika, Sweden
| | - Shashank Upadhyay
- Department of Biotechnology, Invertis University, Bareilly (U.P), India
| | - Piyoosh Kumar Singh
- Department of Anthropology, Delhi University, Delhi, India.,Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - V R Rao
- Department of Genetics, Osmania University, Hyderabad, 500007, India. .,Department of Anthropology, Delhi University, Delhi, India. .,Genome Foundation, Hyderabad, India.
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Sher L, Bierer LM, Flory J, Hill MN, Makotkine I, Yehuda R. Endogenous cannabinoid levels and suicidality in combat veterans. Psychiatry Res 2020; 287:112495. [PMID: 31375282 DOI: 10.1016/j.psychres.2019.112495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
Combat veterans are at elevated suicide risk. The goal of this study was to test the hypothesis that combat veterans who have made a suicide attempt post-deployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. For the latter, we focused on endogenous cannabinoids, neuroendocrine markers that are associated with stress. Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for anandamide (AEA), 2-arachidonoylglycerol (2-AG), and cortisol. Suicide attempters had higher Scale for Suicidal Ideation (SSI) scores in comparison to non-attempters. Controlling for gender, 2-AG levels were higher among suicide attempters in comparison to non-attempters. Cortisol levels positively correlated with 2-AG levels and negatively correlated with SSI scores among non-attempters but not among attempters. AEA levels negatively correlated with SSI scores among attempters but not among non-attempters. Our results indicate that there are psychological and biological differences between combat veterans with or without a history of suicidal attempt. Our findings also suggest that clinically observed differences between the groups may have a neurobiological basis.
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Affiliation(s)
- Leo Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janine Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Iouri Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Yarza S, Vodonos A, Hassan L, Shalev H, Novack V, Novack L. Suicide behavior and meteorological characteristics in hot and arid climate. ENVIRONMENTAL RESEARCH 2020; 184:109314. [PMID: 32187563 DOI: 10.1016/j.envres.2020.109314] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Suicidal behavior is determined by the consequence of an interaction between biological, psychological and sociological factors, as well as between individual and environmental effects. Fluctuations in meteorological factors can modify human behavior and affect suicidal rates. We hypothesize that high temperatures can be associated with an increase rate of suicidal attempts. METHODS We included all the patients admitted to Soroka University Medical Center (SUMC) due to suicide attempts between the years 2002-2017 and were residents of Southern Israel. We computed two sets of regression models: first, a time stratified case-crossover design to control for seasonality and individual differences. Results are presented as odds ratio (OR) with confidence interval (CI); and then, time-series analyses to calculate the incidence rate ratio (IRR) and the cumulative effect of temperature on the daily incidences of emergency department (ED) admissions after suicide attempts. We stratified the analyses by demographic variables to identify significant individual differences. RESULTS We identified 3100 attempts, by 2338 patients who lived in Be'er Sheva between 16 and 90 years of age; 421 patients made 2+ attempts. Suicide attempts were associated with a 5 °C increase during the summer season (OR 1.59, 95% CI 1.22-2.08) and a 5 °C increase in all seasons was associated with those who have made multiple attempts (OR 1.18, 95% CI 1.0005-1.38). The cumulative effect of 5 °C increment is associated with more suicide attempts over 2 days (IRR 1.10, 95% CI 0.98; 1.24) and 5 days (IRR 1.04, 95% CI 1.00; 1.08). The associations were greater for patients with psychiatric diagnosis and patients with multiple attempts. In a stratified analysis by individual characteristics we didn't find significant association. CONCLUSION High temperatures and low amount of precipitations are evidently of great impact on people's susceptibility to suicidal behavior, especially for individuals who have had a prior suicide attempt. Our findings indicate the need for public health attention in the summer when temperature increases precipitously over days, especially for those who have made a prior suicide attempt.
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Affiliation(s)
- Shaked Yarza
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Alina Vodonos
- Department of Environmental Health, Harvard T.H. Chan School of Public Heath, Boston, MA, 02115, USA.
| | - Lior Hassan
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Hadar Shalev
- Department of Psychiatry, Soroka Medical Center, Beer Sheva, Israel.
| | - Victor Novack
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Lena Novack
- Negev Environmental Health Research Institute, Soroka University Medical Center, Beer-Sheva, Israel.
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14
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Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts. Psychiatry Res 2020; 284:112747. [PMID: 31927168 DOI: 10.1016/j.psychres.2020.112747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.
