Ascertaining Whether Suicides Are Caused by Infections

Brundin, Lena; Grit, Jamie

doi:10.1001/jamapsychiatry.2016.1470

Cited by 6 publications

(2 citation statements)

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“…There is increased risk for suicidal behavior with the activation of inflammatory responses following treatment with interferon for patients with cancer, hepatitis C, and multiple sclerosis (Baron et al, 1993; Fragoso et al, 2010; Janssen et al, 1994); in autoimmune disorders (Fuller-Thomson et al, 2016; Ludvigsson et al, 2011); in infections (Brundin and Grit, 2016; Lund-Sorensen et al, 2016); and in diseases that involve exaggerated immune responses, such as allergies and asthma (Goodwin, 2012). Inflammation is also associated with impulsivity and aggression (Coccaro et al, 2014; Isung et al, 2014), which predict suicidal behavior (Melhem et al, 2007); and with sleep problems (Prather et al, 2009), which often precede suicidal behavior.…”

Section: Introductionmentioning

confidence: 99%

Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters

Melhem

Munroe

Marsland

et al. 2017

Psychoneuroendocrinology

106

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Background Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation is associated with increased risk for suicidal behavior. However, it is not clear whether such dysregulation exists prior to or is a consequence of attempt. Studies also show an activation of inflammatory responses in suicidal behavior but often combine attempters with those with ideation. Methods The sample consisted of psychiatric inpatients, aged 15-30 years, admitted for suicide attempt (SA, n=38), inpatients admitted for suicidal ideation with no prior history of attempts (SI, n=40), and healthy controls (n=37). We compared SA, SI, and controls on hair cortisol concentrations (HCC), which provides retrospective levels of cortisol and thus prior to the attempt in SA. We also compared them on the expression of genes in the HPA axis and inflammatory pathways previously implicated in suicidal behavior (GR or NR3C1, SKA2, FKBP5, IL-1β, TNF-α); plasma C-Reactive Protein (CRP); and cellular measures of glucocorticoid receptor (GR) sensitivity and stimulated production of IL-6. Results We found lower HCC [β=−0.55, 95% CI (−0.96, −0.13), p=0.01, ES=−0.54] in first-time SA compared to SI and controls. In addition, SA showed lower GR or NR3C1 (α isoform) mRNA [β=−5.11, 95% CI (−10.9, 0.73), p=0.09, ES=−0.46], higher CRP [β=0.94, 95% CI (−0.004, 1.9), p=0.05, ES=0.60], and higher TNF-α mRNA [β=26.4, 95% CI (7.7, 45.2), p=0.006, ES=0.73]. Conclusions This is the first study to differentiate youth who attempt suicide from those with suicidal ideation on HCC and to show that low HCC precedes suicide attempt. Suicide attempters also showed a distinct biological profile on several markers in both the HPA axis and inflammatory pathways. Future longitudinal studies are needed to examine the ability of these biomarkers to predict suicidal behavior.

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Section: Introductionmentioning

confidence: 99%

Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters

Melhem

Munroe

Marsland

et al. 2017

Psychoneuroendocrinology

106

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“…Nevertheless, there is a major need to identify novel and modifiable risk factors to suicidal behavior. Recently, multiple levels of evidence have pointed towards an immunological link with suicidal behavior (7). Specifically, production of certain inflammatory mediators appears to be upregulated in the brains of individuals who died by suicide (8)(9)(10) and in the cerebrospinal fluid (CSF) of individuals with suicide attempts compared to healthy controls (11).…”

Section: Introductionmentioning

confidence: 99%

Infections, Anti-infective Agents, and Risk of Deliberate Self-harm and Suicide in a Young Cohort: A Nationwide Study

Hansen

Köhler‐Forsberg

Petersen

et al. 2019

Biological Psychiatry

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Background: Evidence links infections to mental disorders and suicidal behavior. However, knowledge is sparse regarding less severe infections, anti-infective treatment and deliberate selfharm. Using nationwide Danish longitudinal registers we estimated associations between infections treated with anti-infective agents and infections requiring hospitalization with the risk of deliberate self-harm. Methods: A total of 1.3 million people born 1977-2002 were followed during 1995-2013. In all 15,042 individuals were recorded with deliberate self-harm (92% had been treated with antiinfective agents and 19% had been hospitalized for infections) and 114 died by suicide (64% had been treated with anti-infective agents and 13% had been hospitalized for infections). Hazard rate ratio (HRR) were obtained while adjusting for age, gender, calendar period, education, hospitalizations with infections, prescribed anti-infective agents during childhood, parental mental disorders, and parental deliberate self-harm. Results: Individuals with infections treated with anti-infective agents had an increased risk of deliberate self-harm with a HRR of 1.80 (95% CI=1.68-1.91). The associations fitted a doseresponse relationship (p<0.001) and remained significant up to 5 years after last infection. An additive effect was found for individuals with an additional hospitalization for infections with an increased HRR of 3.20 (95% CI=2.96-3.45) for deliberate self-harm. Conclusions: An increased risk of deliberate self-harm was found among individuals with infections treated with anti-infective agents in temporal and dose-response associations. These results add to the growing literature on a possible link between infections and the pathophysiological mechanisms of suicidal behavior.

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