Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts

AbstractObjective:The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship.Methods:A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months.Results:At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity.Conclusion:The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.

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Research on serotonin and suicidal behavior: neuroendocrine and molecular approaches

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2002.4.4/hcorrea ◽

2002 ◽

Vol 4 (4) ◽

pp. 408-416

Keyword(s):

Major Depression ◽

Suicide Attempt ◽

Gene Polymorphism ◽

Psychiatric Disorder ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Healthy Controls ◽

Molecular Approaches ◽

History Of ◽

Serotonergic Function

We carried out two studies to test the hypothesis that altered central serotonergic function, as assessed by lower prolactin (PRL) response to fenfluramine (D-FEN), is more closely associated with suicidal behavior than a particular psychiatric diagnosis. A D-FEN test was performed in 85 major depressed inpatients, 33 schizophrenic inpatients, and 18 healthy controls. We showed that PRL response to D-FEN is a marker of suicidality, regardless of psychiatric disorder. We then examined the association en the serotonin (5-hydroxytryptamine) receptor 5-HT(2A) gene polymorphism (T102C) and suicide in a sample of Brazilian psychiatric inpatients (95 with schizophrenia, 78 with major depression) and 52 healthy controls. No differences were found in genotypic frequencies across patients and controls. Overall, no differences were found between patients with (n=66) and without (n=107) a history of suicide attempt. We also compared patients with a history of severe suicide attempts (lethality>3; n=32) and patients without such a history (n=107), but they did not exhibit different genotypic frequencies either. These results show thai the 5-HT(2A) gene polymorphism (T102C) may not be involved in the genetic susceptibility to suicidal behavior.

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Suicidal Behavior in German Adolescents

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000331 ◽

2015 ◽

Vol 43 (1) ◽

pp. 39-45 ◽

Cited By ~ 4

Author(s):

Joana Straub ◽

Ferdinand Keller ◽

Nina Sproeber ◽

Michael G. Koelch ◽

Paul L. Plener

Keyword(s):

Suicidal Behavior ◽

Suicide Attempts ◽

Depression Scale ◽

Epidemiological Studies ◽

Present Sample ◽

Manic Symptoms ◽

Symptoms Of Depression ◽

Adolescent Sample ◽

History Of ◽

Sum Scores

Objective: Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date. Methods: 1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior. Results: In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores. Conclusions: Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.

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Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽

10.1027//0227-5910.24.2.73 ◽

2003 ◽

Vol 24 (2) ◽

pp. 73-78 ◽

Cited By ~ 21

Author(s):

Yves Sarfati ◽

Blandine Bouchaud ◽

Marie-Christine Hardy-Baylé

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Personality Traits ◽

Rating Scales ◽

Suicide Attempts ◽

World Health ◽

Life Questionnaire ◽

Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

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Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality

Crisis ◽

10.1027/0227-5910/a000588 ◽

2019 ◽

Vol 40 (6) ◽

pp. 413-421 ◽

Cited By ~ 2

Author(s):

Megan L. Rogers ◽

Thomas E. Joiner

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Pain Perception ◽

Suicide Attempts ◽

Pain Tolerance ◽

Self Report ◽

Interactive Effects ◽

Physical Pain ◽

Affective Disturbance ◽

The Relationship

Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211003462 ◽

2021 ◽

pp. 003022282110034

Author(s):

Azam Farmani ◽

Mojtaba Rahimianbougar ◽

Yousef Mohammadi ◽

Hossein Faramarzi ◽

Siamak Khodarahimi ◽

...

Keyword(s):

Risk Assessment ◽

Suicide Attempt ◽

Suicide Attempts ◽

Psychological Services ◽

Cross Sectional ◽

Economic Determinants ◽

History Of ◽

Cross Sectional Design ◽

High Level ◽

Risk Assessment And Management

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

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Insomnia Symptom Severity is Associated with Increased Suicidality and Death by Suicide in a Sample of Patients with Psychiatric Disorders

SLEEP ◽

10.1093/sleep/zsab032 ◽

2021 ◽

Author(s):

Zach Simmons ◽

Gary Burlingame ◽

Juergen Korbanka ◽

Kevin Eastman ◽

Douglas Thomas ◽

...

