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Can biological tests assist prediction of suicide in mood disorders?
Open accessAbstract
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were tested to assess their sensitivity, specificity, and predictive power using biological data from published and unpublished studies.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, 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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Metadata
- 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
- 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
- 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
- bronze
- doi.org
- 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 (medical) › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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