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15
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Berardelli I, Forte A, Innamorati M, Imbastaro B, Montalbani B, Sarubbi S, De Luca GP, Mastrangelo M, Anibaldi G, Rogante E, Lester D, Erbuto D, Serafini G, Amore M, Pompili M. Clinical Differences Between Single and Multiple Suicide Attempters, Suicide Ideators, and Non-suicidal Inpatients. Front Psychiatry 2020; 11:605140. [PMID: 33384631 PMCID: PMC7769945 DOI: 10.3389/fpsyt.2020.605140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
Single suicide attempters (SSAs) and multiple suicide attempters (MSAs) represent distinct subgroups of individuals with specific risk factors and clinical characteristics. This retrospective study on a sample of 397 adult psychiatric inpatients analyzed the main sociodemographic and clinical differences between SSAs and MSAs and the possible differences between SSAs, MSAs, and psychiatric patients with and without suicidal ideation (SI). Clinical variables collected included psychiatric diagnoses (Mini International Neuropsychiatric Interview), presence of substance use, current suicide risk status (Columbia Suicide Severity Rating Scale), Clinical Global Impression at admission, Global Assessment of Functioning improvement between admission and discharge, age at onset of psychiatric illness, duration of untreated illness in years, number of hospitalizations in psychiatric settings, and lethality of the most severe suicide attempt. A multinomial logistic regression model with groups showed that MSAs had a higher lethality of their last suicide attempt as compared to SSAs. In addition, MSAs had distinct sociodemographic characteristics compared to both SSAs and patients with SI. Although the study was limited by the relatively small sample size and retrospective nature, the present results suggest that identifying MSAs could be useful in predicting suicide risk and designing ad hoc prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alberto Forte
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Benedetta Imbastaro
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Benedetta Montalbani
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Gabriele Pasquale De Luca
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martina Mastrangelo
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gaia Anibaldi
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, Psychiatry Section, University of Genoa, IRCCS San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Wang X, Cheng S, Xu H. Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression. BMC Psychiatry 2019; 19:303. [PMID: 31623600 PMCID: PMC6798511 DOI: 10.1186/s12888-019-2302-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The potential link between sleep disorders and suicidal behaviour has been the subject of several reviews. We performed this meta-analysis to estimate the overall association between sleep disorders and suicidal behaviour and to identify a more specific relationship in patients with depression. METHODS A systematic search strategy was developed across the electronic databases PubMed, EMBASE and the Cochrane Library from inception to January 1, 2019 for studies that reported a relationship between sleep disorders and suicidal behaviour in depressed patients. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to measure the outcomes. Heterogeneity was evaluated by Cochran's Q test and the I2 statistic. The Newcastle-Ottawa Scale (NOS) was adopted to evaluate the methodological quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of the evidence. We calculated the overall association between sleep disorders and suicidal behaviour and estimated more specific categories, including insomnia, nightmares, hypersomnia, suicidal ideation, suicide attempt, and completed suicide. RESULTS A total of 18 studies were included in this study. Overall, sleep disorders were closely related to suicidal behaviour in patients with depression (OR = 2.45 95% CI: 1.33 4.52). The relatively increased risks of sleep disorders with suicidal ideation, suicide attempt and completed suicide ranged from 1.24 (95% CI: 1.00 1.53) to 2.41 (95% CI: 1.45 4.02). Nightmares were found to be highly correlated with the risk of suicidal behaviour (OR = 4.47 95% CI: 2.00 9.97), followed by insomnia (OR = 2.29 95% CI: 1.69 3.10). The certainty of the evidence was rated as very low for the overall outcome and the major depression subgroup and was rated as low for the depression subgroup. CONCLUSIONS This meta-analysis supports the finding that sleep disorders, particularly nightmares and insomnia, increase the risk of suicidal behaviour in depressed patients. Considering that all included studies were observational, the quality of the evidence is rated as very low. More well-designed studies are needed to confirm our findings and to better explain the mechanisms by which sleep disorders aggravate suicidal behaviour in depressed patients.
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Affiliation(s)
- Xiaofen Wang
- 0000 0001 0379 7164grid.216417.7Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, NO.238 Shang Ma Yuan Ling Road, Kaifu District, Changsha, 410078 Hunan Province China
| | - Sixiang Cheng
- 0000 0001 0379 7164grid.216417.7Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, NO.238 Shang Ma Yuan Ling Road, Kaifu District, Changsha, 410078 Hunan Province China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, NO.238 Shang Ma Yuan Ling Road, Kaifu District, Changsha, 410078, Hunan Province, China.
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Sher L, Flory J, Bierer L, Makotkine I, Yehuda R. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels in combat veterans with or without a history of suicide attempt. Acta Psychiatr Scand 2018; 138:55-61. [PMID: 29790155 DOI: 10.1111/acps.12897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The goal of this study was to determine whether combat veterans who have made a suicide attempt postdeployment can be distinguished from combat veterans who have never made a suicide attempt based on differences in psychological and biological variables. METHODS Demographic and clinical parameters of suicide attempters and non-attempters were assessed. Blood samples were assayed for dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS). RESULTS Suicide attempters had higher Scale for Suicidal Ideation and Montgomery-Åsberg Depression Rating Scale (MADRS)-suicidal thoughts item scores in comparison with non-attempters. There was a trend toward higher MADRS scores in the suicide attempter group compared with non-attempters. Suicide attempters had significantly lower levels of DHEA and DHEAS compared with non-attempters. Scale for Suicidal Ideation scores in all study participants combined negatively correlate with DHEA and DHEAS levels. DHEAS levels negatively correlate with Scale for Suicidal Ideation scores in suicide non-attempters but not in suicide attempters. DHEA/DHEAS ratios positively correlate with total adolescence aggression scores, total adulthood aggression scores, and total aggression scale scores in suicide attempters but not in suicide non-attempters. CONCLUSION There are psychobiological differences between combat veterans with or without a history of suicidal behaviour.
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Affiliation(s)
- L Sher
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Flory
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Bierer
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Makotkine
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R Yehuda
- James J. Peters Veterans' Administration Medical Center, Bronx, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
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