Biological Markers of Suicidal Behavior in Patients with Severe Mental Illness: A Narrative Review

Authors

DOI:

https://doi.org/10.17533/udea.iatreia.296

Keywords:

Biomarkers, Bipolar Disorder, Depression, Schizophrenia, Suicide

Abstract

Introduction: Suicide is a significant public health concern, and mental illnesses are among the prominent risk factors. In the pursuit of early detection of suicidal behaviors, various predictive markers have been studied in psychiatric populations.

Objectives: To present a narrative review of biological markers associated with suicide.

Methodology: A literature search was conducted using PubMed, SCIELO, Science Direct, and EMBASE databases. The search terms included "severe mental illness," "bipolar affective disorder," "major depression," "schizophrenia," "suicide," and "markers." Studies in both Spanish and English were considered, and articles available up to August 2023 were included, regardless of study design. Articles related to other mental illnesses were excluded.

Results: The biological markers most extensively studied in relation to suicidal behaviors in severe mental illness are monoamine systems and systemic inflammatory molecules. Genetic markers, particularly those associated with serotonin and the hypothalamic-pituitary-adrenal (HPA) axis, have also gained significance in recent years.

Conclusions: There has been notable research on biological markers in relation to suicidal behavior in populations with severe mental illness. However, further investigation into other pathophysiological mechanisms of suicide is needed.

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Author Biographies

Rafael Santiago Cárdenas-Urbano, Universidad de Antioquia, Medellín, Colombia

Psychiatry Resident, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia.

Sebastián Vera-Henao, Universidad de Antioquia, Medellín, Colombia

Psychiatry Resident, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia.

Jenny García-Valencia, Universidad Pontificia Bolivariana, Medellín, Colombia

Psychiatrist, MSc, PhD, Departament of Psychiatry, Faculty of Medicine, Universidad de Antioquia.

Carlos López-Jaramillo, Universidad de Antioquia, Medellín, Colombia

Psychiatrist, MSc, PhD, Departament of Psychiatry, Faculty of Medicine, Universidad de Antioquia.

References

(1) World Health Organization. Suicide [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide

(2) World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD) [Internet]. 2023. Available from: https://www.who.int/standards/classifications/classification-of-diseases

(3) Silva D, Vicente B, Saldivia S, Kohn R. Conducta suicida y trastornos psiquiátricos en Chile, un estudio poblacional. Rev Med Chil [Internet]. 2013;141(10):1275–82. https://doi.org/10.4067/S0034-98872013001000006

(4) Dávila-Cervantes CA. Suicide burden in Latin America, 1990–2019: findings from the Global Burden of Disease Study 2019. Public Health [Internet]. 2022;205:28–36. https://doi.org/10.1016/j.puhe.2022.01.014

(5) World Health Organization. Suicide rates [Internet]. 2021 [cited 2023 Sep 6]. Available from: https://www.who.int/data/gho/data/themes/mental-health/suicide-rates

(6) Instituto Nacional de Salud. Boletín Epidemiológico Semanal: Semana 37 [Internet]. 2023. Available from: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2023_Bolet%C3%ADn_epidemiologico_semana_37.pdf

(7) Aparicio-Castillo YA, Blandón-Rodríguez AM, Chaves-Torres NM. High Prevalence of Two or More Suicide Attempts Associated with Suicidal Ideation and Mental Disease in Colombia 2016. Rev Colomb Psiquiatr [Internet]. 2020;49(2):96–101. https://doi.org/10.1016/j.rcp.2018.07.001

(8) Hawton K, van Heeringen K. Suicide. Lancet [Internet]. 2009;373(9672):1372–81. https://doi.org/10.1016/S0140-6736(09)60372-X

(9) Cardona-Arango D, Medina-Pérez ÓA, Cardona-Duque DV. Caracterización del suicidio en Colombia, 2000-2010. Rev Colomb Psiquiatr [Internet]. 2016;45(3):170–7. https://doi.org/10.1016/j.rcp.2015.10.002

(10) Palacio-Acosta C, García-Valencia J, Diago-García J, Zapata C, Ortiz-Tobón J, López-Calle G, et al. Characteristics of people committing suicide in Medellín, Colombia. Rev Salud Pública (Bogota) [Internet]. 2005;7(3):243–53. Available from: https://www.redalyc.org/articulo.oa?id=42270301

(11) Palacio C, García J, Diago J, Zapata C, Lopez G, Ortiz J, et al. Identification of suicide risk factors in Medellín, Colombia: A case-control study of psychological autopsy in a developing country. Arch Suicide Res [Internet]. 2007;11(3):297–308. https://doi.org/10.1080/13811110600894223

(12) Miller JN, Black DW. Bipolar Disorder and Suicide: a Review. Curr Psychiatry Rep [Internet]. 2020;22(2):1–10. https://doi.org/10.1007/s11920-020-1130-0

