HPA axis hyperactivity as suicide predictor in elderly mood disorder inpatients

Jokinen, Jussi; Nordström, Peter

doi:10.1016/j.psyneuen.2008.07.012

Cited by 67 publications

(43 citation statements)

References 50 publications

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“…Our hypotheses were guided by postmortem findings suggesting increased adrenal weight 49,50 and from dexamethasone suppression test studies suggesting HPA-axis hyperreactivity. One possibility for the difference relates to the presence of active psychopathology, particularly major depression, in both postmortem 49,50 and dexamethasone suppression test [11][12][13][14][15] studies finding these associations, whereas our relatives were currently euthymic. Major depression is associated with hypercortisolemia and noradrenergic dysfunction, and the longterm negative health effects of metabolic changes accompanying the stress response are consistent with this finding, which may suggest that prolonged and severe environmental insult in the context of major depression may result in suicide.…”

Section: Salivary Measuresmentioning

confidence: 82%

“…10 The role of dysregulation of the HPA axis as an individual susceptibility factor for suicide has been supported by pharmacologic studies using the dexamethasone suppression test, [11][12][13][14][15][16][17] with several studies indicating that dexamethasone nonsuppression is related to increased risk of suicidal behaviour. The relation of glucocorticoid secretion to suicide is clinically relevant, with potential implications in the etiology of suicide through its well-characterized association with stress.…”

Section: Introductionmentioning

confidence: 99%

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Dysregulation of the sympathetic nervous system, hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide

McGirr

Diaconu²,

Berlim³

et al. 2010

J Psychiatry Neurosci

131

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399Background: Suicidal behaviour aggregates in families, and the hypothalamic-pituitary-adrenal (HPA) axis and noradrenergic dysregulation may play a role in suicide risk. It is unclear whether stress dysregulation is a heritable trait of suicide or how it might increase risk. We investigated stress reactivity of the autonomic nervous system and the HPA axis in suicide predisposition and characterized the effect of this dysregulation on neuropsychologic function. Methods: In this family-based study of first-degree relatives (n = 14) of suicide completers and matched controls with no family or personal history of suicidal behaviour (n = 14), participants underwent the Trier Social Stress Test (TSST). We used salivary α-amylase and cortisol levels to characterize stress reactivity and diurnal variation. We administered a series of neuropsychologic and executive function tests before and after the TSST. Results: Despite normal diurnal variation, relatives of suicide completers exhibited blunted cortisol and α-amylase TSST reactivity. Although there were no baseline differences in conceptual reasoning, sustained attention or executive function, the relatives of suicide completers did not improve on measures of inhibition upon repeated testing after TSST. Secondary analyses suggested that these effects were related to suicide vulnerability independ ent of major depression. Limitations: The sample size was small, and the design prevents us from disentangling our findings from the possible traumatic consequences of losing a relative by suicide. Conclusions: Blunted stress response may be a trait of suicide risk, and impairment of stress-induced executive function may contribute to suicide vulnerability.

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Section: Salivary Measuresmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Dysregulation of the sympathetic nervous system, hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide

McGirr

Diaconu²,

Berlim³

et al. 2010

J Psychiatry Neurosci

131

View full text Add to dashboard Cite

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“…Jokinen and Nordström [38] found that in elderly patients hospitalized for mood disorders such as depression, impaired functioning of the HPA-axis, measured by inability to suppress cortisol in response to the dexamethasone suppression test (DST), was a strong predictor of suicide, indicating possible continuity between in utero Early and later life social characteristics…”

Section: Fetal Growthmentioning

confidence: 99%

Fetal growth, early life circumstances, and risk of suicide in late adulthood

2011

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Recent studies in Sweden and Scotland have found early life conditions to be associated with increased risk of attempted and completed suicide in adolescence and young adulthood. It is not known, however, whether early life conditions affect suicide risk throughout the life course, from adulthood into old age. We examined the effects of early life conditions, including markers of fetal growth, and social and economic characteristics in adulthood, on risk of suicide by violent and non-violent methods in women and men aged 31-87 years using Cox regression. 11,650 women and men born at the Uppsala University Hospital in Sweden between 1915 and 1929 were followed from 1960 until 2002 using linked records from obstetric archives, Census, population and mortality registries. During 435,039 person-years of follow-up 161 completed suicides (104 in males, 57 in females) were observed. An inverse association was found between lower birthweight-for-gestational age and risk of violent suicide in females, although the association did not reach the conventional level of statistical significance (minimally adjusted HR 2.02, 95% CI (0.88-4.63); Table 4). Being male, unmarried, and in the "other or unknown" social class category in adulthood were independently associated with increased rates of suicide. There was a weak association between higher maternal parity and suicide rates. Our findings suggest differences in effects of fetal growth patterns and perinatal circumstances on suicide risk later in life, and suggest that suicide in adults and in the elderly may be influenced by a different combination of factors than those that influence suicide in adolescence and young adulthood.

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“…The Dexamethasone Suppression Test (DST; Carroll et al, 1968) has been commonly employed to assess HPA axis dysregulation by measuring cortisol inhibition after the administration of the synthetic glucocorticoid Dexamethasone. Failure to suppress cortisol is evidence for HPA-axis hyperactivity and has consistently been found to predict completed suicide in patients with mood disorder for example (Coryell and Schlesser, 1981;Coryell et al, 2006;Jokinen and Nordstrom, 2008;Norman et al, 1990). However, whilst DST research has contributed enormously to knowledge regarding HPA axis dysregulation and suicide vulnerability, findings remain inconsistent and contradictory (McGirr et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Cortisol levels and suicidal behavior: A meta-analysis

O’Connor¹,

Ferguson²,

Green³

et al. 2015

Psychoneuroendocrinology

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Suicide is a major cause of death worldwide, responsible for 1.5% of all mortality. The causes of suicidal behavior are not fully understood. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, is one potential risk factor. This meta-analytic review aimed i) to estimate the strength and variability of the association between naturally fluctuating cortisol levels and suicidal behavior and ii) to identify moderators of this relationship. A systematic literature search identified 27 studies (N = 2226; 779 suicide attempters & 1447 non-attempters) that met the study eligibility criteria from a total of 417 unique records initially examined. Estimates of effect sizes (r) obtained from these studies were analysed using Comprehensive Meta-Analysis. In these analyses, we compared participants identified as having a past history of suicide attempt(s) to those with no such history. Study quality, mean age of sample and percentage of male participants were examined as potential moderators. Overall, there was no significant effect of suicide group on cortisol. However, significant associations between cortisol and suicide attempts were observed as a function of age. In studies where the mean age of the sample was below 40 years the association was positive (i.e., higher cortisol was associated with suicide attempts; r = .234, p < .001), and where the mean age was 40 or above the association was negative (i.e., lower cortisol was associated with suicide attempts; r = -.129, p < .001). These findings confirm that HPA axis activity, as indicated by age-dependent variations in cortisol levels, is associated with suicidal behavior. The challenge for theory and clinical practice is to explain the complete reversal of the association with age and to identify its clinical implications.

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HPA axis hyperactivity as suicide predictor in elderly mood disorder inpatients

Cited by 67 publications

References 50 publications

Dysregulation of the sympathetic nervous system, hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide

Dysregulation of the sympathetic nervous system, hypothalamic–pituitary–adrenal axis and executive function in individuals at risk for suicide

Fetal growth, early life circumstances, and risk of suicide in late adulthood

Cortisol levels and suicidal behavior: A meta-analysis

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