Abstract
Suicidal behaviour (SB) is a major public health issue, which encompasses both suicide attempts and suicide completions. Suicide tragically accounts for up to almost one million deaths across the world every year. So far, suicide prediction models have focused on the so-called classic risk factors (male gender, depression, alcohol-related problems, and so on). However, suicide is, thankfully, a very rare outcome. As a result, these suicide predictive models have performed very poorly due to the high number of false positives to pick up suicides.
However, a history previous suicide attempts has been consistently reported to be the strongest predictor of a future SB. Hence, suicide prevention strategies may prioritise high-risk groups such as those who reattempt/repeat suicide. More specifically, an alternative to the classic ‘clinical’ risk assessment approach, which is based on rating ‘clinical’ risk factors, may be to identify biomarkers, which may increase the specificity and sensitivity of the aforementioned suicide prediction models, thus helping clinicians to predict future SB.
Within this context, this chapter provides an up-to-date literature review literature on biomarkers of repeated SB. Three main conclusions can be drawn from our review. First, there is a paucity of studies on the role of biomarkers in repeated suicide attempts to date. Second, the vast majority of these studies focused on two biomarkers, which have been also more comprehensively researched in SB, namely, the serotonin system abnormalities and the HPA axis dysfunction. Finally, ‘it seems to be unlikely that there is a single biomarker of (repeated) SB’. Rather, future research should look at the complex dynamic interaction of a wide range of biological, clinical and neuropsychological contributing risk factors leading up to SB.
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References
Artieda-Urrutia P, Delgado-Gomez D, Ruiz-Hernandez D, Garcia-Vega JM, Berenguer N, Oquendo MA, Blasco-Fontecilla H (2015) Short personality and life event scale for detection of suicide attempters. Rev Psiquiatr Salud Ment 8(4):199–206. https://doi.org/10.1016/j.rpsm.2015.02.004
Asberg M, Traskman L, Thoren P (1976) 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 33(10):1193–1197. https://doi.org/10.1001/archpsyc.1976.01770100055005
Bayard-Burfield L, Alling C, Blennow K, Jonsson S, Traskman-Bendz L (1996) Impairment of the blood-CSF barrier in suicide attempters. Eur Neuropsychopharmacol 6(3):195–199. https://doi.org/10.1016/0924-977x(96)00020-x
Blasco-Fontecilla H, Oquendo MA (2016) Biomarkers of suicide: predicting the predictable? In: Courtet P (ed) Understanding suicide. Springer, London, pp 77–84
Blasco-Fontecilla H, Delgado-Gomez D, Legido-Gil T, de Leon J, Perez-Rodriguez MM, Baca-Garcia E (2012a) Can the Holmes-Rahe social readjustment rating scale (SRRS) be used as a suicide risk scale? An exploratory study. Arch Suicide Res 16(1):13–28. https://doi.org/10.1080/13811118.2012.640616
Blasco-Fontecilla H, Delgado-Gomez D, Ruiz-Hernandez D, Aguado D, Baca-Garcia E, Lopez-Castroman J (2012b) Combining scales to assess suicide risk. J Psychiatr Res 46(10):1272–1277. https://doi.org/10.1016/j.jpsychires.2012.06.013
Blasco-Fontecilla H, Lopez-Castroman J, Giner L, Baca-Garcia E, Oquendo MA (2013) Predicting suicidal behavior: are we really that far along? Comment on "discovery and validation of blood biomarkers for suicidality". Curr Psychiatry Rep 15(12):424. https://doi.org/10.1007/s11920-013-0424-x
Blasco-Fontecilla H, Artieda-Urrutia P, de Leon J (2018) A proposal for using the ratio of attempted to completed suicides across several countries worldwide. Epidemiol Psychiatr Sci:1–5. https://doi.org/10.1017/s2045796018000628
Coryell W, Schlesser M (2001) The dexamethasone suppression test and suicide prediction. Am J Psychiatry 158(5):748–753. https://doi.org/10.1176/appi.ajp.158.5.748
Courtet P, Picot MC, Bellivier F, Torres S, Jollant F, Michelon C et al (2004) Serotonin transporter gene may be involved in short-term risk of subsequent suicide attempts. Biol Psychiatry 55(1):46–51. https://doi.org/10.1016/j.biopsych.2003.07.004