(13) American Psychiatric Association. What is Mental Illness? [Internet]. 2022. Available from: https://www.psychiatry.org/patients-families/what-is-mental-illness

(14) Zhou Y, Lutz PE, Ibrahim EC, Courtet P, Tzavara E, Turecki G, et al. Suicide and suicide behaviors: A review of transcriptomics and multiomics studies in psychiatric disorders. J Neurosci Res [Internet]. 2020;98(4):601–15. https://doi.org/10.1002/jnr.24367

(15) National Human Genome Research Institute. Genetic Marker [Internet]. Talking Glossary of Genomic and Genetic Terms; 2022. Available from: https://www.genome.gov/genetics-glossary/Genetic-Marker

(16) Sokolowski M, Wasserman J, Wasserman D. Genome-wide association studies of suicidal behaviors: A review. Eur Neuropsychopharmacol [Internet]. 2014;24(10):1567–77. https://doi.org/10.1016/j.euroneuro.2014.08.006

(17) Ganança L, Galfalvy HC, Cisneros-Trujillo S, Basseda Z, Cooper TB, Ren X, et al. Relationships between inflammatory markers and suicide risk status in major depression. J Psychiatr Res [Internet]. 2021;134:192–9. https://doi.org/10.1016/j.jpsychires.2020.12.029

(18) Hernández-Díaz Y, Genis-Mendoza AD, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez ML, et al. Association and genetic expression between genes involved in HPA axis and suicide behavior: A systematic review. Genes (Basel) [Internet]. 2021;12(10):1608. https://doi.org/10.3390/genes12101608

(19) Courtet P, Giner L, Seneque M, Guillaume S, Olie E, Ducasse D. Neuroinflammation in suicide: Toward a comprehensive model. World J Biol Psychiatry [Internet]. 2016;17(8):564–86. https://doi.org/10.3109/15622975.2015.1054879

(20) Mirkovic B, Laurent C, Podlipski MA, Frebourg T, Cohen D, Gerardin P. Genetic association studies of suicidal behavior: A review of the past 10 years, progress, limitations, and future directions. Front Psychiatry [Internet]. 2016;7(158):1–16. https://doi.org/10.3389/fpsyt.2016.00158

(21) Turecki G, Brent DA, Gunnell D, O’Connor RC, Oquendo MA, Pirkis J, et al. Suicide and suicide risk. Nat Rev Dis Prim [Internet]. 2019;5(1). https://doi.org/10.1038/s41572-019-0121-0

(22) González-Castro TB, Tovilla-Zárate CA, Genis-Mendoza AD, Juárez-Rojop IE, Nicolini H, López-Narváez ML, et al. Identification of gene ontology and pathways implicated in suicide behavior: Systematic review and enrichment analysis of GWAS studies. Am J Med Genet Part B Neuropsychiatr Genet [Internet]. 2019;180(5):320–9. https://doi.org/10.1002/ajmg.b.32731

(23) Willour VL, Seifuddin F, Mahon PB, Jancic D, Pirooznia M, Steele J, et al. A genome-wide association study of attempted suicide. Mol Psychiatry [Internet]. 2012;17(4):433–44. https://doi.org/10.1038/mp.2011.4

(24) De Sousa A, Shah B, Shrivastava A. Suicide and Schizophrenia: an Interplay of Factors. Curr Psychiatry Rep [Internet]. 2020;22(12):2–5. https://doi.org/10.1007/s11920-020-01188-7

(25) Notaras M, Hill R, Van den Buuse M. A role for the BDNF gene Val66Met polymorphism in schizophrenia? A comprehensive review. Neurosci Biobehav Rev [Internet]. 2015;51:15–30. https://doi.org/10.1016/j.neubiorev.2014.12.016

(26) García-Moll X. Marcadores de inflamación y de antiinflamación en el síndrome coronario agudo: ¿Listos para usarlos en la práctica clínica? Rev Esp Cardiol [Internet]. 2005;58(6):615–7. https://doi.org/10.1157/13076412

(27) Marini S, Vellante F, Matarazzo I, De Berardis D, Serroni N, Gianfelice D, et al. Inflammatory markers and suicidal attempts in depressed patients: A review. Int J Immunopathol Pharmacol [Internet]. 2016;29(4):583–94. https://doi.org/10.1177/0394632015623793

(28) Steiner J, Bielau H, Brisch R, Danos P, Ullrich O, Mawrin C, et al. Immunological aspects in the neurobiology of suicide: Elevated microglial density in schizophrenia and depression is associated with suicide. J Psychiatr Res [Internet]. 2008;42(2):151–7. https://doi.org/10.1016/j.jpsychires.2006.10.013

