Evidence for an association between inflammatory markers and suicide: a cohort study based on 359,849 to 462,747 Taiwanese adults
Open accessAbstract
Background Biological markers of suicide risk have the potential to inform prevention and treatment efforts. It has recently been hypothesised that inflammation may influence mood and in turn suicide risk. We investigated the association between indicators of systemic inflammation and suicide in a large cohort of Taiwanese adults.Methods White blood cell (WBC) count and levels of C-reactive protein (CRP) were measured in 462,747 and 359,849 adults in the Taiwan MJ cohort, respectively. The associations between WBC, CRP and suicide risk were investigated using Cox proportional hazards models adjusting for a range of potential confounding factors.Results During a mean 15.1 and 15.8 years of follow-up, 687 and 605 suicides were identified in participants who had information on WBC and CRP respectively. There was an association of suicide with WBC count (adjusted hazard ratio [aHR] = 1.13 per 1 standard deviation increase of log-transformed WBC, 95% confidence interval [CI] 1.05, 1.22). The association was driven by the highest quintile of WBC count (aHR = 1.39, 95% CI 1.09, 1.77; reference: the lowest quintile). No association between CRP and suicide was found.Limitations Our cohort was from a privately-run health check-up programme and had a lower suicide rate than that in the general population.Conclusions Individuals with the highest WBC counts may have increased risk of suicide. Peripheral markers of inflammation are potential biomarkers of suicide risk; however, this seems to vary by population and the marker investigated and could be influenced by a range of confounding factors.
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Higher levels of CRP, IL-6, IL-8, white blood cell count, and TNF-α were found to be significantly associated with suicidal behavior or idealization in studies with MDD.
“Higher levels of CRP,32 IL-6,33 IL-8,33 white blood cell count,33,34 and TNF-α35 were found to be significantly associated with suicidal behavior or idealization in studies with MDD.”
From Association Between Mood Disorder Severity, Treatment Response and Systemic Inflammatory Markers: Exploring the Role of NLR, PLR, MLR, and SII (2024) · cites this paper as [34]
Citation 34 is attached to white blood cell count, not the other listed markers. The Results (pp. 2, 7) report a significant association between higher WBC count and death by suicide, but the study followed Taiwanese adults generally; it does not establish that finding specifically in studies of people with MDD or for suicidal ideation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe mechanisms underlying the relationship between inflammation and suicide are still unclear.
“(ii) the mechanisms underlying the relationship between inflammation and suicide are still unclear [38]:”
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- Authors
- Russell, A. E., Mars, B., Wen, C. P., Chang, S.-S., & Gunnell, D.
- Affiliations
- University of Exeter (GB)
- University of Bristol (GB)
- National Health Research Institutes (TW)
- National Taiwan University (TW)
- Corresponding author
- Wen, Chi Pang
- Chang, Shu-Sen
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 281
- Pages
- 967-971
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3094649766
- Cited by
- 18
- References
- 28
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 3
- FWCI
- 0.90
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by-nc-nd)
- Explore Bristol Research (acceptedVersion, cc-by-nc-nd)
- Funders
- Ministry of Science and Technology, Taiwan (105-2628-B-002-039-MY4, 109-2321-B-039-002)
- National Taiwan University (NTU-CDP-105R7726, NTU-CDP-106R7726, NTU-CDP-109L7702, NTU-CDP-108L7708, NTU-CDP-107L7721)
- National Institute for Health Research
- University Hospitals Bristol NHS Foundation Trust
- China Medical University Hospital (DMR-109-231)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- suicide, systemic inflammation, white blood cell count, C-reactive protein
- MeSH terms
- Adult, C-Reactive Protein, Humans, Suicide, Taiwan, Cohort Studies, Biomarkers
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