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Stein MB, Jain S, Papini S, Campbell-Sills L, Choi KW, Martis B, Sun X, He F, Ware EB, Naifeh JA, Aliaga PA, Ge T, Smoller JW, Gelernter J, Kessler RC, Ursano RJ. Polygenic risk for suicide attempt is associated with lifetime suicide attempt in US soldiers independent of parental risk. J Affect Disord 2024; 351:671-682. [PMID: 38309480 PMCID: PMC11259154 DOI: 10.1016/j.jad.2024.01.254] [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: 09/03/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Suicide is a leading cause of death worldwide. Whereas some studies have suggested that a direct measure of common genetic liability for suicide attempts (SA), captured by a polygenic risk score for SA (SA-PRS), explains risk independent of parental history, further confirmation would be useful. Even more unsettled is the extent to which SA-PRS is associated with lifetime non-suicidal self-injury (NSSI). METHODS We used summary statistics from the largest available GWAS study of SA to generate SA-PRS for two non-overlapping cohorts of soldiers of European ancestry. These were tested in multivariable models that included parental major depressive disorder (MDD) and parental SA. RESULTS In the first cohort, 417 (6.3 %) of 6573 soldiers reported lifetime SA and 1195 (18.2 %) reported lifetime NSSI. In a multivariable model that included parental history of MDD and parental history of SA, SA-PRS remained significantly associated with lifetime SA [aOR = 1.26, 95%CI:1.13-1.39, p < 0.001] per standardized unit SA-PRS]. In the second cohort, 204 (4.2 %) of 4900 soldiers reported lifetime SA, and 299 (6.1 %) reported lifetime NSSI. In a multivariable model that included parental history of MDD and parental history of SA, SA-PRS remained significantly associated with lifetime SA [aOR = 1.20, 95%CI:1.04-1.38, p = 0.014]. A combined analysis of both cohorts yielded similar results. In neither cohort or in the combined analysis was SA-PRS significantly associated with NSSI. CONCLUSIONS PRS for SA conveys information about likelihood of lifetime SA (but not NSSI, demonstrating specificity), independent of self-reported parental history of MDD and parental history of SA. LIMITATIONS At present, the magnitude of effects is small and would not be immediately useful for clinical decision-making or risk-stratified prevention initiatives, but this may be expected to improve with further iterations. Also critical will be the extension of these findings to more diverse populations.
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Affiliation(s)
- Murray B Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Karmel W Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian Martis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Feng He
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Erin B Ware
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tian Ge
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joel Gelernter
- Departments of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, CT, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Bigdeli TB, Barr PB, Rajeevan N, Graham DP, Li Y, Meyers JL, Gorman BR, Peterson RE, Sayward F, Radhakrishnan K, Natarajan S, Nielsen DA, Wilkinson AV, Malhotra AK, Zhao H, Brophy M, Shi Y, O'Leary TJ, Gleason T, Przygodzki R, Pyarajan S, Muralidhar S, Gaziano JM, Huang GD, Concato J, Siever LJ, DeLisi LE, Kimbrel NA, Beckham JC, Swann AC, Kosten TR, Fanous AH, Aslan M, Harvey PD. Correlates of suicidal behaviors and genetic risk among United States veterans with schizophrenia or bipolar I disorder. Mol Psychiatry 2024:10.1038/s41380-024-02472-1. [PMID: 38491344 DOI: 10.1038/s41380-024-02472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Persons diagnosed with schizophrenia (SCZ) or bipolar I disorder (BPI) are at high risk for self-injurious behavior, suicidal ideation, and suicidal behaviors (SB). Characterizing associations between diagnosed health problems, prior pharmacological treatments, and polygenic scores (PGS) has potential to inform risk stratification. We examined self-reported SB and ideation using the Columbia Suicide Severity Rating Scale (C-SSRS) among 3,942 SCZ and 5,414 BPI patients receiving care within the Veterans Health Administration (VHA). These cross-sectional data were integrated with electronic health records (EHRs), and compared across lifetime diagnoses, treatment histories, follow-up screenings, and mortality data. PGS were constructed using available genomic data for related traits. Genome-wide association studies were performed to identify and prioritize specific loci. Only 20% of the veterans who reported SB had a corroborating ICD-9/10 EHR code. Among those without prior SB, more than 20% reported new-onset SB at follow-up. SB were associated with a range of additional clinical diagnoses, and with treatment with specific classes of psychotropic medications (e.g., antidepressants, antipsychotics, etc.). PGS for externalizing behaviors, smoking initiation, suicide attempt, and major depressive disorder were associated with SB. The GWAS for SB yielded no significant loci. Among individuals with a diagnosed mental illness, self-reported SB were strongly associated with clinical variables across several EHR domains. Analyses point to sequelae of substance-related and psychiatric comorbidities as strong correlates of prior and subsequent SB. Nonetheless, past SB was frequently not documented in health records, underscoring the value of regular screening with direct, in-person assessments, especially among high-risk individuals.
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Affiliation(s)
- Tim B Bigdeli
- VA New York Harbor Healthcare System, Brooklyn, NY, US.
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, US.
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US.
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US.
| | - Peter B Barr
- VA New York Harbor Healthcare System, Brooklyn, NY, US
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
| | - Nallakkandi Rajeevan
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - David P Graham
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Yuli Li
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Jacquelyn L Meyers
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
| | - Bryan R Gorman
- Massachusetts Area Veterans Epidemiology, Research and Information Center (MAVERIC), Jamaica Plain, MA, USA
| | - Roseann E Peterson
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, US
| | - Frederick Sayward
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Krishnan Radhakrishnan
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | | | - David A Nielsen
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anna V Wilkinson
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Epidemiology, Human Genetics and Environmental Science, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anil K Malhotra
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Hongyu Zhao
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Mary Brophy
- Massachusetts Area Veterans Epidemiology, Research and Information Center (MAVERIC), Jamaica Plain, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Yunling Shi
- Massachusetts Area Veterans Epidemiology, Research and Information Center (MAVERIC), Jamaica Plain, MA, USA
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Theresa Gleason
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Ronald Przygodzki
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Saiju Pyarajan
- Massachusetts Area Veterans Epidemiology, Research and Information Center (MAVERIC), Jamaica Plain, MA, USA
| | | | - J Michael Gaziano
- Massachusetts Area Veterans Epidemiology, Research and Information Center (MAVERIC), Jamaica Plain, MA, USA
- Harvard University, Boston, MA, USA
| | - Grant D Huang
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - John Concato
- Yale University School of Medicine, New Haven, CT, USA
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Larry J Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Nathan A Kimbrel
- Durham VA Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Alan C Swann
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Thomas R Kosten
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ayman H Fanous
- VA New York Harbor Healthcare System, Brooklyn, NY, US
- Department of Psychiatry, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Bruce W. Carter Miami Veterans Affairs (VA) Medical Center, Miami, FL, USA
- University of Miami School of Medicine, Miami, FL, USA
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