Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: a meta-analysis
Abstract
Aim The purpose of this meta-analysis was to critically examine the data from individual studies on CSF neurotransmitter metabolites to see whether there were consistencies in the results of the comparison of suicide attempters and psychiatric controls and of the comparison of attempted suicides using violent versus nonviolent methods.Method Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Cochrane library was conducted for studies that reported concentration of CSF-neurotransmitter metabolites: 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy phenylglycol (MHPG) in suicide attempters, from January'1981 to November'2020. Standardized mean differences (SMDs) and corresponding 95 % confidence interval (CIs) were deduced for outcome measures. I 2 statistics were used to assess heterogeneity within studies. Data were analyzed using STATA software.Results A total of 36 studies (N = 1987 attempted suicide and N = 1235 psychiatry control) were included for the meta-analysis. We found CSF levels of all the 3 metabolites i.e. 5-HIAA (SMD= -0.43; 95 %CI: -0.61, -0.24), HVA (SMD= -0.16; 95 %CI: -0.33, -0.00) and MHPG (SMD= -0.33; 95 %CI: -0.71, -0.05) were lower in suicide attempters. While the findings were consistent for 5-HIAA, they were inconsistent for the HVA and MHPG. CSF levels of 5-HIAA (SMD= -0.66; 95 %; CI: -1.01, -0.31), HVA (SMD= -0.14; 95 %CI: -0.45, 0.16) and MHPG (SMD= -0.12; 95 %CI: -0.56, 0.31) were significantly lower in violent suicide attempters than non-violent attempters. No significant publication bias found in any study.Conclusion We found a significant association between lower levels of CSF 5-HIAA in suicide attempters, particularly the violent ones, compared to psychiatric controls, whereas findings from CSF HVA and MHPG were inconsistent.
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Reduced cerebrospinal fluid concentrations of 5-HIAA, the main serotonin metabolite, have been shown among suicide attempters, especially in those employing violent methods.
“Biochemical studies have shown reduced cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA), the main serotonin metabolite, among suicide attempters, especially in those employing violent methods (23, 24).”
From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [24]
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Salehi, M., Saeidi, M., Amanat, M., Barias, T., Anyeji, U., Alzein, O., & Gunturu, S. (2026) · Frontiers in Pediatrics · doi:10.3389/fped.2026.1738009
“Biochemical studies have shown reduced cerebrospinal fluid (CSF) concentrations of 5-hydroxyindoleacetic acid (5-HIAA), the main serotonin metabolite, among suicide attempters, especially in those employing violent methods (23, 24).”
- Authors
- Sharma, R., Tikka, S. K., Yadav, A. K., Bhute, A. R., Dhamija, P., & Bastia, B. K.
- Affiliations
- All India Institute of Medical Sciences Rishikesh (IN)
- All India Institute of Medical Sciences Bibinagar (IN)
- Armed Forces Medical College (IN)
- Corresponding author
- Sharma, Rishi
- Venue
- Asian Journal of Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 62
- Pages
- 102711
- ISSN
- 1876-2018 (ISSN-L)
- OpenAlex
- W3169790471
- Cited by
- 13
- References
- 62
- Citations by year
- 2026: 7 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1
- FWCI
- 0.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Asian Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- suicide attempts, cerebrospinal fluid, monoamine metabolites, 5-hydroxyindoleacetic acid, homovanillic acid, MHPG, violent suicide attempts, serotonin, dopamine, norepinephrine, neurotransmitter metabolism
- MeSH terms
- Aggression, Homovanillic Acid, Humans, Hydroxyindoleacetic Acid, Methoxyhydroxyphenylglycol, Suicide, Attempted
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