in violent suicidal behaviour: association with personality and monoaminergic
van Heeringen K, Audenaert K, Van de Wiele L, Verstraete A.
Department of Psychiatry,
University Hospital Gent, De Pintelaan 185, B-9000, Gent, Belgium.
BACKGROUND: According to recent theories, suicidal behaviour is associated with
depressive disorders that are commonly induced by social stressors in persons
with a trait-dependent vulnerability. Stressor-induced increased cortisol
secretion may interfere with this vulnerability that can be defined in terms of
(possibly inter-related) biological and psychological or personality-related
characteristics. Delineation of such trait-like characteristics may increase
the specificity in the prediction of suicidal behaviour and thus lead to new
approaches to the treatment and prevention of suicidal behaviour. METHODS:
Psychiatric symptomatology, personality dimensions (Cloninger's Temperament
and Character), peripheral markers of serotonergic (whole blood serotonin,
platelet MAO activity) and noradrenergic (plasma MHPG) activity, and urinary
cortisol were measured in a random sample of patients with a history of violent
suicidal behaviour and compared to those of patients without such a history.
RESULTS: When compared to patients without a history of violent suicidal
behaviour (n=23), patients with such a history (n=17) were characterised by higher
urinary cortisol levels, a significantly lower mean score on Reward
Dependence, a borderline significantly increased score on Novelty Seeking and a
significantly lower mean plasma MHPG level. Urinary cortisol level
correlated significantly with Reward Dependence and Novelty Seeking scores.
There were no differences between patient groups regarding severity of anxiety
or depressive symptomatology. No differences with regard to the biological
parameters were found between patients who recently attempted suicide and those
with a history of suicidal behaviour. LIMITATIONS: Limitations of this study
included a relatively small number of study subjects and the use of peripheral
markers to assess central neurotransmission functions. CONCLUSIONS: Violent
suicidal behaviour is associated with increased cortisol secretion, a
personality profile defined by low Reward Dependence (reflecting the degree of
sensitivity to social stressors) and a tendency of increased Novelty Seeking
(related to impulsivity and the regulation of anger), and reduced noradrenergic
functioning (possibly reflecting an inability to adapt to stressors).