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Effects of chronic physical disease and systemic inflammation on suicide risk in patients with depression: a hospital-based case–control study

Published online by Cambridge University Press:  04 January 2019

Kyu Young Oh ,
Nicholas T. Van Dam ,
John T. Doucette  and
James W. Murrough Open the ORCID record for James W. Murrough [Opens in a new window]
Kyu Young Oh
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Nicholas T. Van Dam
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
John T. Doucette
Affiliation:
Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
James W. Murrough*
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author for correspondence: James W. Murrough, E-mail: [email protected]
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Abstract

Background

Few studies have examined the concurrent effects of physical disease and systemic inflammation on suicide risk in patients with depression. The authors investigated the independent contributions of chronic physical disease and systemic inflammation as indexed by C-reactive protein (CRP), on risk of suicide attempt.

Methods

In this case–control study, 1468 cases of suicide attempters and 14 373 controls, both aged 18–65 years with a diagnosis of depression during 2011–2015, were identified from the hospital-wide database. Regression models were implemented to identify separate effects of physical diseases and systemic inflammation indexed by CRP, on risk of suicide attempt.

Results

Compared with having no physical disease, having one, two, and three or more physical diseases was associated with a 3.6-, 6.4-, and 14.9-fold increase in odds of making a suicide attempt, respectively, after adjusting for age, sex, and race/ethnicity. In a sub-sample of cases and controls with available CRP values, patients with high CRP (>3 mg/L) had 1.9 times the odds of suicide attempt compared with patients with low CRP (<1 mg/L). This association was no longer significant when controlling for the effect of physical disease.

Conclusions

The presence of physical disease is an important risk factor for suicide attempt among patients with depression. Systemic inflammation is likewise associated with increased risk for suicide attempt, however, this association appears to be accounted for by the presence of physical disease among patients receiving care in a medical center setting. Healthcare providers should consider the risk of suicide attempt in depressed patients burdened with multiple comorbidities.

Keywords

DepressionsuicideinflammationC-reactive proteinmedical comorbidityhospital-based study
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 29 - 37
Copyright
Copyright © Cambridge University Press 2019 

