PDF(Pubmed)
Abstract：
Higher intent suicide attempts carry elevated risk of future suicidal behavior. Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis is both linked to nonfatal suicidal behavior and suicide deaths in major depressive disorder. Few studies, however, have identified biological markers of a high-intent suicidal subgroup. We examined HPA axis output and reactivity to the Trier Social Stress Test (TSST) via salivary cortisol in depressed individuals (N=68) with a suicide attempt (SA) history. A median split of higher and lower suicidal intent scores was used to define groups. Individuals with high intent SA had attenuated total cortisol output (AUCg), F(1,60)=10.04, SE=5.095, p=.003, and lower HPA-axis stress responsivity to the TSST (AUCi), F(1,60)=4.50, SE=4.604, p=.039, compared with the low intent SA group. The high intent group also reported more pronounced negative affect than the low intent group (F[1,61]=6.413, SE=10.55, p=.014) both at baseline (meandiff=22.32, p=.038) and in response to the stressor task (meandiff=37.62, p=.003). Vulnerability to suicidal behavior in high-intent individuals may be related to the combined profile of impaired physiological responses to stress and greater negative affectivity. This clinical and biologic subgroup may benefit from targeted suicide prevention interventions.
摘要：
更高的意图自杀企图会增加未来自杀行为的风险。下丘脑-垂体-肾上腺（HPA）轴的异常功能与非致命性自杀行为和重度抑郁症中的自杀死亡有关。很少有研究，然而,已经确定了高意图自杀亚组的生物学标记。我们通过唾液皮质醇检查了有自杀企图（SA）史的抑郁症患者（N=68）的HPA轴输出和对Trier社会压力测试（TSST）的反应性。使用较高和较低自杀意图评分的中位数划分来定义组。具有高意图SA的个体具有减弱的总皮质醇输出(AUCg),F（1,60）=10.04，SE=5.095，p=.003，并且较低的HPA轴对TSST（AUCi）的应激反应率，与低意图SA组相比，F（1,60）=4.50，SE=4.604，p=.039。在基线（meandiff=22.32，p=.038）和响应压力源任务（meandiff=37.62，p=.003）时，高意图组也报告了比低意图组更明显的负面影响（F[1,61]=6.413，SE=10.55，p=.014）。高意图个体对自杀行为的脆弱性可能与对压力的生理反应受损和更大的负面情感的组合有关。这种临床和生物学亚组可能受益于有针对性的自杀预防干预措施。
