The Relationship Between DST Results and Suicidal Behavior
Abstract
The authors assessed the relationship between dexamethasone suppression test (DST) results and suicidal ideations and behavior. Four-hundred-twenty-three mood disorder patients admitted to a tertiary care medical center were administered the DST from 1978 to 1981. The patients were subsequently followed up to determine death status using a record-linkage method. More than 44% had abnormal cortisol suppression (nonsuppressors) at the index admission. Suppressors and nonsuppressors did not differ significantly with respect to frequency of suicidal ideations or completed suicides. Suppressors were significantly more likely than nonsuppressors to have a history of suicide attempts or to have a suicide attempt following hospital discharge. Using logistic regression, and controlling for several important variables including diagnosis, maximum postdexamethasone cortisol was not significantly associated with suicide, suicidal ideation, or suicide attempts. We conclude that an abnormal DST is not useful as a predictor of suicidal behavior.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [158]
Cited by
Sorted by citations
Bipolar Disorder and Suicide: a Review
Miller, J. N., & Black, D. W. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-1130-0 · Cited by 477 · see citing works
Self-citationCarter, G., Milner, A., McGill, K., Pirkis, J., Kapur, N., & Spittal, M. J. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.182717 · Cited by 361 · see citing works
Hypercortisolemia and depression
Gillespie, C. F., & Nemeroff, C. B. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000163456.22154.d2 · Cited by 361 · see citing works
Bradley, A. J., & Dinan, T. G. (2010) · Journal of Psychopharmacology · doi:10.1177/1359786810385491 · Cited by 258 · see citing works
Can biological tests assist prediction of suicide in mood disorders?
Mann, J. J., Currier, D., Stanley, B., Oquendo, M. A., Amsel, L. V., & Ellis, S. P. (2006) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145705005687 · Cited by 215 · see citing works
A brain-centric model of suicidal behavior
Mann, J. J., & Rizk, M. M. (2020) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20081224 · Cited by 214 · see citing works
A Review of Prospective Studies of Biologic Predictors of Suicidal Behavior in Mood Disorders
Mann, J. J., & Currier, D. (2006) · Archives of Suicide Research · doi:10.1080/13811110600993124 · Cited by 166 · see citing works
Hypothalamus-pituitary-adrenal system regulation and suicidal behavior in depression
Pfennig, A., Kunzel, H. E., Kern, N., Ising, M., Majer, M., Fuchs, B., Ernst, G., Holsboer, F., & Binder, E. B. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.11.017 · Cited by 153 · see citing works
HPA axis hyperactivity and attempted suicide in young adult mood disorder inpatients
Jokinen, J., & Nordström, P. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.10.015 · Cited by 143 · see citing works
Stress, Genes and the Biology of Suicidal Behavior
Currier, D., & Mann, J. J. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.01.005 · Cited by 142 · see citing works
Risk factors for suicide in bipolar disorder: A systematic review
Costa, L. D. S., Alencar, Á. P., Neto, P. J. N., dos Santos, M. D. S. V., da Silva, C. G. L., Pinheiro, S. D. F. L., Silveira, R. T., Bianco, B. A. V., Pinheiro, R. F. F., de Lima, M. A. P., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.09.003 · Cited by 129 · see citing works
Biological risk factors for suicidal behaviors: a meta-analysis
Chang, B., Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., & Nock, M. K. (2016) · Translational Psychiatry · doi:10.1038/tp.2016.165 · Cited by 115 · see citing works
DST non-suppression predicts suicide after attempted suicide
Jokinen, J., Carlborg, A., Mårtensson, B., Forslund, K., Nordström, A., & Nordström, P. (2007) · Psychiatry Research · doi:10.1016/j.psychres.2006.12.001 · Cited by 97 · see citing works
The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression
Yerevanian, B. I., Feusner, J. D., Koek, R. J., & Mintz, J. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.08.009 · Cited by 93 · see citing works
Potential peripheral biological predictors of suicidal behavior in major depressive disorder.
Lee, B.-H., & Kim, Y.-K. (2011) · Progress in Neuro-psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2010.08.001 · Cited by 91 · see citing works
The neurobiology of suicide - A Review of post-mortem studies
Furczyk, K., Schutová, B., Michel, T. M., Thome, J., & Büttner, A. (2013) · Journal of Molecular Psychiatry · doi:10.1186/2049-9256-1-2 · Cited by 78 · see citing works
HPA axis hyperactivity as suicide predictor in elderly mood disorder inpatients
Jokinen, J., & Nordström, P. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.07.012 · Cited by 73 · see citing works
Hyperactivity of the hypothalamic–pituitary–adrenal axis and mortality in major depressive disorder
Coryell, W. H., Young, E. A., & Carroll, B. J. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2005.08.009 · Cited by 71 · see citing works
Kamali, M., Saunders, E. F. H., Prossin, A. R., Brucksch, C. B., Harrington, G. J., Langenecker, S. A., & McInnis, M. G. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.11.027 · Cited by 68 · see citing works
Combined DEX/CRH test among Japanese patients with major depression
Kunugi, H., Urushibara, T., & Nanko, S. (2003) · Journal of Psychiatric Research · doi:10.1016/s0022-3956(03)00103-1 · Cited by 65 · see citing works
The androgen model of suicide completion
Lenz, B., Röther, M., Bouna-Pyrrou, P., Mühle, C., Tektas, O. Y., & Kornhuber, J. (2018) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2018.06.003 · Cited by 56 · see citing works
What can post-mortem studies tell us about the pathoetiology of suicide?
