Increased Levels of Cortisol in Individuals With Suicide Attempt and Its Relation With the Number of Suicide Attempts and Depression

Do Cortisol Levels Play a Role in Suicidal Behaviors and Non-Suicidal Self-Injuries in Children and Adolescents?-A Narrative Review

Background/Objectives: Suicidal behaviors (SBs) and non-suicidal self-injury (NSSI) are significant mental health concerns in children and adolescents. The hypothalamic-pituitary-adrenal (HPA) axis, of which cortisol is a key hormone, has been implicated in these behaviors. This narrative review aims to explore whether cortisol levels play a role in SBs and NSSI in youth and to synthesize current evidence on this topic. Methods: A comprehensive literature search was conducted on studies published through November 2024, using PubMed, Web of Science, and Google Scholar databases. Studies were screened for eligibility, including only human studies published in English, with no animal models or studies excluding cortisol levels. A narrative synthesis approach was used due to the methodological diversity across studies. Due to limited adolescent-focused research, studies involving adults were also considered. Results: Findings indicate inconsistent cortisol patterns in relation to SBs and NSSI. Elevated cortisol levels are linked to SBs, with some studies suggesting they may predict future suicide attempts, though no definitive cause-and-effect relationship is established. Conversely, cortisol levels in relation to NSSI show mixed results, with some studies reporting no differences. Cortisol responses to stress, measured by saliva, blood, and hair, reveal complex interactions with psychological factors such as depression and impulsivity, influencing cortisol secretion. Discussion: Despite some evidence pointing to a role of cortisol dysregulation in SBs and NSSI, the relationship remains unclear due to study heterogeneity, including small sample sizes and methodological variations. Gender and the type of stressor used in studies also complicate the findings. Future research should prioritize longitudinal studies, better control for confounding factors, and utilize more diverse cortisol assessment methods to clarify these links. Conclusions: While cortisol may play a role in the pathophysiology of SBs and NSSI, further research is needed to establish clearer, more reliable patterns. Identifying alterations in cortisol levels may aid in early detection and targeted interventions for at-risk adolescents.

Association between body roundness index and suicidal ideation in U.S. adults: A cross-sectional study

Purpose

The relationship between the body roundness index (BRI) and suicidal ideation has not been previously examined. This study aimed to investigate this association through a cross-sectional analysis.

Method

The data used in this study was extracted from the National Health and Nutrition Examination Survey ranging from 2011 to 2012 to 2017-2018. The BRI was calculated from body measurement data, while a questionnaire was used to assess suicidal ideation. Weighted multivariable logistic regression analysis, weighted stratified analysis, and smooth curve fitting were conducted to assess the relationship between the BRI and suicidal ideation. Results: A total of 12,878 participants were included in the study with 441 of them reported experiencing suicidal thoughts. After adjusted for all covariates, a one-unit increase in BRI was associated with a 5 % greater likelihood of having suicidal thoughts [1.05 (1.00, 1.10)]. Additionally, BRI was categorized into quartiles, and individuals in the highest quartile were 1.52 times as likely to experience suicidal thoughts compared to those in the lowest quartile [1.52 (1.03, 2.25)]. There were no interaction effects between BRI and suicidal ideation for any subgroups stratified by demographics.

Conclusion

The present study indicated that a greater BRI was significantly associated with higher levels of suicidal ideation. The findings underscore the importance of considering BRI as a potential indicator for identifying individuals at elevated risk of suicidal ideation. The study also emphasizes the need for a shift towards a weight-inclusive approach in public health, which can help reduce societal pressures and mitigate the psychological impact of weight stigma.

Comprehensive view of suicide: A neuro-immune-endocrine approach

Suicide is defined as the act of a person attempting to take their own life by causing death. Suicide is a complex phenomenon that is influenced by a multitude of factors, including psychosocial, cultural, and religious aspects, as well as genetic, biochemical, and environmental factors. From a biochemical perspective, it is crucial to consider the communication between the endocrine, immune, and nervous systems when studying the etiology of suicide. Several pathologies involve the bidirectional communication between the peripheral activity and the central nervous system by the action of molecules such as cytokines, hormones, and neurotransmitters. These humoral signals, when present in optimal quantities, are responsible for maintaining physiological homeostasis, including mood states. Stress elevates the cortisol and proinflammatory cytokines levels and alter neurotransmitters balance, thereby increasing the risk of developing a psychiatric disorder and subsequently the risk of suicidal behavior. This review provides an integrative perspective about the neurochemical, immunological, and endocrinological disturbances associated with suicidal behavior, with a particular focus on those alterations that may serve as potential risk markers and/or indicators of the state preceding such a tragic act.

Prediction of suicidal thoughts and behaviors based on the diurnal cortisol pattern and THC dosage in continued cannabis users, a 5 year population-based matched cohort study

It appears that the THC dosage is the link between dysregulation of the hypothalamic pituitary adrenal (HPA) axis and suicidal thoughts and behaviors (STB). We proposed a new model to understand the underlying pathophysiological mechanism of STB based on the interaction of cortisol and THC dosage. From September 1, 2019, to January 1, 2024, we conducted a population-based, matched-pair, nested case-control study resulting from a three-wave complete longitudinal, multicenter cohort study on a sample of congress 60 clients. A total of 368 male continued cannabis users (CCu) were allocated to four categories, including low, moderate and high THC dosages and relapse, using optimal matching. Several HPA axis measures were analyzed in the saliva using liquid chromatography with tandem mass spectrometry (LC-MS-MS), and carboxylic acids levels in the urine were assessed via gas chromatography/mass spectrometry (GC-MS). We used structural equation modeling (SEM) to examine the relationship between the variables of interest and the model fit test, and used the Akaike information criterion (AIC) to compare the model fit and select the best-fitting model. Population attributable fractions (PAFs) and cumulative risk score were also calculated for the best-fitting pattern. The analysis showed that the likelihood of STB in individuals with a cortisol awakening response (CAR) and a blunted diurnal cortisol slope (DCS) and higher area under the curve (AUC) who reported heavy cannabis use was more than three times higher than the control group (OR 3.2, 95 % CI 2.4-4.1). These findings indicate the importance of the specific cortisol secretion pattern in the increased clinical expression of STB and may be an important factor for guiding preventive efforts in this area.