(29) Åsberg M, Träskman L, Thorén P. 5-HIAA in the Cerebrospinal Fluid. Arch Gen Psychiatry [Internet]. 1976;33(10):1193. https://doi.org/10.1001/archpsyc.1976.01770100055005

(30) Molcho A, Stanley B, Stanley M. Biological studies and markers in suicide and attempeted suicide. Int Clin Psychopharmacol [Internet]. 1991;6(2):77–92. https://doi.org/10.1097/00004850-199100620-00002

(31) Stanley M. Cholinergic Receptor Binding in the Frontal Cortex of Suicide Victims. Am J Psychiatry [Internet]. 1984;141(11):1432–6. https://doi.org/10.1176/ajp.141.11.1432

(32) Mann JJ, Stanley M, McBride PA, McEwen BS. Increased Serotonin2 and β-Adrenergic Receptor Binding in the Frontal Cortices of Suicide Victims. Arch Gen Psychiatry [Internet]. 1986;43(10):954–9. https://doi.org/10.1001/archpsyc.1986.01800100048007

(33) Mann JJ, Rizk MM. A brain-centric model of suicidal behavior. Am J Psychiatry [Internet]. 2020;177(10):902–16. https://doi.org/10.1176/appi.ajp.2020.20081224

(34) Träskman L, Åsberg M, Bertilsson L, Sjüstrand L. Monoamine Metabolites in CSF and Suicidal Behavior. Arch Gen Psychiatry [Internet]. 1981;38(6):631–6. https://doi.org/10.1001/archpsyc.1981.01780310031002

(35) Meyerson LR, Wennogle LP, Abel MS, Coupet J, Lippa AS, Rauh CE, et al. Human brain receptor alterations in suicide victims. Pharmacol Biochem Behav [Internet]. 1982;17(1):159–63. https://doi.org/10.1016/0091-3057(82)90279-9

(36) Ninan PT, van Kammen DP, Scheinin M, Linnoila M, Bunney WE, Goodwin FK. CSF 5-hydroxyindoleacetic acid levels in suicidal schizophrenic patients. Am J Psychiatry [Internet]. 1984;141(4):566–9. https://doi.org/10.1176/ajp.141.4.566

(37) Jokinen J, Carlborg A, Mårtensson B, Forslund K, Nordström AL, Nordström P. DST non-suppression predicts suicide after attempted suicide. Psychiatry Res [Internet]. 2007;150(3):297–303. https://doi.org/10.1016/j.psychres.2006.12.001

(38) Norman WH, Brown WA, Miller IW, Keitner GI, Overholser JC. The dexamethasone suppression test and completed suicide. Acta Psychiatr Scand [Internet]. 1990;81(2):120–5. https://doi.org/10.1111/j.1600-0447.1990.tb06463.x

(39) Grangeon MC, Seixas C, Quarantini LC, Miranda-Scippa A, Pompili M, Steffens DC, et al. White matter hyperintensities and their association with suicidality in major affective disorders: A meta-analysis of magnetic resonance imaging studies. CNS Spectr [Internet]. 2010;15(6):375–81. https://doi.org/10.1017/S1092852900029242

(40) Pompili M, Innamorati M, Mann JJ, Oquendo MA, Lester D, Del Casale A, et al. Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression. Prog Neuro-Psychopharmacology Biol Psychiatry [Internet]. 2008;32(6):1501–7. https://doi.org/10.1016/j.pnpbp.2008.05.009

(41) Fazel S, Runeson B. Suicide NEJM Review Fazel. N Engl J Med [Internet]. 2020;382(3):266–74. https://doi.org/10.1056/NEJMra1902944

(42) Zhang R, Zhang L, Wei S, Wang P, Jiang X, Tang Y, et al. Increased Amygdala-Paracentral Lobule/Precuneus Functional Connectivity Associated With Patients With Mood Disorder and Suicidal Behavior. Front Hum Neurosci [Internet]. 2021;14:1–9. https://doi.org/10.3389/fnhum.2020.585664

(43) Pantazatos SP, Huang Y, Rosoklina GB, Dwork AJ, Arango V, Mann JJ. Whole-transcriptome brain expression and exon-usage profiling in major depression and suicide: evidence for altered glial, endothelial and ATPase activity. Mol Psychiatry [Internet]. 2017;22(5):760–3. https://doi.org/10.1038/mp.2016.130

Published

2024-09-17

How to Cite

1.
Cárdenas-Urbano RS, Vera-Henao S, García-Valencia J, López-Jaramillo C. Biological Markers of Suicidal Behavior in Patients with Severe Mental Illness: A Narrative Review. Iatreia [Internet]. 2024 Sep. 17 [cited 2025 Feb. 1];1(1). Available from: https://revistas.udea.edu.co/index.php/iatreia/article/view/355638

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