Skip to main content
Top
Published in: European Archives of Psychiatry and Clinical Neuroscience 8/2008

01-12-2008 | ORIGINAL PAPER

Suicide attempters: biological stressmarkers and adverse life events

Authors: Charlotta Sunnqvist, Åsa Westrin, Lil Träskman-Bendz

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 8/2008

Login to get access

Abstract

Risk factors for suicidal behaviour include adverse life events as well as biochemical parameters acting, e.g. within the hypothalamic–pituitary–adrenal axis and/or monoaminergic systems. The aim of the present investigation was to study stressful life events and biological stress markers among former psychiatric inpatients, who were followed up 12 years after an index suicide attempt. At the time of the index suicide attempt, and before treatment, cerebrospinal fluid (CSF) samples were taken, and 24 h (h) urine (U) was collected. 3-Methoxy-4-hydroxyphenylglycole (MHPG) in CSF and 24 h urinary samples of cortisol and noradrenaline/adrenaline (NA/A) were analysed. Data concerning stressful life events were collected retrospectively from all participants in the study through semi-structured interviews at follow-up. We found that patients who reported sexual abuse during childhood and adolescence had significantly higher levels of CSF-MHPG and U-NA/A, than those who had not. Low 24 h U-cortisol was associated with feelings of neglect during childhood and adolescence. In conclusion, this study has shown significant and discrepant biological stress-system findings in relation to some adverse life events.
Literature
1.
go back to reference American Psychiatric Association (1987) Diagnostic and statistic manual of mental disorders, 3rd edn (rev). APA, Washington, DC American Psychiatric Association (1987) Diagnostic and statistic manual of mental disorders, 3rd edn (rev). APA, Washington, DC
2.
go back to reference American Psychiatric Association (1994) Diagnostic and statistic manual of mental disorders, 4th edn. APA, Washington American Psychiatric Association (1994) Diagnostic and statistic manual of mental disorders, 4th edn. APA, Washington
3.
go back to reference Beck AT, Davis JH, Frederick CJ, Perlin S, Pokorny AD, Schulman RE, Seiden RH, Wittlin BJ (1972) Classification and nomenclature. In: Resnik HLP, Hathorne BC (eds) Suicide prevention in the seventies. Government Printing Office, Washington, pp 7–12 Beck AT, Davis JH, Frederick CJ, Perlin S, Pokorny AD, Schulman RE, Seiden RH, Wittlin BJ (1972) Classification and nomenclature. In: Resnik HLP, Hathorne BC (eds) Suicide prevention in the seventies. Government Printing Office, Washington, pp 7–12
4.
go back to reference Bäckman J, Alling C, Alsén M, Regnéll G, Träskman-Bendz L (2000) Changes of cerebrospinal fluid monoamine metabolites during long-term antidepressant treatment. Eur Neuropsychopharmacol 10:341–349PubMedCrossRef Bäckman J, Alling C, Alsén M, Regnéll G, Träskman-Bendz L (2000) Changes of cerebrospinal fluid monoamine metabolites during long-term antidepressant treatment. Eur Neuropsychopharmacol 10:341–349PubMedCrossRef
5.
go back to reference Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH (2007) Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Soc Biol Psychiatry 62:1080–1087CrossRef Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH (2007) Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Soc Biol Psychiatry 62:1080–1087CrossRef
6.
go back to reference Caspi A, McClay J, Moffit TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R (2002) Role of genotype in the cycle of violence in maltreated children. Science 297:851–854PubMedCrossRef Caspi A, McClay J, Moffit TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R (2002) Role of genotype in the cycle of violence in maltreated children. Science 297:851–854PubMedCrossRef
7.
go back to reference Cavanagh JTO, Owens DGC, Johnstone EC (1999) Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy. Soc Psychiatry Psychiatr Epidemiol 34:645–650PubMedCrossRef Cavanagh JTO, Owens DGC, Johnstone EC (1999) Life events in suicide and undetermined death in south-east Scotland: a case-control study using the method of psychological autopsy. Soc Psychiatry Psychiatr Epidemiol 34:645–650PubMedCrossRef
8.
go back to reference Coplan JD, Andrews MW, Rosenblum LA, Owens MJ, Friedman S, Gorman JM, Nemeroff CB (1996) Persistent elevations of cerebrospinal fluid concentrations of corticotrophin-releasing factor in adult nonhuman primates exposed to early-life stressors:implications for the pathophysiology of mood and anxiety disorders. Proc Natl Acad Sci USA 93:1619–1623PubMedCrossRef Coplan JD, Andrews MW, Rosenblum LA, Owens MJ, Friedman S, Gorman JM, Nemeroff CB (1996) Persistent elevations of cerebrospinal fluid concentrations of corticotrophin-releasing factor in adult nonhuman primates exposed to early-life stressors:implications for the pathophysiology of mood and anxiety disorders. Proc Natl Acad Sci USA 93:1619–1623PubMedCrossRef
9.
go back to reference Coryell W, Schlesser M (2001) The dexamethasone suppression test and suicide prediction. Am J Psychiatry 158:748–753PubMedCrossRef Coryell W, Schlesser M (2001) The dexamethasone suppression test and suicide prediction. Am J Psychiatry 158:748–753PubMedCrossRef
10.
go back to reference Coryell W, Schlesser M (2007) Combined biological tests for suicide prediction. Psychiatry Res 150:187–191PubMedCrossRef Coryell W, Schlesser M (2007) Combined biological tests for suicide prediction. Psychiatry Res 150:187–191PubMedCrossRef
11.
go back to reference Courtet P, Jollant F, Castelnau D, Astruc B, Buresi C, Malafosse A (2004) Implication of genes of the serotonergic system on vulnerability to suicidal behavior. J Psychiatry Neurosci 29(5):350–359PubMed Courtet P, Jollant F, Castelnau D, Astruc B, Buresi C, Malafosse A (2004) Implication of genes of the serotonergic system on vulnerability to suicidal behavior. J Psychiatry Neurosci 29(5):350–359PubMed
13.
go back to reference Ehnvall A, Palm-Beskow A, Beskow J, Ågren H (2005) Perception of rearing circumstances relates to course of illness in patients with therapy-refractory affective disorders. J Affect Disord 86:299–303PubMedCrossRef Ehnvall A, Palm-Beskow A, Beskow J, Ågren H (2005) Perception of rearing circumstances relates to course of illness in patients with therapy-refractory affective disorders. J Affect Disord 86:299–303PubMedCrossRef
14.
go back to reference Elzinga BM, Roelofs K, Tollenaar MS, Bakvis P, van Pelt, J, Spinhoven P (2007) Diminished cortisol responses to psychosocial stress associated with lifetime adverse events A study among healthy young subjects. Psychoneuroendocrinology (in press) Elzinga BM, Roelofs K, Tollenaar MS, Bakvis P, van Pelt, J, Spinhoven P (2007) Diminished cortisol responses to psychosocial stress associated with lifetime adverse events A study among healthy young subjects. Psychoneuroendocrinology (in press)
15.
go back to reference Engström G, Alling C, Gustavsson P, Oreland L, Träskman-Bendz L (1997) Clinical characteristics and biological parameters in temperamental clusters of suicide attempters. J Affect Disord 44:45–55PubMedCrossRef Engström G, Alling C, Gustavsson P, Oreland L, Träskman-Bendz L (1997) Clinical characteristics and biological parameters in temperamental clusters of suicide attempters. J Affect Disord 44:45–55PubMedCrossRef
16.
go back to reference Eriksson BM, Gustafsson S, Persson BA (1983) Determination of catecholamines in urine by ion-exchange liquid chromatography with electrochemical detection. J Chromatogr 278(2):255–263PubMed Eriksson BM, Gustafsson S, Persson BA (1983) Determination of catecholamines in urine by ion-exchange liquid chromatography with electrochemical detection. J Chromatogr 278(2):255–263PubMed
17.
go back to reference Hagnell O, Rorsman B (1980) Suicide in the Lundby study: a controlled prospective investigation of stressful life events. Neuropsychobiology 6:319–332PubMedCrossRef Hagnell O, Rorsman B (1980) Suicide in the Lundby study: a controlled prospective investigation of stressful life events. Neuropsychobiology 6:319–332PubMedCrossRef
18.
go back to reference Heim C, Jeffrey Newport D, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB (2000) Pituitary–adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. J Am Med Assoc 284(5):592–597CrossRef Heim C, Jeffrey Newport D, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB (2000) Pituitary–adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. J Am Med Assoc 284(5):592–597CrossRef
19.
go back to reference Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB (2007) The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Soc Biol Psychiatry (in press) Heim C, Mletzko T, Purselle D, Musselman DL, Nemeroff CB (2007) The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Soc Biol Psychiatry (in press)
20.
go back to reference Jokinen J, Carlborg A, Mårtensson B, Forslund K, Nordström A-L, Nordström P (2007) DST non-suppression predicts suicide after attempted suicide. Psychiatry Res 150:297–303PubMedCrossRef Jokinen J, Carlborg A, Mårtensson B, Forslund K, Nordström A-L, Nordström P (2007) DST non-suppression predicts suicide after attempted suicide. Psychiatry Res 150:297–303PubMedCrossRef
21.
go back to reference Kaufman J, Plotsky PM, Nemeroff CB, Charney DS (2000) Effects of early adverse experiences on brain structure and function: clinical implications. Soc Biol Psychiatry 48:778–790CrossRef Kaufman J, Plotsky PM, Nemeroff CB, Charney DS (2000) Effects of early adverse experiences on brain structure and function: clinical implications. Soc Biol Psychiatry 48:778–790CrossRef
22.
go back to reference Leon AC, Friedman RA, Sweeney JA, Brown RP, Mann JJ (1990) Statistical issue in the identification of risk factors for suicidal behaviour: the application of survival analysis. Psychiatry Res 31:99–108PubMedCrossRef Leon AC, Friedman RA, Sweeney JA, Brown RP, Mann JJ (1990) Statistical issue in the identification of risk factors for suicidal behaviour: the application of survival analysis. Psychiatry Res 31:99–108PubMedCrossRef
24.
go back to reference Mann JJ, Brent DA, Arango V (2001) The neurobiology and genetics of suicide and attempted suicide: a focus on the serotonergic system. Neuropsychopharmacology 24(5):467–477PubMedCrossRef Mann JJ, Brent DA, Arango V (2001) The neurobiology and genetics of suicide and attempted suicide: a focus on the serotonergic system. Neuropsychopharmacology 24(5):467–477PubMedCrossRef
25.
go back to reference McEwen BS (2000) Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology 22(2):109–124CrossRef McEwen BS (2000) Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology 22(2):109–124CrossRef
26.
go back to reference Norman WH, Brown WA, Miller IW, Keitner GI, Overholser JC (1990) The dexamethasone suppression test and completed suicide. Acta Psychiatr Scand 81(2):120–125PubMedCrossRef Norman WH, Brown WA, Miller IW, Keitner GI, Overholser JC (1990) The dexamethasone suppression test and completed suicide. Acta Psychiatr Scand 81(2):120–125PubMedCrossRef
27.
go back to reference Pfenning A, Kunzel HE, Kern N, Ising M, Majer M, Fuchs B, Ernst G, Holsboer F, Binder EB (2005) Hypothalamus–pituitary–adrenal system regulation and suicidal behavior in depression. Biol Psychiatry 57(4):336–342CrossRef Pfenning A, Kunzel HE, Kern N, Ising M, Majer M, Fuchs B, Ernst G, Holsboer F, Binder EB (2005) Hypothalamus–pituitary–adrenal system regulation and suicidal behavior in depression. Biol Psychiatry 57(4):336–342CrossRef
28.
go back to reference Plotsky PM, Meaney MJ (1993) Early, postnatal experience alters hypothalamic corticotrophin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Mol Brain Res 18:195–200PubMedCrossRef Plotsky PM, Meaney MJ (1993) Early, postnatal experience alters hypothalamic corticotrophin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Mol Brain Res 18:195–200PubMedCrossRef
29.