Pandey, G. N., & Dwivedi, Y. (2010) · Future Neurology · doi:10.2217/fnl.10.49 · Cited by 49 · see citing works
Jokinen, J., Nordström, A.-L., & Nordström, P. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.06.008 · Cited by 45 · see citing works
Lindqvist, D., Träskman‐Bendz, L., & Vang, F. (2008) · Archives of Suicide Research · doi:10.1080/13811110802100775 · Cited by 36 · see citing works
HPA-axis hyperactivity and mortality in psychotic depressive disorder: Preliminary findings
Coryell, W. H., Fiedorowicz, J. G., Zimmerman, M. A., & Young, E. A. (2008) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.02.005 · Cited by 22 · see citing works
Should the dexamethasone suppression test be resurrected?
Scandinavica, A. P., & Fink, M. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00628.x · Cited by 22 · see citing works
Clinical Assessment of Suicide Risk in Depressive Disorder
Coryell, W. H. (2006) · CNS Spectrums · doi:10.1017/s109285290001467x · Cited by 17 · see citing works
Suicide and the hypothalamic-pituitary-adrenal axis
Young, E. A., & Coryell, W. H. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67348-5 · Cited by 15 · see citing works
Marazziti, D., Dell’Osso, B. M., Baroni, S., Másala, I., Nasso, E. D., Giannaccini, G., & Conti, L. (2005) · Life Sciences · doi:10.1016/j.lfs.2005.04.031 · Cited by 11 · see citing works
Biological predictors of suicidal behaviour in mood disorders
Mann, J. J., & Currier, D. (2009) · doi:10.1093/med/9780198570059.003.0045 · Cited by 10 · see citing works
Spaan, P., Verrijp, T., Michielsen, P. J. S., Birkenhäger, T. K., Hoogendijk, W. J. G., & Roza, S. J. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.048 · Cited by 7 · see citing works
Suicide and Psychotic Depression
Black, D. W. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.4.765 · Cited by 2 · see citing works
Self-citationBiological Prediction of Suicidal Behavior in Patients with Major Depressive Disorder
Kim, Y.-K. (2012) · InTech eBooks · doi:10.5772/32269 · Cited by 3 · see citing works
Lee, B.-H., & Kim, Y. (2016) · Springer eBooks · doi:10.1007/978-3-319-26282-6_13 · Cited by 2 · see citing works
Suicidal Behavior in Mania and Hypomania
Bendaş, D. B., & Hocaoğlu, Ç. (2025) · IntechOpen eBooks · doi:10.5772/intechopen.1007902 · Cited by 2 · see citing works
Suicide et environnement social
(2013) · Dunod eBooks · doi:10.3917/dunod.court.2013.01.0157 · Cited by 1 · see citing works
Sultzer, D. L., & Mendez, M. A. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.4.764-c
Kundu, S. R., & Sarkar, J. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-33112-1.00008-2
Toward subtyping of suicidality: Brief suicidal ideation is associated with greater stress response
Rizk, M. M., Galfalvy, H., Singh, T., Keilp, J. G., Sublette, M. E., Oquendo, M. A., Mann, J. J., & Stanley, B. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.01.012 · Cited by 52 · see citing works
- Authors
- Black, D., Monahan, P., & Winokur, G.
- Affiliations
- University of Iowa (US)
- Indiana University School of Medicine (US)
- Venue
- Annals of Clinical Psychiatry
- Publisher
- SAGE Publications
- Published
- 2002-06-01
- Volume
- 14
- Issue
- 2
- Pages
- 83-88
- ISSN
- 1040-1237 (ISSN-L)
- OpenAlex
- W2069343532
- Cited by
- 49
- References
- 0
- Citations by year
- 2025: 2 · 2024: 1 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 1 · 2014: 1 · 2013: 3 · 2012: 3
- FWCI
- 4.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- dexamethasone suppression test, suicidal ideation, suicide attempts, suicide mortality, cortisol suppression, mood disorders, suicide risk prediction, hypothalamic-pituitary-adrenal axis
- MeSH terms
- Adult, Dexamethasone, Female, Follow-Up Studies, Glucocorticoids, Humans, Hydrocortisone, Male, Middle Aged, Risk Factors, Suicide, 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 ›
Are you an author, or do you see a problem with this page? Request a review
