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Cited by 215Suicide and Self-Harm StudiesBipolar Disorder and TreatmentTreatment of Major Depression

Can biological tests assist prediction of suicide in mood disorders?

Open access
Mann, J. John, Currier, Dianne, Stanley, Barbara, Oquendo, Maria A., Amsel, Lawrence V., Ellis, Steven P.·2006·The International Journal of Neuropsychopharmacology
DOI 10.1017/s1461145705005687
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Abstract

Predicting suicide is difficult due to its low base-rate and the limited specificity of clinical predictors. Prospective biological studies suggest that dysfunctions in the serotonergic system and hypothalamic-pituitary-adrenal axis have some predictive power for completed suicide in mood disorders. A prediction model that incorporates biological testing to increase specificity and sensitivity of prediction of suicide is of potential clinical value. Meta-analyses of prospective biological studies of suicide and cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) and suicide and the dexamethasone suppression test (DST) in mood disorders using the penalized quasi-likelihood (PQL) and bootstrap method yield odds ratios for prediction of suicide of 4.48 and 4.65 respectively. Two combinatory prediction models, the first requiring positive results on more than one test, and the second requiring a positive result on either one of two tests, were tested to assess their sensitivity, specificity, and predictive power using biological data from published and unpublished studies. The prediction model that requires both DST and CSF 5-HIAA tests to be positive results in 37.5% sensitivity, 88% specificity, and has a positive predictive value of 23%. The prediction model that requires either DST or CSF 5-HIAA tests to be positive results in 87.5% sensitivity, 28% specificity, and has a positive predictive value of 10%. Thus, models attempting to predict a lethal outcome that is uncommon perform very differently making model choice of major importance. Further work on refining biological predictors and integration with clinical predictors is needed to optimize a model to predict suicide in the clinic.

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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 [151]

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Research works printed but not linked: 3

  1. Amsel L, Mann JJ (2001). Suicide risk assessment and the suicidal process approach. In: van Heeringen K (Ed.), Understanding Suicidal Behaviour: The Suicidal Process Approach to Research and Treatment (pp. 163-181). Sussex: John Wiley and Sons, Ltd.
  2. A ˚sberg M, Nordstro ¨m P, Tra ¨skman-Bendz L (1986). Biological factors in suicide. In: Roy A (Ed.), Suicide (pp. 47-71). Baltimore: Williams and Wilkins.
  3. Stanley M, Mann JJ, Gershon S (1983). Alterations in pre-and postsynaptic serotonergic neurons in suicide victims. Psychopharmacological Bulletin 19, 684-687.

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Related

Authors
Mann, J. J., Currier, D., Stanley, B., Oquendo, M. A., Amsel, L. V., & Ellis, S. P.
Affiliations
New York State Psychiatric Institute (US)
Corresponding author
Mann, J. John
ORCID
Venue
The International Journal of Neuropsychopharmacology
Publisher
Oxford University Press (OUP)
Published
2005-06-21
Volume
9
Issue
04
Pages
465
ISSN
  • 1461-1457 (ISSN-L)
  • 1469-5111
DOI
10.1017/s1461145705005687
OpenAlex
W2137625559
Cited by
215
References
55
Citations by year
2026: 3 · 2025: 8 · 2024: 5 · 2023: 9 · 2022: 8 · 2021: 14 · 2020: 16 · 2019: 5 · 2018: 24 · 2017: 6 · 2016: 14 · 2015: 7 · 2014: 12 · 2013: 16 · 2012: 7
FWCI
1.55
Type
journal article
Language
en
Open access
Locations
  • The International Journal of Neuropsychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (MH48514, MH 62184, R01MH048514)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
suicide risk prediction, mood disorders, serotonergic dysfunction, hypothalamic-pituitary-adrenal axis, dexamethasone suppression test, biological predictors, penalized quasi-likelihood
MeSH terms
Humans, Predictive Value of Tests, Prospective Studies, Suicide, Biomarkers, Mood Disorders

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