BDNF, impulsiveness and avoidant focused coping in suicide attempters

Brain-derived neurotrophic factor (BDNF) is an important protein for neuroplasticity and neurogenesis. In this thesis the role of BDNF, in suicidal behaviour was investigated with focus on possible risk factors for suicidal behaviour such as avoidant focused coping, dysfuntional personality traits like impulsiveness and hyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis.Paper I: The association between avoidant focused coping and the BDNF Val66Met gene polymorphism in two different cohorts of suicide attempters was investigated. The Met allele of this gene polymorphism was associated with increased use of avoidant focused coping, irrespectively of age and the severity of depressive symptoms. Paper II: The relationships between BDNF in plasma, clinical symptoms and personality dimensions were studied in recent suicide attempters. BDNF concentrations in plasma were correlated significantly with Solidity but not with symptoms of depression or anxiety.Paper III: The association between BDNF in plasma and HPA axis activity in recent suicide attempters was investigated. Plasma BDNF concentrations were correlated significantly and negatively with post-dexamethasone cortisol in female but not in male suicide attempters. Paper IV: The association between avoidant coping strategies, suicide risk measured with the Suicide assessment self-rating scale (SUAS-S) and suicidal ideation was studied in two different cohorts of suicide attempters, and in a cohort of depressed patients without a history of attempted suicide. Regression analyses revealed significant positive correlations between avoidant coping strategies and the total scores of SUAS-S adjusted for age, gender, the severity of depressive symptoms and the co-morbidity with personality disorder in both cohorts of suicide attempters and in depressed patients without a history of attempted suicide. Furthermore, a significant correlation between more severe suicidal ideations and increased use of avoidant focused coping was observed in all three cohorts of patients.Paper V: The relationship between avoidant focused coping and personality traits in recent suicide attempters and in healthy controls was examined. Avoidant focused coping was correlated significantly with Solidity in suicide attempters. The finding remained significant after controlling for age and gender. Conclusion: The results indicate that there are associations between BDNF, impulsiveness and HPA axis hyperactivity in suicide attempters. Furthermore, an increased use of avoidant focused coping is suggested as a risk factor for suicidal behaviour in psychatric patients

Leptin, Anxiety Symptoms, and Hypothalamic-Pituitary-Adrenal Axis Activity among Drug-Free, Female Suicide Attempters

BACKGROUND: Dysregulation of leptin secretion and functioning of the hypothalamic-pituitary-adrenal (HPA) axis may be involved in the pathophysiology of suicide. Preclinical and clinical studies have shown interactions between the HPA axis and leptin. There is also evidence for a negative relationship between leptin and anxiety in humans. However, these possible associations have not been studied in individuals with attempted suicide.OBJECTIVES: To examine the relationship between leptin, HPA axis activity, and anxiety in individuals with a recent suicide attempt.METHOD: Sixty-nine individuals with a recent suicide attempt (n = 37 females; n = 32 males) were recruited and subjected to the Dexamethasone Suppression Test (DST), lumbar puncture, and evaluation with the Comprehensive Psychopathological Rating Scale from which the Brief Scale for Anxiety (BSA) was derived. Leptin was analyzed in cerebrospinal fluid (CSF) and cortisol in serum. Leptin was corrected for body mass index (BMI) by dividing CSF-leptin by BMI (CSF-leptin/BMI). Due to gender-related differences in leptin secretion and HPA axis activity, calculations were made for males and females separately.RESULTS: Significant differences were only found among females; CSF-leptin/BMI levels correlated significantly and negatively with BSA (p < 0.05), pre-DST cortisol, and post-DST serum cortisol at 8 a.m. and 3 p.m. (all p < 0.05). Furthermore, CSF-leptin/BMI was significantly lower in nonsuppressors of dexamethasone as compared to suppressors (p < 0.05).CONCLUSIONS: These findings suggest that in females with a recent suicide attempt, low CSF leptin may be related to symptoms of anxiety and a hyperactive HPA axis

Gender-Related Differences in the Relationship between Homovanillic Acid in the Cerebrospinal Fluid and Clinical Symptoms in Suicide Attempters

INTRODUCTION: Decreased dopaminergic activity - as reflected by lower levels of the major metabolite homovanillic acid (HVA) in cerebrospinal fluid (CSF) - may be involved in the pathophysiology of attempted suicide. An inverse association has also been found between dopaminergic activity and clinical symptoms of depression and anxiety in non-suicidal individuals. The aim of this study was to assess the relationship between CSF-HVA and clinical symptoms associated with an increased risk of suicide in individuals who attempted suicide.METHODS: Ninety-five people (52 women; 43 men) who had recently attempted suicide received lumbar punctures to analyse levels of HVA in the CSF. They were also evaluated with the Comprehensive Psychopathological Rating Scale, from which scores on the Montgomery-Åsberg Depression Rating Scale (MADRS), the Brief Scale of Anxiety (BSA), and an item on suicidal thoughts were analysed.RESULTS: Among female participants, CSF-HVA was significantly and negatively correlated with BSA total scores, after adjusting for covariates (beta = -0.442, p = 0.002), but not with scores on the MADRS or suicidal thought item. No significant correlations were observed between CSF-HVA and symptoms among male participants.CONCLUSION: Our findings suggest that lower dopaminergic activity may be associated with clinical symptoms of anxiety among women who have recently attempted suicide

Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt

BACKGROUND AND AIM: Albumin is a protein with multifaceted functions in the human body. According to many studies, lower serum albumin may be associated with depression in various groups of psychiatric and non-psychiatric patients, as well as with attempted suicide. As more severe depressive symptoms have been identified as a reliable risk factor for suicide in patients with high suicide risk, it would be of interest to study whether, the inverse association between depressive symptoms and albumin may exist among patients with attempted suicide. Therefore, the aim of the study was to investigate the possible association between albumin and depressive symptoms among individuals who recently attempted suicide.METHODS: One-hundred twenty-seven individuals with a recent suicide attempt were involved in the study between 1987 and 2001. Albumin was analyzed in serum. Patients were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS) from which the Montgomery-Åsberg Depression Rating Scale (MADRS) and the item assessing Apparent sadness were derived.RESULTS: Only among patients aged ≥45, serum albumin levels were significantly and negatively correlated with total scores of MADRS and the item Apparent sadness (all p values <.00625).CONCLUSIONS: Our findings indicate an inverse association between serum albumin and the severity of depressive symptoms in individuals who attempted suicide, older than 45 years

The Association between Neuroticism and Re-Attempted Suicide

Background: Strong evidence suggests that suicide attempters who repeatsuicide (re-attempters) may differ from those with a single attempt (singleattempters) in various clinical and sociodemographic factors. Furthermore, thereis some evidence that re-attempters may be characterized by higher levels ofneuroticism, a well-known risk factor for completed suicide compared to singleattempters.Purpose: The aim of the present study was to investigate the possibleassociation between neuroticism and re-attempted suicide.Methods and Materials: 230 recent drug-free suicide attempters wereinvolved into the study. Clinical diagnoses were assessed by the Diagnosticand Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R).Personality traits were measured by the Karolinska Scale of Personality (KSP).Results and Conclusions: There was a significant association betweenre-attempted suicide, female gender, personality disorder and higher levelsof impulsivity. We found that re-attempters had significantly higher levels ofneuroticism compared to single attempters adjusted of gender, personalitydisorder diagnosis, age and impulsivity. Our result gives further evidence for theassociation between re-attempted suicide and neuroticism

Hypothalamic–pituitary–adrenal axis hyperactivity is associated with decreased brain-derived neurotrophic factor in female suicide attempters

Introduction: Both decreased levels of brain-derived neurotrophic factor (BDNF) and hypothalamic–pituitary–adrenal (HPA) axis dysregulation may be involved in the pathophysiology of suicidal behaviour, as well as cognitive symptoms of depression. Pre-clinical and clinical studies have shown interactions between HPA-axis activity and BDNF, but this has not been studied in a clinical cohort of suicidal subjects. The purpose of this study was, therefore, to investigate associations between HPA-axis activity and BDNF in suicide attempters. Furthermore, this study examined the relationship between the HPA-axis, BDNF, and cognitive symptoms in suicidal patients. Since previous data indicate gender-related differences in BDNF and the HPA axis, males and females were examined separately. Method: Seventy-five recent suicide attempters (n = 41 females; n = 34 males) were enrolled in the study. The Dexamethasone Suppression Test (DST) was performed and BDNF in plasma were analysed. Patients were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS) from which items ‘Concentration difficulties’ and ‘Failing memory’ were extracted. Results: Only among females, DST non-suppressors had significantly lower BDNF compared to DST suppressors (p = 0.022), and there was a significant correlation between post-DST serum cortisol at 8 a.m. and BDNF (rs = −0.437, p = 0.003). Concentration difficulties correlated significantly with post-DST cortisol in all patients (rs = 0.256, p = 0.035), in females (rs = 0.396, p = 0.015), and with BDNF in females (rs = −0.372, p = 0.020). Conclusion: The findings suggest an inverse relationship between the HPA-axis and BDNF in female suicide attempters. Moreover, concentration difficulties may be associated with low BDNF and DST non-suppression in female suicide attempters

Coping and suicide risk in high risk psychiatric patients

Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited. Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts. Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17–20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used. Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17–20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts. Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide

Coping and suicide risk in high risk psychiatric patients

Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited. Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts. Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17–20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used. Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17–20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts. Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide