Increased inflammation is linked to suicide risk. However, it is unclear whether increased inflammation drives suicidal crises or is a trait associated with lifetime suicidal behavior. Limited data exist on the sources of increased inflammation observed in suicidal patients and on its downstream effects.
Aims:
To examine factors associated with inflammation and with suicidal ideation severity in acutely suicidal depressed patients.
Methods:
Fifty-two adult depressed patients of both sexes hospitalized for severe suicidal ideation were characterized for suicidality, depression, anxiety, medical comorbidity, psychological and physical pain, impulsivity, verbal fluency, C-reactive protein (CRP) and interleukin (IL) 6. Two generalized linear models were performed with either CRP or suicidal ideation severity as dependent variables.
Results:
CRP levels were positively associated with age, body mass index (BMI), IL6, current physical pain and number of lifetime suicide attempts. Suicidal ideation severity was not significantly correlated with either CRP or IL6. Suicidal ideation severity was positively associated with female sex, presence of an anxiety disorder, current physical pain, number of lifetime suicide attempts and with delay discounting for medium and large losses.
Conclusions:
Increased inflammation is not associated with acute suicidal risk, but seems to represent a trait associated with lifetime suicidal behavior.
AlesciSMartinezPEKelkarSet al. (2005) Major depression is associated with significant diurnal elevations in plasma interleukin-6 levels, a shift of its circadian rhythm, and loss of physiological complexity in its secretion: Clinical implications. J Clin Endocrinol Metab90: 2522–2530.
2.
American Psychiatric Association (2000) Diagnostic Criteria from DSM-IV-TR. Washington, DC: American Psychiatric Association.
BattyGDBellSStamatakisEet al. (2016) Association of systemic inflammation with risk of completed suicide in the general population. JAMA Psychiatry73: 993–995.
5.
BaumeisterRF (1990) Suicide as escape from self. Psychol Rev97: 90–113.
6.
Bay-RichterCLinderholmKRLimCKet al. (2015) A role for inflammatory metabolites as modulators of the glutamate N-methyl-D-aspartate receptor in depression and suicidality. Brain Behav Immun43: 110–117.
7.
BeckAT (1988) Beck Hopelessness Scale. San Antonio: The Psychological Corporation.
BeckATSteerRABallRet al. (1996) Comparison of Beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess67: 588–597.
10.
BrundinLErhardtSBrylevaEYet al. (2015) The role of inflammation in suicidal behaviour. Acta Psychiatr Scand132: 192–203.
11.
CácedaRDurandDCortesEet al. (2014) Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med76: 445–451.
12.
CacedaRKordsmeierNCGoldenEet al. (2017) Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom86: 116–118.
13.
CharlsonMEPompeiPAlesKLet al. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis40: 373–383.
14.
CourtetPGinerLSenequeMet al. (2016) Neuroinflammation in suicide: Toward a comprehensive model. World J Biol Psychiatry17: 564–586.
15.
CourtetPJaussentIGentyCet al. (2015) Increased CRP levels may be a trait marker of suicidal attempt. Eur Neuropsychopharmacol25: 1824–1831.
16.
DantzerRO’ConnorJCFreundGGet al. (2008) From inflammation to sickness and depression: When the immune system subjugates the brain. Nat Rev Neurosci9: 46–56.
17.
DickersonFStallingsCOrigoniAet al. (2007) Elevated serum levels of C-reactive protein are associated with mania symptoms in outpatients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry31: 952–955.
18.
DombrovskiAYSiegleGJSzantoKet al. (2012) The temptation of suicide: Striatal gray matter, discounting of delayed rewards, and suicide attempts in late-life depression. Psychol Med42: 1203–1215.
19.
DowlatiYHerrmannNSwardfagerWet al. (2010) A meta-analysis of cytokines in major depression. Biol Psychiatry67: 446–457.
20.
DunnAJ (2006) Effects of cytokines and infections on brain neurochemistry. Clin Neurosci Res6: 52–68.
21.
EngelmannJBMaciubaBVaughanCet al. (2013) Posttraumatic stress disorder increases sensitivity to long term losses among patients with major depressive disorder. PLoS One8: e78292.
22.
FazelSWolfAPillasDet al. (2014) Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury: A 41-year Swedish population study. JAMA Psychiatry71: 326–333.
23.
FelgerJCLiZHaroonEet al. (2016) Inflammation is associated with decreased functional connectivity within corticostriatal reward circuitry in depression. Mol Psychiatry21: 1358–1365.
24.
FredriksonSChengQJiangGXet al. (2003) Elevated suicide risk among patients with multiple sclerosis in Sweden. Neuroepidemiology22: 146–152.
25.
GabbayVKleinRGGuttmanLEet al. (2009) A preliminary study of cytokines in suicidal and nonsuicidal adolescents with major depression. J Child Adolesc Psychopharmacol19: 423–430.
26.
GanancaLOquendoMATyrkaARet al. (2016) The role of cytokines in the pathophysiology of suicidal behavior. Psychoneuroendocrinology63: 296–310.