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References

Ahmedani, BK, Simon, GE, Stewart, C, Beck, A, Waitzfelder, BE, Rossom, R, Lynch, F, Owen-Smith, A, Hunkeler, EM, Whiteside, U, Operskalski, BH, Coffey, MJ and Solberg, LI (2014) Health care contacts in the year before suicide death. Journal of General Internal Medicine 29, 870–877.Google Scholar
Batty, GD, Bell, S, Stamatakis, E and Kivimaki, M (2016) Association of systemic inflammation with risk of completed suicide in the general population. JAMA Psychiatry 73, 993–995.Google Scholar
Beevers, CG and Miller, IW (2004) Perfectionism, cognitive bias, and hopelessness as prospective predictors of suicidal ideation. Suicide and Life-Threatening Behavior 34, 126–137.Google Scholar
Black, C and Miller, BJ (2015) Meta-analysis of cytokines and chemokines in suicidality: distinguishing suicidal versus nonsuicidal patients. Biological Psychiatry 78, 28–37.Google Scholar
Caceda, R, Griffin, WST and Delgado, PL (2018) A probe in the connection between inflammation, cognition and suicide. Journal of Psychopharmacology 32, 482–488.Google Scholar
Chang, CC, Tzeng, NS, Kao, YC, Yeh, CB and Chang, HA (2017) The relationships of current suicidal ideation with inflammatory markers and heart rate variability in unmedicated patients with major depressive disorder. Psychiatry Research 258, 449–456.Google Scholar
Courtet, P, Jaussent, I, Genty, C, Dupuy, AM, Guillaume, S, Ducasse, D and Olie, E (2015) Increased CRP levels may be a trait marker of suicidal attempt. European Neuropsychopharmacology 25, 1824–1831.Google Scholar
Crump, C, Sundquist, K, Sundquist, J and Winkleby, MA (2014) Sociodemographic, psychiatric and somatic risk factors for suicide: a Swedish national cohort study. Psychological Medicine 44, 279–289.Google Scholar
Cukrowicz, KC, Cheavens, JS, Van Orden, KA, Ragain, RM and Cook, RL (2011) Perceived burdensomeness and suicide ideation in older adults. Psychology and Aging 26, 331–338.Google Scholar
Danese, A, Moffitt, TE, Pariante, CM, Ambler, A, Poulton, R and Caspi, A (2008) Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Archives of General Psychiatry 65, 409–415.Google Scholar
Dieperink, E, Ho, SB, Tetrick, L, Thuras, P, Dua, K and Willenbring, ML (2004) Suicidal ideation during interferon-alpha2b and ribavirin treatment of patients with chronic hepatitis C. General Hospital Psychiatry 26, 237–240.Google Scholar
Garcia-Rizo, C, Fernandez-Egea, E, Miller, BJ, Oliveira, C, Justicia, A, Griffith, JK, Heaphy, CM, Bernardo, M and Kirkpatrick, B (2013) Abnormal glucose tolerance, white blood cell count, and telomere length in newly diagnosed, antidepressant-naive patients with depression. Brain, Behavior, and Immunity 28, 49–53.Google Scholar
Gibbs, HM, Davis, L, Han, X, Clothier, J, Eads, LA and Caceda, R (2016) Association between C-reactive protein and suicidal behavior in an adult inpatient population. Journal of Psychiatric Research 79, 28–33.Google Scholar
Gorton, HC, Webb, RT, Kapur, N and Ashcroft, DM (2016) Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review. BMJ Open 6, e009074.Google Scholar
Grudet, C, Malm, J, Westrin, A and Brundin, L (2014) Suicidal patients are deficient in vitamin D, associated with a pro-inflammatory status in the blood. Psychoneuroendocrinology 50, 210–219.Google Scholar
Hamer, M, Chida, Y and Stamatakis, E (2010) Association of very highly elevated C-reactive protein concentration with cardiovascular events and all-cause mortality. Clinical Chemistry 56, 132–135.Google Scholar
Harrison, M (2015) Erythrocyte sedimentation rate and C-reactive protein. Australian Prescriber 38, 93–94.Google Scholar
Hawton, K, Casanas, ICC, Haw, C and Saunders, K (2013) Risk factors for suicide in individuals with depression: a systematic review. Journal of Affective Disorders 147, 17–28.Google Scholar
Henriksson, MM, Aro, HM, Marttunen, MJ, Heikkinen, ME, Isometsa, ET, Kuoppasalmi, KI and Lonnqvist, JK (1993) Mental disorders and comorbidity in suicide. American Journal of Psychiatry 150, 935–940.Google Scholar
Holma, KM, Haukka, J, Suominen, K, Valtonen, HM, Mantere, O, Melartin, TK, Sokero, TP, Oquendo, MA and Isometsa, ET (2014) Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder. Bipolar Disorders 16, 652–661.Google Scholar
Karlovic, D, Serretti, A, Vrkic, N, Martinac, M and Marcinko, D (2012) Serum concentrations of CRP, IL-6, TNF-alpha and cortisol in major depressive disorder with melancholic or atypical features. Psychiatry Research 198, 74–80.Google Scholar
