Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India.
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad Metropolitan Region, Telangana, India.
Asian J Psychiatr. 2021 Aug;62:102711. doi: 10.1016/j.ajp.2021.102711. Epub 2021 Jun 2.
The purpose of this meta-analysis was to critically examine the data from individual studies on CSF neurotransmitter metabolites to see whether there were consistencies in the results of the comparison of suicide attempters and psychiatric controls and of the comparison of attempted suicides using violent versus nonviolent methods.
Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Cochrane library was conducted for studies that reported concentration of CSF-neurotransmitter metabolites: 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy phenylglycol (MHPG) in suicide attempters, from January'1981 to November'2020. Standardized mean differences (SMDs) and corresponding 95 % confidence interval (CIs) were deduced for outcome measures. I statistics were used to assess heterogeneity within studies. Data were analyzed using STATA software.
A total of 36 studies (N = 1987 attempted suicide and N = 1235 psychiatry control) were included for the meta-analysis. We found CSF levels of all the 3 metabolites i.e. 5-HIAA (SMD= -0.43; 95 %CI: -0.61, -0.24), HVA (SMD= -0.16; 95 %CI: -0.33, -0.00) and MHPG (SMD= -0.33; 95 %CI: -0.71, -0.05) were lower in suicide attempters. While the findings were consistent for 5-HIAA, they were inconsistent for the HVA and MHPG. CSF levels of 5-HIAA (SMD= -0.66; 95 %; CI: -1.01, -0.31), HVA (SMD= -0.14; 95 %CI: -0.45, 0.16) and MHPG (SMD= -0.12; 95 %CI: -0.56, 0.31) were significantly lower in violent suicide attempters than non-violent attempters. No significant publication bias found in any study.
We found a significant association between lower levels of CSF 5-HIAA in suicide attempters, particularly the violent ones, compared to psychiatric controls, whereas findings from CSF HVA and MHPG were inconsistent.
本荟萃分析的目的是批判性地检查个别研究中关于 CSF 神经递质代谢物的数据，以观察自杀未遂者与精神科对照者之间的比较结果以及使用暴力与非暴力方法自杀未遂者之间的比较结果是否存在一致性。
使用 PubMed/Google Scholar/EMBASE/Cochrane 图书馆对不同电子数据库进行系统文献检索，以检索报告 CSF-神经递质代谢物浓度的研究：5-羟吲哚乙酸（5-HIAA）、高香草酸（HVA）和 3-甲氧基-4-羟基苯乙二醇（MHPG）的研究，研究时间为 1981 年 1 月至 2020 年 11 月。为结局指标推导出标准化均数差（SMD）和相应的 95%置信区间（CI）。使用 I 统计量评估研究内的异质性。使用 STATA 软件进行数据分析。
共有 36 项研究（自杀未遂者 N=1987 例，精神病对照者 N=1235 例）纳入荟萃分析。我们发现所有 3 种代谢物的 CSF 水平均降低，即 5-HIAA（SMD=-0.43；95%CI：-0.61，-0.24）、HVA（SMD=-0.16；95%CI：-0.33，-0.00）和 MHPG（SMD=-0.33；95%CI：-0.71，-0.05）。5-HIAA 的发现是一致的，而 HVA 和 MHPG 的发现则不一致。5-HIAA（SMD=-0.66；95%CI：-1.01，-0.31）、HVA（SMD=-0.14；95%CI：-0.45，0.16）和 MHPG（SMD=-0.12；95%CI：-0.56，0.31）的 CSF 水平在暴力自杀未遂者中明显低于非暴力自杀未遂者。任何研究均未发现显著的发表偏倚。
我们发现，与精神科对照者相比，自杀未遂者特别是暴力自杀未遂者的 CSF 5-HIAA 水平显著降低，而 CSF HVA 和 MHPG 的结果则不一致。