go back to reference Queiroz EA, Lombardi AB, Furtado CR, Peixoto CC, Soares TA, Fabre ZL, Basques JC, Fernandes ML, Lippi JR (1991) Biochemical correlates of depression in children. Arq Neuropsiquiatr 49(4):418–425PubMed Queiroz EA, Lombardi AB, Furtado CR, Peixoto CC, Soares TA, Fabre ZL, Basques JC, Fernandes ML, Lippi JR (1991) Biochemical correlates of depression in children. Arq Neuropsiquiatr 49(4):418–425PubMed
30.
go back to reference Roy A (2004) Relationship of childhood trauma to age of suicide attempt and number of attempts in substance dependent patients. Acta Psychiatr Scand 109:121–125PubMedCrossRef Roy A (2004) Relationship of childhood trauma to age of suicide attempt and number of attempts in substance dependent patients. Acta Psychiatr Scand 109:121–125PubMedCrossRef
31.
go back to reference Schalling D (1978) Psychopathy-related personality variables and the psychophysiology of socialization. In: Hare RD, Schalling D (eds) Psychopathic behavior. Approaches to research. Wiley, Chichester, pp 85–106 Schalling D (1978) Psychopathy-related personality variables and the psychophysiology of socialization. In: Hare RD, Schalling D (eds) Psychopathic behavior. Approaches to research. Wiley, Chichester, pp 85–106
32.
go back to reference Schalling D, Asberg M, Edman G, Oreland L (1987) Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity. Acta Psychiatr Scand 76(2):172–182PubMedCrossRef Schalling D, Asberg M, Edman G, Oreland L (1987) Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity. Acta Psychiatr Scand 76(2):172–182PubMedCrossRef
33.
go back to reference Schalling D (1993) Neurochemical correlates of personality, impulsivity and disinhibitory suicidality. In: Hodgkins S (eds) Mental disorder and crime. Sage Publications, New York, pp 208–226 Schalling D (1993) Neurochemical correlates of personality, impulsivity and disinhibitory suicidality. In: Hodgkins S (eds) Mental disorder and crime. Sage Publications, New York, pp 208–226
34.
go back to reference Swahn CG, Sandgarde B, Wiesel FA, Sedvall G (1976) Simultaneous determination of three major monoamine metabolites in brain tissue and body fluids by a mass fragmentographic method. Psychoparmacology 48:147–152CrossRef Swahn CG, Sandgarde B, Wiesel FA, Sedvall G (1976) Simultaneous determination of three major monoamine metabolites in brain tissue and body fluids by a mass fragmentographic method. Psychoparmacology 48:147–152CrossRef
35.
go back to reference Träskman-Bendz L, Asberg M, Bertilsson L (1981) Serotonin and noradrenalin uptake inhibitors in the treatment of depression-relationship to 5-HIAA in spinal fluid. Acta Psychiatr Scand 290:209–218CrossRef Träskman-Bendz L, Asberg M, Bertilsson L (1981) Serotonin and noradrenalin uptake inhibitors in the treatment of depression-relationship to 5-HIAA in spinal fluid. Acta Psychiatr Scand 290:209–218CrossRef
36.
go back to reference Träskman-Bendz L, Alling C, Oreland L, Regnéll G, Vinge E, Öhman R (1992) Prediction of suicidal behaviour from biologic tests. J Clin Psychopharmacol 12:21–26CrossRef Träskman-Bendz L, Alling C, Oreland L, Regnéll G, Vinge E, Öhman R (1992) Prediction of suicidal behaviour from biologic tests. J Clin Psychopharmacol 12:21–26CrossRef
37.
go back to reference Van Heeringen K, Audenaert K, Van de Wiele L, Verstraete A (2000) Cortisol in violent suicidal behaviour: association with personality and monoaminergic activity. J Affect Disord 60:181–189PubMedCrossRef Van Heeringen K, Audenaert K, Van de Wiele L, Verstraete A (2000) Cortisol in violent suicidal behaviour: association with personality and monoaminergic activity. J Affect Disord 60:181–189PubMedCrossRef
38.
go back to reference Van Heeringen K (2003) The neurobiology of suicide and suicidality. Can J Psychiatry 48:292–300PubMed Van Heeringen K (2003) The neurobiology of suicide and suicidality. Can J Psychiatry 48:292–300PubMed
39.
