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Cited by 45Suicide and Self-Harm StudiesStress Responses and CortisolAdrenal Hormones and Disorders

ROC analysis of dexamethasone suppression test threshold in suicide prediction after attempted suicide

Jokinen, Jussi, Nordström, Anna-Lena, Nordström, Peter·2008·Journal of Affective Disorders
DOI 10.1016/j.jad.2007.06.008
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Abstract

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis function is associated with suicidal behavior. In suicide attempters with mood disorder, the non-suppressor status in the dexamethasone suppression test (DST) is associated with suicide indicating that HPA-axis hyperactivity is a biological risk factor for suicide and may be a useful predictor. The threshold of 5 microg/dl for cortisol levels measured at 08:00 a.m. or 4:00 p.m. following dexamethasone at 11:00 p.m. to define the DTS nonsuppression was derived as being optimal for the separation of melancholia and nonmelancholic conditions rather than the prediction of suicide. A different threshold may offer a better identification of suicide. The aim of this study was to find the optimal threshold level of post DST plasma cortisol at 4 p.m. for suicide prediction using receiver operating characteristics (ROC) analysis. A cohort of 106 depressed inpatients with an index suicide attempt admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000, were submitted to DST and followed up for causes of death. During the follow-up (mean 17 years), 25 suicides (24%) were identified. The ROC analysis revealed that a lower threshold of 3.3 microg/dl for the nonsuppressor status predicted 17 of 25 suicides (sensitivity of 68%) compared with 15 of 25 suicides (sensitivity 60%) with a conventional threshold of 5 microg/dl at 4:00 p.m. In male suicide attempters the lower threshold for pathological DST result (3.3 microg/dl) changed the Odds ratio from 6.7 till 18. In female suicide attempters a higher threshold (7.3 microg/dl) optimised the value of DST as a biological test for suicide prediction indicating a gender difference.

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  • Nonsuppression on the dexamethasone suppression test predicts suicide, but there is disagreement about nonfatal attempts.

    “Nonsuppression on the dexamethasone suppression test, which assesses this HPA axis glucocorticoid receptor feedback loop, predicts suicide (151-153), but there is disagreement about nonfatal attempts (154-158).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [154]

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Authors
Jokinen, J., Nordström, A.-L., & Nordström, P.
Affiliations
Karolinska University Hospital (SE)
Corresponding author
Jokinen, Jussi
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2008-02
Volume
106
Issue
1-2
Pages
145-152
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2007.06.008
OpenAlex
W2088675874
Cited by
45
References
46
Citations by year
2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 6 · 2019: 2 · 2018: 2 · 2016: 9 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 4
FWCI
3.62
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
Funders
Department of Science and Technology, Ministry of Science and Technology, India
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
dexamethasone suppression test, suicide risk prediction, hypothalamic-pituitary-adrenal axis, cortisol, depression, suicide attempters, diagnostic thresholds, receiver operating characteristic, gender differences, melancholia, biological risk factors
MeSH terms
Suicide Prevention, Adult, Bipolar Disorder, Cause of Death, Circadian Rhythm, Major Depressive Disorder, Depressive Disorder, Dexamethasone, Female, Follow-Up Studies, Humans, Hydrocortisone, Male, Middle Aged, Predictive Value of Tests, ROC Curve, Sex Factors, Suicide, Suicide, Attempted, Sweden, Odds Ratio, Dysthymic Disorder

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