Daray FM, Mann JJ, Sublette ME (2018) How lipids may affect risk for suicidal behavior. J Psychiatr Res 104:16–23. https://doi.org/10.1016/j.jpsychires.2018.06.007
Duman RS, Monteggia LM (2006) A neurotrophic model for stress-related mood disorders. Biol Psychiatry 59(12):1116–1127. https://doi.org/10.1016/j.biopsych.2006.02.013
Dwivedi Y, Rizavi HS, Conley RR, Roberts RC, Tamminga CA, Pandey GN (2003) Altered gene expression of brain-derived neurotrophic factor and receptor tyrosine kinase B in postmortem brain of suicide subjects. Arch Gen Psychiatry 60(8):804–815. https://doi.org/10.1001/archpsyc.60.8.804
Falcone T, Fazio V, Lee C, Simon B, Franco K, Marchi N, Janigro D (2010) Serum S100B: a potential biomarker for suicidality in adolescents? PLoS One 5(6):e11089. https://doi.org/10.1371/journal.pone.0011089
Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X et al (2017) Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 143(2):187–232. https://doi.org/10.1037/bul0000084
Fudalej S, Ilgen M, Fudalej M, Kostrzewa G, Barry K, Wojnar M et al (2010) Association between tryptophan hydroxylase 2 gene polymorphism and completed suicide. Suicide Life Threat Behav 40(6):553–560. https://doi.org/10.1521/suli.2010.40.6.553
Gerszten RE, Wang TJ (2008) The search for new cardiovascular biomarkers. Nature 451(7181):949–952. https://doi.org/10.1038/nature06802
Giner L, Blasco-Fontecilla H, Mercedes Perez-Rodriguez M, Garcia-Nieto R, Giner J, Guija JA et al (2013) Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison. J Affect Disord 151(2):474–483. https://doi.org/10.1016/j.jad.2013.06.029
Giraud P, Fortanier C, Fabre G, Ghariani J, Guillermain Y, Rouviere N et al (2013) Suicide attempts by young adolescents: epidemiological characteristics of 517 15-year-old or younger adolescents admitted in French emergency departments. Arch Pediatr 20(6):608–615. https://doi.org/10.1016/j.arcped.2013.03.024
Golier JA, Marzuk PM, Leon AC, Weiner C, Tardiff K (1995) Low serum cholesterol level and attempted suicide. Am J Psychiatry 152(3):419–423. https://doi.org/10.1176/ajp.152.3.419
Hampton T (2010) Depression care effort brings dramatic drop in large HMO population’s suicide rate. JAMA 303:1903–1905
Hegerl U, Mergl R, Havers I, Schmidtke A, Lehfeld H, Niklewski G, Althaus D (2010) Sustainable effects on suicidality were found for the Nuremberg alliance against depression. Eur Arch Psychiatry Clin Neurosci 260(5):401–406. https://doi.org/10.1007/s00406-009-0088-z
Heyerdahl F, Bjornaas MA, Dahl R, Hovda KE, Nore AK, Ekeberg O, Jacobsen D (2009) Repetition of acute poisoning in Oslo: 1-year prospective study. Br J Psychiatry 194(1):73–79. https://doi.org/10.1192/bjp.bp.107.048322
Isometsa ET, Heikkinen ME, Marttunen MJ, Henriksson MM, Aro HM, Lonnqvist JK (1995) The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 152(6):919–922. https://doi.org/10.1176/ajp.152.6.919
Jimenez-Trevino L, Saiz PA, Garcia-Portilla MP, Blasco-Fontecilla H, Carli V, Iosue M et al (2017) 5-HTTLPR-brain-derived neurotrophic factor (BDNF) gene interactions and early adverse life events effect on impulsivity in suicide attempters. World J Biol Psychiatry:1–13. https://doi.org/10.1080/15622975.2017.1376112
Jokinen J, Martensson B, Nordstrom AL, Nordstrom P (2008a) CSF 5-HIAA and DST non-suppression -independent biomarkers in suicide attempters? J Affect Disord 105(1–3):241–245. https://doi.org/10.1016/j.jad.2007.04.008
Jokinen J, Nordstrom AL, Nordstrom P (2008b) ROC analysis of dexamethasone suppression test threshold in suicide prediction after attempted suicide. J Affect Disord 106(1–2):145–152. https://doi.org/10.1016/j.jad.2007.06.008
Jones R (2010) Biomarkers: casting the net wide. Nature 466(7310):S11–S12. https://doi.org/10.1038/466S11a
Kim YK, Myint AM (2004) Clinical application of low serum cholesterol as an indicator for suicide risk in major depression. J Affect Disord 81(2):161–166. https://doi.org/10.1016/s0165-0327(03)00166-6
Lee BH, Kim YK (2011) Potential peripheral biological predictors of suicidal behavior in major depressive disorder. Prog Neuro-Psychopharmacol Biol Psychiatry 35(4):842–847. https://doi.org/10.1016/j.pnpbp.2010.08.001
