Citation

Melhem NM, Keilp JG, Porta G, Oquendo MA, Burke A, Stanley B, Cooper TB, Mann JJ, Brent DA. Neuropsychopharmacology 2015; 41(6): 1447-1456.

Affiliation

From the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Copyright

(Copyright © 2015, Nature Publishing Group)

DOI

10.1038/npp.2015.309

PMID

26450815

Abstract

Studies looking at the relationship of the hypothalamic-pituitary-adrenal axis (HPA) to suicidal behavior and its risk factors, such as depression, childhood abuse, and impulsive aggression, report inconsistent results. These studies also do not always differentiate between subjects who go on to attempt suicide, suicidal subjects who never attempted suicide, and non-suicidal subjects with psychiatric disorders. In this study, we examined cortisol responses to an experimental stressor, the Trier Social Stress Test (TSST), in 208 offspring of parents with mood disorder. Offspring suicide attempters showed lower total cortisol output [β=-0.47, 95% CI (-0.83, -0.11), p=0.01] compared to offspring with suicide-related behavior but never attempted, non-suicidal offspring, and a healthy control group. The result remained significant even after controlling for sex, age, race, ethnicity, site, socioeconomic status, and hour of the day when the TSST was conducted. Suicide attempters also showed lower baseline cortisol prior to the TSST [β=-0.45, 95% CI (-0.74, -0.17), p=0.002]. However, there were no significant differences between the groups on cortisol reactivity to stress [β=4.5, 95% CI (-12.9, 22), p=0.61]. Although subjects with suicide attempt and suicide-related behavior have similar clinical and psychosocial characteristics, this is the first study to differentiate them biologically on HPA axis indices. Blunted HPA axis activity may increase risk for suicide attempt among individuals with psychopathology by reducing their ability to respond adaptively to ongoing stressors. These results may help better identify subjects at high-risk for suicidal behavior for targeted prevention and intervention efforts.Neuropsychopharmacology accepted article preview online, 09 October 2015. doi:10.1038/npp.2015.309.

Language: en