title: Blunted HPA Axis Activity in Suicide Attempters Compared to those at High Risk for Suicidal Behavior.
abstract: Studies looking at the relationship of the hypothalamic-pituitary-adrenal (HPA) axis to suicidal behavior and its risk factors, such as depression, childhood abuse, and impulsive aggression, report inconsistent results. These studies also do not always differentiate between subjects who go on to attempt suicide, suicidal subjects who never attempted suicide, and non-suicidal subjects with psychiatric disorders. In this study, we examined cortisol responses to an experimental stressor, the Trier Social Stress Test (TSST), in 208 offspring of parents with mood disorder. Offspring suicide attempters showed lower total cortisol output (β=-0.47, 95% CI (-0.83, -0.11), p=0.01) compared with offspring with suicide-related behavior (SRB) but never attempted, non-suicidal offspring, and a healthy control group. The result remained significant even after controlling for sex, age, race, ethnicity, site, socio-economic status, and hour of the day when the TSST was conducted. Suicide attempters also showed lower baseline cortisol before the TSST (β=-0.45, 95% CI (-0.74, -0.17), p=0.002). However, there were no significant differences between the groups on cortisol reactivity to stress (β=4.5, 95% CI (-12.9, 22), p=0.61). Although subjects with suicide attempt and SRB have similar clinical and psychosocial characteristics, this is the first study to differentiate them biologically on HPA axis indices. Blunted HPA axis activity may increase risk for suicide attempt among individuals with psychopathology by reducing their ability to respond adaptively to ongoing stressors. These results may help better identify subjects at high risk for suicidal behavior for targeted prevention and intervention efforts.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nadine M
authors.initials: NM
authors.lastname: Melhem
authors.affiliation: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Keilp
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.affiliation: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.affiliation: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Ainsley
authors.initials: A
authors.lastname: Burke
authors.affiliation: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stanley
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Cooper
authors.affiliation: Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000503:physiopathology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D006854:Hydrocortisone