go back to reference Weiss EL, Longhurst JG, Mazure CM (1999) Childhood sexual abuse as a risk factor for depression in women: psychosocial and neurobiological correlates. Am J Psychiatry 156(6):816–828PubMed Weiss EL, Longhurst JG, Mazure CM (1999) Childhood sexual abuse as a risk factor for depression in women: psychosocial and neurobiological correlates. Am J Psychiatry 156(6):816–828PubMed
40.
go back to reference Westrin Å, Niméus A (2003) The dexamethasone suppression test and CSF-5-HIAA in relation to suicidality and depression in suicide attempters. Eur Psychiatry 18:166–171PubMedCrossRef Westrin Å, Niméus A (2003) The dexamethasone suppression test and CSF-5-HIAA in relation to suicidality and depression in suicide attempters. Eur Psychiatry 18:166–171PubMedCrossRef
41.
go back to reference Yehuda R, Resnick HS, Schmeidler J, Yang RK, Pitman RK (1989). Predictors of cortisol and 3-methoxy-4-hydroxyphenylglycol responses in the acute aftermath of rape. Biol Psychiatry 43(11):855–859CrossRef Yehuda R, Resnick HS, Schmeidler J, Yang RK, Pitman RK (1989). Predictors of cortisol and 3-methoxy-4-hydroxyphenylglycol responses in the acute aftermath of rape. Biol Psychiatry 43(11):855–859CrossRef
42.
go back to reference Yehuda R, Bierer LM, Schmeidler J, Aferiat DH, Breslau I, Dolan S (2000) Low cortisol and risk for PTSD in adult offspring of holocaust survivors. Am J Psychiatry 157(8):1252–1259PubMedCrossRef Yehuda R, Bierer LM, Schmeidler J, Aferiat DH, Breslau I, Dolan S (2000) Low cortisol and risk for PTSD in adult offspring of holocaust survivors. Am J Psychiatry 157(8):1252–1259PubMedCrossRef
43.
go back to reference Yehuda R, Halligan SL, Grossman R (2001) Childhood trauma and risk for PTSD: relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Dev Psychopathol 13(3):733–753PubMedCrossRef Yehuda R, Halligan SL, Grossman R (2001) Childhood trauma and risk for PTSD: relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Dev Psychopathol 13(3):733–753PubMedCrossRef
44.
go back to reference Yehuda R, Halligan SL, Bierer LM (2003) Cortisol levels in adult offspring of Holocaust survivors: relation to PTSD symptom severity in the parent and child. Psychoneuroendocrinology 27(1–2):171–180 Yehuda R, Halligan SL, Bierer LM (2003) Cortisol levels in adult offspring of Holocaust survivors: relation to PTSD symptom severity in the parent and child. Psychoneuroendocrinology 27(1–2):171–180
45.
go back to reference Yehuda R, Teicher MH, Seckl JR, Grossman RA, Morris A, Bierer LM (2007) Parental posttraumatic stress disorder as a vulnerability factor for low cortisol trait in offspring of holocaust survivors. Arch Gen Psychiatry 64(9):1040–1048PubMedCrossRef Yehuda R, Teicher MH, Seckl JR, Grossman RA, Morris A, Bierer LM (2007) Parental posttraumatic stress disorder as a vulnerability factor for low cortisol trait in offspring of holocaust survivors. Arch Gen Psychiatry 64(9):1040–1048PubMedCrossRef
46.
go back to reference Ystgaard M, Hestetun I, Loeb M, Mehlum L (2004) Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? Child Abuse Negl ct 28:863–875PubMedCrossRef Ystgaard M, Hestetun I, Loeb M, Mehlum L (2004) Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior? Child Abuse Negl ct 28:863–875PubMedCrossRef
47.
go back to reference Öjehagen A, Johnsson E, Träskman-Bendz L (2003) The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska scales of personality (KSP). Nord J Psychiatry 57(2):125–130PubMedCrossRef Öjehagen A, Johnsson E, Träskman-Bendz L (2003) The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska scales of personality (KSP). Nord J Psychiatry 57(2):125–130PubMedCrossRef
Metadata
Title
Suicide attempters: biological stressmarkers and adverse life events
Authors
Charlotta Sunnqvist
Åsa Westrin
Lil Träskman-Bendz
Publication date
01-12-2008
Publisher
D. Steinkopff-Verlag
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 8/2008
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-008-0819-6

Other articles of this Issue 8/2008

European Archives of Psychiatry and Clinical Neuroscience 8/2008 Go to the issue