27.
GibbsHMDavisLHanXet al. (2016) Association between C-reactive protein and suicidal behavior in an adult inpatient population. J Psychiatr Res79: 28–33.
28.
GreenLMyersonJOliveiraLet al. (2014) Discounting of delayed and probabilistic losses over a wide range of amounts. J Exp Anal Behav101: 186–200.
29.
GvionYHoreshNLevi-BelzYet al. (2015) A proposed model of the development of suicidal ideations. Compr Psychiatry56: 93–102.
30.
HooglandICHouboltCvan WesterlooDJet al. (2015) Systemic inflammation and microglial activation: Systematic review of animal experiments. J Neuroinflammation12: 114.
31.
JollantFNearJTureckiGet al. (2017) Spectroscopy markers of suicidal risk and mental pain in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry73: 64–71.
32.
JuengstSBKumarRGArenthPMet al. (2014) Exploratory associations with tumor necrosis factor-alpha, disinhibition and suicidal endorsement after traumatic brain injury. Brain Behav Immun41: 134–143.
33.
KarlovicDSerrettiAVrkicNet al. (2012) Serum concentrations of CRP, IL-6, TNF-alpha and cortisol in major depressive disorder with melancholic or atypical features. Psychiatry Res198: 74–80.
34.
KesslerRCBerglundPBorgesGet al. (2005) Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA293: 2487–2495.
35.
KirbyKNPetryNMBickelWK (1999) Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls. J Exp Psychol Gen128: 78–87.
36.
KlonskyEDQiuTSafferBY (2017) Recent advances in differentiating suicide attempters from suicide ideators. Curr Opin Psychiatry30: 15–20.
37.
Lund-SorensenHBenrosMEMadsenTet al. (2016) A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry73: 912–919.
38.
MartinezJMGarakaniAYehudaRet al. (2012) Proinflammatory and “resiliency” proteins in the CSF of patients with major depression. Depress Anxiety29: 32–38.
39.
MarzukPMHartwellNLeonACet al. (2005) Executive functioning in depressed patients with suicidal ideation. Acta Psychiatr Scand112: 294–301.
40.
MendlovicSMozesEEilatEet al. (1999) Immune activation in non-treated suicidal major depression. Immunol Lett67: 105–108.
41.
MillerBJMellorABuckleyP (2013) Total and differential white blood cell counts, high-sensitivity C-reactive protein, and the metabolic syndrome in non-affective psychoses. Brain Behav Immun31: 82–89.
42.
MonfrimXGazalMDe LeonPBet al. (2014) Immune dysfunction in bipolar disorder and suicide risk: Is there an association between peripheral corticotropin-releasing hormone and interleukin-1beta?Bipolar Disord16: 741–747.
43.
MyersonJBaumannAAGreenL (2014) Discounting of delayed rewards: (A)theoretical interpretation of the Kirby questionnaire. Behav Processes107: 99–105.
44.
NewcombeF (1969) Missile Wounds of the Brain: A Study of Psychological Deficits. London: Oxford UP.
45.
O’DonovanARushGHoatamGet al. (2013) Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depress Anxiety30: 307–314.
46.
OlieEGuillaumeSJaussentIet al. (2010) Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord120: 226–230.
47.
OrbachISteinDPalgiYet al. (1996) Perception of physical pain in accident and suicide attempt patients: Self-preservation vs self-destruction. J Psychiatr Res30: 307–320.
48.
PandeyGNRizaviHSRenXet al. (2012) Proinflammatory cytokines in the prefrontal cortex of teenage suicide victims. J Psychiatr Res46: 57–63.
49.
PosnerKBrownGKStanleyBet al. (2011) The Columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry168: 1266–1277.
50.
ReitanRWolfsonD (1985) The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. Tucson: Neuropsychology Press.
51.
Richard-DevantoySBerlimMTJollantF (2014) A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychol Med44: 1663–1673.
52.
Richard-DevantoySDingYLepageMet al. (2016) Cognitive inhibition in depression and suicidal behavior: A neuroimaging study. Psychol Med46: 933–944.
53.
SerafiniGPompiliMElena SerettiMet al. (2013) The role of inflammatory cytokines in suicidal behavior: A systematic review. Eur Neuropsychopharmacol23: 1672–1686.
54.
SteptoeAHamerMChidaY (2007) The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain Behav Immun21: 901–912.
55.
VargasHONunesSOde CastroMRet al. (2013) Oxidative stress and inflammatory markers are associated with depression and nicotine dependence. Neurosci Lett544: 136–140.
56.
WangYYJiangNZCheungEFet al. (2015) Role of depression severity and impulsivity in the relationship between hopelessness and suicidal ideation in patients with major depressive disorder. J Affect Disord183: 83–89.
57.
WolffJCDavisSLiuRTet al. (2018) Trajectories of suicidal ideation among adolescents following psychiatric hospitalization. J Abnorm Child Psychol46: 355–363.
