DataSheet_1_Dexamethasone Suppression Test May Predict More Severe/Violent Suicidal Behavior.xlsx

IntroductionSeveral studies demonstrated that the hypothalamic-pituitary-adrenal (HPA) axis is dysregulated in suicide attempters. Prospective studies found that people with an abnormal response at the dexamethasone suppression test (DST) are more likely to commit suicide. However, whether DST may predict suicide attempts remains less clear. A possible strategy to address this question is to consider the suicide attempt lethality.Objectives(1) To compare the pre- and post-DST cortisol levels in serious/violent suicide attempters and in non-serious/non-violent suicide attempters, and (2) to investigate whether cortisol level can predict new suicide attempts or their lethality.MethodsThe study included 70 recent suicide attempters (25 with a serious or violent attempt) who were followed for two years. Three saliva samples for cortisol measurement were obtained at 8a.m., 3p.m., and 9p.m. before the DST (pre-DST). Then, at 11 p.m., 1 mg of dexamethasone was given orally. The following day (post-DST), three saliva samples were collected at the same hours as before. The post-DST–pre-DST salivary cortisol Δ index was calculated for each collection time. The Risk-Rescue Ratio Scale (RRRS) and the Suicidal Intent Scale (SIS) were used to characterize the suicide attempt at inclusion and those occurring during the follow-up.ResultsPost-DST cortisol level at 9 p.m. was higher in patients with an initial violent or serious suicide attempt than in non-violent/non-serious attempters (p < .010). Higher post-DST cortisol at 9p.m. was associated with lower RRRS rescue score and higher clinical impression of suicide severity at inclusion. Among the 66 patients who completed the follow-up, 26 attempted suicide again at least once. Higher pre-DST cortisol at 8a.m. predicted new suicide attempts during the follow-up (OR = 2.15 [1.11, 4.15]), and higher cortisol Δ index at 9p.m. was associated with higher suicide intent during the follow-up.ConclusionsOur results suggest that HPA axis hyper-reactivity monitored with the DST is a marker of violent/serious suicide attempt with lower rescue possibility. Furthermore, higher changes between pre-DST and post-DST cortisol levels may predict higher suicide intent. These findings might help to characterize the biological features of nearest suicide phenotypes.

引言：众多研究业已证实，自杀尝试者下丘脑-垂体-肾上腺（HPA）轴存在失调现象。前瞻性研究指出，在地塞米松抑制试验（DST）中表现出异常反应的人群，自杀倾向更为显著。然而，DST是否能够预测自杀尝试仍存在一定的不确定性。针对此问题，一种可能的策略是考虑自杀尝试的致命性。目标：（1）比较严重/暴力自杀尝试者与不严重/非暴力自杀尝试者在DST前后的皮质醇水平，以及（2）探究皮质醇水平是否能够预测新的自杀尝试或其致命性。方法：本研究纳入了70名近期自杀尝试者（其中25名有严重或暴力尝试史），对他们进行了为期两年的追踪。在DST前，于早晨8点、下午3点和晚上9点收集唾液样本以测量皮质醇水平。随后，在晚上11点口服1毫克地塞米松。在DST后的次日，同样在早晨8点、下午3点和晚上9点收集唾液样本。计算每个收集时间点的DST前后唾液皮质醇Δ指数。采用风险救援比量表（RRRS）和自杀意图量表（SIS）对纳入时的自杀尝试以及随访期间发生的自杀尝试进行特征描述。结果：晚上9点的DST后皮质醇水平在最初有暴力或严重自杀尝试的患者中高于非暴力/非严重尝试者（p < .010）。较高的晚上9点DST后皮质醇水平与较低的RRRS救援评分和较高的自杀严重性临床印象相关。在完成随访的66名患者中，有26名至少再次尝试自杀。早晨8点的DST前皮质醇水平可以预测随访期间的新的自杀尝试（OR = 2.15 [1.11, 4.15]），而晚上9点的皮质醇Δ指数较高与随访期间的自杀意图增强相关。结论：本研究结果表明，通过DST监测到的HPA轴超反应性是暴力/严重自杀尝试且救援可能性较低的标志。此外，DST前后皮质醇水平变化较大可能预示着更高的自杀意图。这些发现有助于描述最近自杀表型的生物学特征。