Loas, G, Dalleau, E, Lecointe, H and Yon, V (2016) Relationships between anhedonia, alexithymia, impulsivity, suicidal ideation, recent suicide attempt, C-reactive protein and serum lipid levels among 122 inpatients with mood or anxious disorders. Psychiatry Research 246, 296–302.Google Scholar
Lopresti, AL, Maker, GL, Hood, SD and Drummond, PD (2014) A review of peripheral biomarkers in major depression: the potential of inflammatory and oxidative stress biomarkers. Progress in Neuro-Psychopharmacology & Biological Psychiatry 48, 102–111.Google Scholar
Lund-Sorensen, H, Benros, ME, Madsen, T, Sorensen, HJ, Eaton, WW, Postolache, TT, Nordentoft, M and Erlangsen, A (2016) A nationwide cohort study of the association between hospitalization with infection and risk of death by suicide. JAMA Psychiatry 73, 912–919.Google Scholar
Mann, JJ (2002) A current perspective of suicide and attempted suicide. Annals of Internal Medicine 136, 302–311.Google Scholar
Mann, JJ (2003) Neurobiology of suicidal behaviour. Nature Reviews Neuroscience 4, 819–828.Google Scholar
Melhem, NM, Munroe, S, Marsland, A, Gray, K, Brent, D, Porta, G, Douaihy, A, Laudenslager, ML, DePietro, F, Diler, R, Driscoll, H and Gopalan, P (2017) Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters. Psychoneuroendocrinology 77, 284–294.Google Scholar
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V and Ustun, B (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet 370, 851–858.Google Scholar
National Center for Health Statistics (Atlanta; 2010) International Classification of Diseases, Ninth Revision, Clinical Modification. CDC.Google Scholar
O'Donovan, A, Rush, G, Hoatam, G, Hughes, BM, McCrohan, A, Kelleher, C, O'Farrelly, C and Malone, KM (2013) Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depression and Anxiety 30, 307–314.Google Scholar
Park, RJ and Kim, YH (2017) Association between high sensitivity CRP and suicidal ideation in the Korean general population. European Neuropsychopharmacology 27, 885–891.Google Scholar
Pearson, TA, Mensah, GA, Alexander, RW, Anderson, JL, Cannon, RO III, Criqui, M, Fadl, YY, Fortmann, SP, Hong, Y, Myers, GL, Rifai, N, Smith, SC Jr, Taubert, K, Tracy, RP and Vinicor, F (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107, 499–511.Google Scholar
Priya, PK, Rajappa, M, Kattimani, S, Mohanraj, PS and Revathy, G (2016) Association of neurotrophins, inflammation and stress with suicide risk in young adults. Clinica Chimica Acta 457, 41–45.Google Scholar
R Core Team (2015) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing.Google Scholar
Raison, CL and Miller, AH (2011) Is depression an inflammatory disorder? Current Psychiatry Reports 13, 467–475.Google Scholar
Shanahan, L, Freeman, J and Bauldry, S (2014) Is very high C-reactive protein in young adults associated with indicators of chronic disease risk? Psychoneuroendocrinology 40, 76–85.Google Scholar
Taylor, PJ, Gooding, P, Wood, AM and Tarrier, N (2011) The role of defeat and entrapment in depression, anxiety, and suicide. Psychological Bulletin 137, 391–420.Google Scholar
The PLOS Medicine Editors (2014) Observational studies: getting clear about transparency. PLoS Medicine 11, e1001711.Google Scholar
Turecki, G and Brent, DA (2016) Suicide and suicidal behaviour. The Lancet 387, 1227–1239.Google Scholar
van Heeringen, K and Mann, JJ (2014) The neurobiology of suicide. The Lancet Psychiatry 1, 63–72.Google Scholar
Vargas, HO, Nunes, SO, Pizzo de Castro, M, Bortolasci, CC, Sabbatini Barbosa, D, Kaminami Morimoto, H, Venugopal, K, Dodd, S, Maes, M and Berk, M (2013) Oxidative stress and lowered total antioxidant status are associated with a history of suicide attempts. Journal of Affective Disorders 150, 923–930.Google Scholar
Visser, M, Bouter, LM, McQuillan, GM, Wener, MH and Harris, TB (1999) Elevated C-reactive protein levels in overweight and obese adults. JAMA 282, 2131–2135.Google Scholar
Waern, M, Rubenowitz, E, Runeson, B, Skoog, I, Wilhelmson, K and Allebeck, P (2002) Burden of illness and suicide in elderly people: case–control study. BMJ 324, 1355.Google Scholar
Webb, RT, Kontopantelis, E, Doran, T, Qin, P, Creed, F and Kapur, N (2012) Suicide risk in primary care patients with major physical diseases: a case–control study. Archives of General Psychiatry 69, 256–264.Google Scholar
Weissman, MM, Bland, R, Joyce, PR, Newman, S, Wells, JE and Wittchen, H-U (1993) Sex differences in rates of depression: cross-national perspectives. Journal of Affective Disorders 29, 77–84.Google Scholar
World Health Organization (2014) Preventing suicide: a global imperative. (http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/). Accessed 9 November 2018.Google Scholar
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