Brains, genes and environment of suicide attempters

Abstract: Identification of symptoms or biological abnormalities that predispose to suicide or identifies specific vulnerabilities, may one day improve allocation of resources or help tailor treatment to the patient. Paper I: We compared the predictive value of symptom-oriented questions against direct questions about suicidality in assessing risk for suicide attempts. The self-rated Suicide Assessment Scale was administered to 496 psychiatric patients, whose medical records were analyzed a year later. Four questions directly concerned with suicidality contributed to predictive power, but not the symptom-oriented ones. Paper II: We investigated the relationship between suicidal intent and hypothalamic-pituitary-adrenal axis dysfunction in 78 suicide attempters with depression and adjustment disorder. In depressed patients, lower cortisol was associated with more serious suicide attempts. Paper III: We investigated how life-time adversities related to past and present morbidity, and genotype. Forty-two, suicide attempters and 22 matched control patients were followed-up after 13 years. Genotype may have affected risk of attempting suicide, but showed no signs of affecting long term prognosis. Paper IV: Previously published SPECT data showed a correlation between temperament and serotonin transporter availability in suicide attempters. We studied whether these findings were reflected in anatomical differences. Magnetic resonance images were retrieved from 13 of the original subjects, and we found changes in the globus pallidus consistent with this hypothesis. Paper V: Altered perceptual asymmetry measured with dichotic listening has been associated with reduced white matter integrity, prefrontal functioning and response to treatment in depression. Perceptual asymmetry correlated with clinical measures of suicidality in 20 suicide attempters.