Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: a systematic review and meta-analysis
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Abstract
A meta-analysis showed a significant association between activated immune-inflammatory and nitro-oxidative (IO&NS) pathways and suicide attempts (SA). There is no data on whether recent suicidal ideation (SI) is accompanied by activated IO&NS pathways and whether there are differences between recent SA and SI. The current study searched PubMed, Google Scholar, and Web of Science, for articles published from inception until May 10, 2021, and systematically reviewed and meta-analysed the association between recent SA/SI (<3 months) and IO&NS biomarkers. We included studies which compared psychiatric patients with and without SA and SI and controls (either healthy controls or patients without SA/SI) and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence intervals (CI). Our search included 59 studies comprising 4.034 SA/SI cases and 12.377 controls. Patients with SA/SI showed activated IO&NS pathways (SMD: 0.299; CI: 0.200; 0.397) when compared to controls. The immune profiles were more strongly associated with SA than with SI, particularly when compared to healthy controls, as evidenced by activated IO&NS (SMD: 0.796; CI: 0.503; 1.089), immune (SMD: 1.409; CI: 0.637; 1.462), inflammatory (SMD: 1.200; CI: 0.584; 1.816), and neurotoxic (SMD: 0.904; CI: 0.431; 1.378) pathways. The effects sizes of the IO&NS, immune and inflammatory profiles were significantly greater in SA than in SI. In conclusion: activated IO&NS pathways are associated with recent SA and SI, and inflammation, T helper-1 activation, nitro-oxidative stress, lowered neuroprotection, and increased neurotoxicity explain at least in part why psychiatric patients show increased suicidal behaviours, especially SA.
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Sleep disturbances, stress, childhood abuse, and infections induce dysregulation of the hypothalamic-pituitary-adrenal axis that is associated with a chronic low-grade inflammatory state and increased risk of suicidal behaviors.
“In this model, sleep disturbances, stress, childhood abuse, and infections induce dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis that is associated with a chronic low-grade inflammatory state and increased risk of SBs [6].”
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Diamond, L. M., & Alley, J. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104720 · Cited by 412 · see citing works
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Self-citationLet’s Move Towards Precision Suicidology
Courtet, P., & Saiz, P. A. (2025) · Current Psychiatry Reports · doi:10.1007/s11920-025-01605-9 · Cited by 7 · see citing works
- Authors
- Vasupanrajit, A., Jirakran, K., Tunvirachaisakul, C., Solmi, M., & Maes, M.
- Affiliations
- Chulalongkorn University (TH)
- University of Ottawa (CA)
- Deakin University (AU)
- Corresponding author
- Vasupanrajit, Asara
- Maes, Michael
- Venue
- Molecular Psychiatry
- Published
- 2022-01-08
- Volume
- 27
- Issue
- 3
- Pages
- 1350-1361
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- OpenAlex
- W4226094208
- Cited by
- 109
- References
- 106
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 16 · 2023: 28 · 2022: 29 · 2021: 2 · 2012: 1
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Molecular Psychiatry (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Chulalongkorn University (Grant Batch#47 No. 3/2020)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- suicide attempts, suicidal ideation, inflammation, nitro-oxidative stress, immune-inflammatory pathways, neurotoxicity, neuroprotection, biomarkers, psychiatric patients, suicidal behavior
- MeSH terms
- Humans, Inflammation, Suicide, Attempted, Biomarkers, Oxidative Stress, Suicidal Ideation
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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