Lee JM, Han JJ, Altwerger G, Kohn EC (2011) Proteomics and biomarkers in clinical trials for drug development. J Proteome 74(12):2632–2641. https://doi.org/10.1016/j.jprot.2011.04.023
Le-Niculescu H, Levey DF, Ayalew M, Palmer L, Gavrin LM, Jain N et al (2013) Discovery and validation of blood biomarkers for suicidality. Mol Psychiatry 18(12):1249–1264. https://doi.org/10.1038/mp.2013.95
Lester D (1995) The concentration of neurotransmitter metabolites in the cerebrospinal fluid of suicidal individuals: a meta-analysis. Pharmacopsychiatry 28(2):45–50. https://doi.org/10.1055/s-2007-979587
Lindh AU, Dahlin M, Beckman K, Stromsten L, Jokinen J, Wiktorsson S et al (2019) A comparison of suicide risk scales in predicting repeat suicide attempt and suicide: a clinical cohort study. J Clin Psychiatry 80(6). https://doi.org/10.4088/JCP.18m12707
Lindqvist D, Isaksson A, Traskman-Bendz L, Brundin L (2008) Salivary cortisol and suicidal behavior--a follow-up study. Psychoneuroendocrinology 33(8):1061–1068. https://doi.org/10.1016/j.psyneuen.2008.05.012
Lopez-Castroman J, Blasco-Fontecilla H, Courtet P, Baca-Garcia E, Oquendo MA (2015) Are we studying the right populations to understand suicide? World Psychiatry 14(3):368–369. https://doi.org/10.1002/wps.20261
Lopez-Morinigo JD, Ayesa-Arriola R, Torres-Romano B, Fernandes AC, Shetty H, Broadbent M et al (2016) Risk assessment and suicide by patients with schizophrenia in secondary mental healthcare: a case-control study. BMJ Open 6(9):e011929. https://doi.org/10.1136/bmjopen-2016-011929
Lopez-Morinigo JD, Fernandes AC, Shetty H, Ayesa-Arriola R, Bari A, Stewart R, Dutta R (2018) Can risk assessment predict suicide in secondary mental healthcare? Findings from the South London and Maudsley NHS foundation trust biomedical research centre (SLaM BRC) case register. Soc Psychiatry Psychiatr Epidemiol 53(11):1161–1171. https://doi.org/10.1007/s00127-018-1536-8
Mann JJ (2003) Neurobiology of suicidal behaviour. Nat Rev Neurosci 4(10):819–828. https://doi.org/10.1038/nrn1220
Mann JJ, Currier D (2007) A review of prospective studies of biologic predictors of suicidal behavior in mood disorders. Arch Suicide Res 11(1):3–16. https://doi.org/10.1080/13811110600993124
Mann JJ, Waternaux C, Haas GL, Malone KM (1999) Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 156(2):181–189
Mann JJ, Currier D, Stanley B, Oquendo MA, Amsel LV, Ellis SP (2006) Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol 9(4):465–474. https://doi.org/10.1017/s1461145705005687
Mendez-Bustos P, de Leon-Martinez V, Miret M, Baca-Garcia E, Lopez-Castroman J (2013) Suicide reattempters: a systematic review. Harv Rev Psychiatry 21(6):281–295. https://doi.org/10.1097/hrp.0000000000000001
Merali Z, Kent P, Du L, Hrdina P, Palkovits M, Faludi G et al (2006) Corticotropin-releasing hormone, arginine vasopressin, gastrin-releasing peptide, and neuromedin B alterations in stress-relevant brain regions of suicides and control subjects. Biol Psychiatry 59(7):594–602. https://doi.org/10.1016/j.biopsych.2005.08.008
Nordstrom P, Samuelsson M, Asberg M, Traskman-Bendz L, Aberg-Wistedt A, Nordin C, Bertilsson L (1994) CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav 24(1):1–9
Oquendo MA, Currier D, Mann JJ (2006) Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors? Acta Psychiatr Scand 114(3):151–158. https://doi.org/10.1111/j.1600-0447.2006.00829.x
Oquendo MA, Sullivan GM, Sudol K, Baca-Garcia E, Stanley BH, Sublette ME, Mann JJ (2014) Toward a biosignature for suicide. Am J Psychiatry 171(12):1259–1277. https://doi.org/10.1176/appi.ajp.2014.14020194
Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm. Systematic review. Br J Psychiatry 181:193–199. https://doi.org/10.1192/bjp.181.3.193
Oyesanya M, Lopez-Morinigo J, Dutta R (2015) Systematic review of suicide in economic recession. World J Psychiatry 5(2):243–254. https://doi.org/10.5498/wjp.v5.i2.243
Pandey GN (2013) Biological basis of suicide and suicidal behavior. Bipolar Disord 15(5):524–541. https://doi.org/10.1111/bdi.12089
Papadopoulou A, Markianos M, Christodoulou C, Lykouras L (2013) Plasma total cholesterol in psychiatric patients after a suicide attempt and in follow-up. J Affect Disord 148(2–3):440–443. https://doi.org/10.1016/j.jad.2012.11.032