Keyword(s):

Psychiatric Disorders ◽

Suicidal Behavior ◽

Symptom Severity ◽

Suicide Attempts ◽

Sleep Problems ◽

Manner Of Death ◽

Insomnia Symptom ◽

History Of ◽

Depressive Personality ◽

Insomnia Symptoms

Abstract Study Objectives Insomnia is a risk factor for suicidal behavior including attempts and death by suicide. We investigated whether insomnia symptom severity was associated with suicidality and death by suicide in patients with psychiatric disorders. Methods The sample included 180 deceased patients with psychiatric disorders seen at Weber Human Services between 2008 and 2018 who completed the Outpatient Questionnaire-45.2 (OQ) prior to death. Insomnia symptom severity was assessed using item 41 from the OQ. Manner of death was determined by death records and autopsy reports. History of suicidality was determined through electronic medical records. Cases were grouped into 4 lifetime categories: non-suicidal (n=30), suicidal ideation (n=36), suicide attempt (n=95), and death by suicide (n=19). Demographic, medical, and psychiatric features of each group were compared using linear regression. Logistic regression was used to determine whether insomnia symptom severity was associated with lifetime suicidality severity grouping, adjusting for psychiatric disorders commonly linked to suicidality. Results Lifetime suicidality was associated with sleep problems, fatigue, headaches, and psychiatric disorders (i.e., depressive, personality, and trauma-related disorders). Referenced to the non-suicidal group, greater insomnia symptom severity was significantly associated with suicide attempts and death by suicide, with odds ratios (OR) of OR=2.67, p=0.011, and OR=5.53, p=0.002, respectively, even after adjusting important psychiatric diagnoses. Conclusions Results suggest that insomnia symptom severity endorsed during a clinical visit is associated with heightened suicidality, especially suicidal behavior. The presence of insomnia symptoms in patients with psychiatric disorders may indicate risk for suicide and is a target for suicide prevention.

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The serotonin transporter gene may be involved in the short-term risk of subsequent suicide attempt

European Neuropsychopharmacology ◽

10.1016/s0924-977x(02)80734-9 ◽

2002 ◽

Vol 12 ◽

pp. 423-424

Author(s):

P. Courtet ◽

S. Torres ◽

B. Astruc ◽

F. Jollant ◽

D. Castelnau ◽

...

Keyword(s):

Suicide Attempt ◽

Serotonin Transporter ◽

Serotonin Transporter Gene ◽

Transporter Gene ◽

Short Term

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Suicide attempts preceding completed suicide

The British Journal of Psychiatry ◽

10.1192/bjp.173.6.531 ◽

1998 ◽

Vol 173 (6) ◽

pp. 531-535 ◽

Cited By ~ 167

Author(s):

Erkki T. Isometsä ◽

Jouko K. Lönnqvist

Keyword(s):

Suicide Attempt ◽

Suicide Prevention ◽

Suicide Risk ◽

Suicide Attempts ◽

Early Recognition ◽

Preventive Measure ◽

Time Interval ◽

Psychological Autopsy ◽

Autopsy Study ◽

History Of

BackgroundThis study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.MethodThe lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.ResultsOverall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).ConclusionsMost male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

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Assessment of Suicidal Behavior in a Psychiatric Emergency Room in Lisbon,

Acta Médica Portuguesa ◽

10.20344/amp.5888 ◽

2015 ◽

Vol 28 (4) ◽

pp. 469

Author(s):

João Gama Marques ◽

Diogo Frasquilho Guerreiro ◽

Daniel Sampaio

Keyword(s):

Emergency Room ◽

Suicidal Behavior ◽

Suicidal Behaviour ◽

Psychiatric Emergency ◽

Emergency Rooms ◽

Psychiatric Emergency Room ◽

Suicide Intent ◽

History Of ◽

Clinical Records

Introduction: Some studies alerted for the burden of suicidal attempters at emergency rooms. In this study we characterized the suicidal patients admitted to a Portuguese emergency room. Material and Methods: For three years, all patients assessed by the first author after suicidal behaviour were included. Suicidal intentionality was evaluated with the Pierce Suicide Intent Scale. Clinical records were searched for follow-up status and satisfaction level was assessed through telephone call. Results: From 120 included patients 70.8% were female, with mean age of 42.35 years. Pierce Suicide Intent Scale suicidal intentionality was low in 30.1%, medium in 59.3%, and high in 10.6% of the sample. The most important predictors of Pierce Suicide Intent Scale intentionality were male gender (p < 0.001), family history of suicide (p < 0.01), divorced or widowed marital status (p < 0.013), and severe mental illness (p < 0.015). In 41.6% of the patients the follow-up status was unknown. Regarding satisfaction, only 19.5% gave a valid answer: 2.7% ‘mildly satisfied’, 4.4% ‘moderately satisfied’, and 12.5% ‘very satisfied’. Discussion: The Pierce Suicide Intent Scale is useful on suicidal behavior assessment at emergency rooms. Highly intentional suicidal behaviour is related to male sex, social problems and personal and familial psychiatric history. Conclusion: The quality of administrative records on this psychiatric emergency room setting are still unacceptable. The most important variables correlated with higher suicidal intentionality are the same described in other countries. Of the reachable patients, one fifth was satisfied with provided follow-up. We still need studies for better understanding of suicidal behaviour observed on this Portuguese emergency room.

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