Blasco-Fontecilla Hilario, Mendez-Bustos Pablo, Lopez-Morinigo Javier David
Department of Psychiatry, IDIPHIM-Puerta de Hierro University Hospital, CIBERSAM, Autonoma University, Madrid, Spain.
Department of Psychology, Universidad Católica del Maule, Maule, Chile.
Curr Top Behav Neurosci. 2020;46:79-88. doi: 10.1007/7854_2020_164.
Suicidal behaviour (SB) is a major public health issue, which encompasses both suicide attempts and suicide completions. Suicide tragically accounts for up to almost one million deaths across the world every year. So far, suicide prediction models have focused on the so-called classic risk factors (male gender, depression, alcohol-related problems, and so on). However, suicide is, thankfully, a very rare outcome. As a result, these suicide predictive models have performed very poorly due to the high number of false positives to pick up suicides.However, a history previous suicide attempts has been consistently reported to be the strongest predictor of a future SB. Hence, suicide prevention strategies may prioritise high-risk groups such as those who reattempt/repeat suicide. More specifically, an alternative to the classic 'clinical' risk assessment approach, which is based on rating 'clinical' risk factors, may be to identify biomarkers, which may increase the specificity and sensitivity of the aforementioned suicide prediction models, thus helping clinicians to predict future SB.Within this context, this chapter provides an up-to-date literature review literature on biomarkers of repeated SB. Three main conclusions can be drawn from our review. First, there is a paucity of studies on the role of biomarkers in repeated suicide attempts to date. Second, the vast majority of these studies focused on two biomarkers, which have been also more comprehensively researched in SB, namely, the serotonin system abnormalities and the HPA axis dysfunction. Finally, 'it seems to be unlikely that there is a single biomarker of (repeated) SB'. Rather, future research should look at the complex dynamic interaction of a wide range of biological, clinical and neuropsychological contributing risk factors leading up to SB.
自杀行为（SB）是一个重大的公共卫生问题，它包括自杀未遂和自杀身亡。不幸的是，自杀每年在全球造成近100万人死亡。到目前为止，自杀预测模型一直聚焦于所谓的经典风险因素（男性、抑郁症、酒精相关问题等）。然而，值得庆幸的是，自杀是一种非常罕见的结果。因此，由于误报自杀的数量众多，这些自杀预测模型的表现非常糟糕。然而，一直有报告称，既往有自杀未遂史是未来发生自杀行为的最强预测因素。因此，自杀预防策略可能会优先考虑高风险群体，如那些再次尝试/重复自杀的人。更具体地说，一种替代基于对“临床”风险因素进行评分的经典“临床”风险评估方法的方式，可能是识别生物标志物，这可能会提高上述自杀预测模型的特异性和敏感性，从而帮助临床医生预测未来的自杀行为。在此背景下，本章提供了关于重复自杀行为生物标志物的最新文献综述。我们的综述可以得出三个主要结论。第一，迄今为止，关于生物标志物在重复自杀未遂中的作用的研究很少。第二，这些研究绝大多数集中在两种生物标志物上，这两种生物标志物在自杀行为中也得到了更全面的研究，即血清素系统异常和下丘脑-垂体-肾上腺（HPA）轴功能障碍。最后，“似乎不太可能存在单一的（重复）自杀行为生物标志物”。相反，未来的研究应该关注导致自杀行为的广泛生物、临床和神经心理风险因素之间复杂的动态相互作用。