From trenches to technology: a narrative review of sleep medicine in the military

Diagnoses of military-relevant sleep disorders have increased substantially since the terrorist attacks of September 11, 2001. The cause of this increase appears to be complicated and multifactorial, with military and civilian populations clearly differing with respect to both the nature and distribution of sleep disorders diagnoses. In part, these differences may be attributable to the fact that a majority of service members are chronically sleep-restricted-an unavoidable consequence of continuous and sustained military operations that "set the stage" for development of specific sleep disorders. The purpose of this narrative review is to describe the military relevance of several common sleep disorders, assess the extent to which these disorders currently constitute a burden on the military health care system, and suggest strategies to alleviate that burden. The military health care system does not have enough sleep medicine providers to address the immediate and long-term consequences of sleep disorders in military personnel. Digital technologies and education packages can be leveraged to improve access to care.

CITATION

Thomas CL, Carr K, Yang F, et al. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med. 2024;20(6):973-981.

Emotional Processing and Maltreatment During Childhood as Factors of Vulnerability to Alcohol Abuse in Young Adults

Different studies suggest a strong association between childhood abuse and alcohol use disorders (AUDs). The modulation of the startle response has been used to assess emotional processing in AUDs. The main objective of the study was to investigate the startle reflex responses to different stimuli in young adults with varying types of childhood abuse in comparison with a control group according to their current alcohol consumption and the presence of a parent with alcohol dependence or not. A clinical sample of 606 adolescents, divided into five groups: no abuse, physical neglect, emotional neglect, emotional abuse, physical abuse, and sexual abuse, were assessed on their pattern of alcohol consumption and their family history of alcoholism. The proportion of participants with at least one alcohol-dependent parent was higher in all types of abuse. The proportion of heavy drinkers and alcohol-dependent participants was higher in the groups with physical neglect and sexual abuse. Heavy drinkers and alcohol dependents showed a lower startle reflex response to emotional pictures, especially alcohol-related ones. Adolescents exposed to physical and sexual abuse during childhood showed a mitigated startle response to appetitive and alcohol-related pictures. The results of this exploratory study reveal that childhood maltreatment modulates emotional processing to alcohol-related stimuli during adolescence. The evaluation of these patients’ startle response could be considered a prognostic biomarker for establishing personalized preventive strategies during the adolescent stage to avoid, to a large extent, future problems derived from alcohol consumption.

Increased suicide rates in Mexico City during the COVID-19 pandemic outbreak: An analysis spanning from 2016 to 2021

Objective

Coronavirus disease 2019 (COVID-19) has impacted mental health worldwide, and suicide can be a serious outcome of this. Thus, suicide characteristics were examined before and during the COVID-19 pandemic in Mexico City.

Methods

This is a retrospective study including all Mexico City residents who had a coroner's record with a cause of death of intentional self-harm (ICD-10) from January 2016 to December 2021.

Results

From 2016 to 2021, 3636 people committed suicide, of which 2869 were males (78.9%) and 767 females (21.1%). From 2016 to 2019 the suicide rate remained constant (∼6 per 100000) and dramatically increased in 2020 (10.45 per 100,000), to return to the levels of the previous year in 2021 (6.95 per 100000). The suicide rate in 2020 specifically increased from January to June (COVID-19 outbreak) in all age groups. Moreover, every year young people (15-24 years) have the maximum suicide rate and depression was the main suicide etiology.

Conclusion

The COVID-19 pandemic outbreak increased the suicide rate, regardless of age, but suicide prevalence was higher in males and young people, regardless of the COVID-19 pandemic. These findings confirm that suicide is a complex and multifactorial problem and will allow the establishment of new guidelines for prevention and care strategies.

Adrenal aging and its effects on the stress response and immunosenescence

Normal aging is linked to various endocrine gland changes, including changes in the adrenal glands. Aging is linked to alterations of the hypothalamic-pituitary-adrenal (HPA) axis, including an increase in cortisol levels, a disruption of the negative cortisol feedback, and attenuation of cortisol's diurnal pattern. In addition, secretion of aldosterone and adrenal androgens [dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS)] from the adrenal cortex decreases with aging. In this review, we describe normal adrenal function, the adrenal response to stress and immunomodulation in aging individuals as well as the effects of adrenal aging on body composition, metabolic profile, bone health and cognition.

The Role of Inflammation in the Pathophysiology of Depression and Suicidal Behavior: Implications for Treatment

Depression and suicidal behavior are 2 complex psychiatric conditions of significant public health concerns due to their debilitating nature. The need to enhance contemporary treatments and preventative approaches for these illnesses not only calls for distillation of current views on their pathogenesis but also provides an impetus for further elucidation of their novel etiological determinants. In this regard, inflammation has recently been recognized as a potentially important contributor to the development of depression and suicidal behavior. This review highlights key evidence that supports the presence of dysregulated neurometabolic and immunologic signaling and abnormal interaction with microbial species as putative etiological hallmarks of inflammation in depression as well as their contribution to the development of suicidal behavior. Furthermore, therapeutic insights addressing candidate mechanisms of pathological inflammation in these disorders are proposed.