Parra Uribe I, Blasco-Fontecilla H, Garcia-Pares G, Giro Batalla M, Llorens Capdevila M, Cebria Meca A et al (2013) Attempted and completed suicide: not what we expected? J Affect Disord 150(3):840–846. https://doi.org/10.1016/j.jad.2013.03.013
Parra-Uribe I, Blasco-Fontecilla H, Garcia-Pares G, Martinez-Naval L, Valero-Coppin O, Cebria-Meca A et al (2017) Risk of re-attempts and suicide death after a suicide attempt: a survival analysis. BMC Psychiatry 17(1):163. https://doi.org/10.1186/s12888-017-1317-z
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K et al (2009) Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 374(9693):881–892. https://doi.org/10.1016/s0140-6736(09)60741-8
Pokorny AD (1983) Prediction of suicide in psychiatric patients. Report of a prospective study. Arch Gen Psychiatry 40(3):249–257
Pokorny AD (1993) Suicide prediction revisited. Suicide Life Threat Behav 23(1):1–10
Roy A, De Jong J, Linnoila M (1989) Cerebrospinal fluid monoamine metabolites and suicidal behavior in depressed patients. A 5-year follow-up study. Arch Gen Psychiatry 46(7):609–612. https://doi.org/10.1001/archpsyc.1989.01810070035005
Roy A, Karoum F, Pollack S (1992) Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide. Arch Gen Psychiatry 49(6):447–450. https://doi.org/10.1001/archpsyc.1992.01820060027004
Samuelsson M, Jokinen J, Nordstrom AL, Nordstrom P (2006) CSF 5-HIAA, suicide intent and hopelessness in the prediction of early suicide in male high-risk suicide attempters. Acta Psychiatr Scand 113(1):44–47. https://doi.org/10.1111/j.1600-0447.2005.00639.x
Schillani G, Goljevscek S, Carlino D, De Vanna M, Aguglia E, Giraldi T (2009) Repeated suicidal behaviour: stressful life events and 5-HTTLPR genetic polymorphism. Int J Psychiatry Clin Pract 13(3):229–232. https://doi.org/10.1080/13651500902785652
Singh I, Rose N (2009) Biomarkers in psychiatry. Nature 460(7252):202–207. https://doi.org/10.1038/460202a
Smith EG, Kim HM, Ganoczy D, Stano C, Pfeiffer PN, Valenstein M (2013) Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. J Clin Psychiatry 74(3):226–232. https://doi.org/10.4088/JCP.12m07853
Soreni N, Apter A, Weizman A, Don-Tufeled O, Leschiner S, Karp L, Gavish M (1999) Decreased platelet peripheral-type benzodiazepine receptors in adolescent inpatients with repeated suicide attempts. Biol Psychiatry 46(4):484–488. https://doi.org/10.1016/s0006-3223(98)00342-4
Sublette ME, Hibbeln JR, Galfalvy H, Oquendo MA, Mann JJ (2006) Omega-3 polyunsaturated essential fatty acid status as a predictor of future suicide risk. Am J Psychiatry 163(6):1100–1102. https://doi.org/10.1176/ajp.2006.163.6.1100
Traskman L, Asberg M, Bertilsson L, Sjostrand L (1981) Monoamine metabolites in CSF and suicidal behavior. Arch Gen Psychiatry 38(6):631–636. https://doi.org/10.1001/archpsyc.1981.01780310031002
Traskman-Bendz L, Alling C, Oreland L, Regnell G, Vinge E, Ohman R (1992) Prediction of suicidal behavior from biologic tests. J Clin Psychopharmacol 12(2 Suppl):21s–26s
Verkes RJ, Hengeveld MW, van der Mast RC, Fekkes D, van Kempen GM (1998) Mood correlates with blood serotonin, but not with glucose measures in patients with recurrent suicidal behavior. Psychiatry Res 80(3):239–248. https://doi.org/10.1016/s0165-1781(98)00075-4
WHO (Producer) (2019) Suicide in the world. Global Health Estimates
Zhang L, Su TP, Choi K, Maree W, Li CT, Chung MY et al (2011) P11 (S100A10) as a potential biomarker of psychiatric patients at risk of suicide. J Psychiatr Res 45(4):435–441. https://doi.org/10.1016/j.jpsychires.2010.08.012
Zureik M, Courbon D, Ducimetiere P (1996) Serum cholesterol concentration and death from suicide in men: Paris prospective study I. BMJ 313(7058):649–651. https://doi.org/10.1136/bmj.313.7058.649
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Blasco-Fontecilla, H., Mendez-Bustos, P., Lopez-Morinigo, J.D. (2020). Toward a Biosignature of Suicide Reattempt. In: Baca-Garcia, E. (eds) Behavioral Neurobiology of Suicide and Self Harm. Current Topics in Behavioral Neurosciences, vol 46. Springer, Cham. https://doi.org/10.1007/7854_2020_164
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