Zhang Anqi, Qin Yuncong, Wang Han, Lyu Nan, Zhao Qian, Zhang Ling, Huang Juan
Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
BMC Psychiatry. 2025 Jul 31;25(1):745. doi: 10.1186/s12888-025-07183-7.
Major depressive disorder (MDD) is a leading contributor to the global disease burden, with suicide constituting a critical complication. Current clinical assessment tools are limited by subjectivity and diagnostic delays, highlighting the urgent need for objective biomarkers to enable early detection of suicide risk.
We conducted a retrospective observational study by extracting electronic health records (EHRs) from the Hospital Information System of Beijing Anding Hospital. A total of 1,115 patients diagnosed with MDD between January 1, 2013, and December 31, 2020, were identified. Using propensity score matching (PSM), 483 patients exhibiting suicidal ideation or behavior (MDS) were matched to 483 non-suicidal controls (MDNS). Binary logistic regression analyses were performed to assess the associations between suicide risk and serum levels of folate, homocysteine (HCY), C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), and testosterone.
After PSM, higher serum folate levels (> 6 ng/mL) were significantly associated with a reduced risk of suicidal ideation or behavior (OR = 0.648; 95% CI: 0.496–0.847; = 0.001). This association was particularly pronounced among male patients (OR = 0.569; 95% CI: 0.338–0.959; = 0.034) and individuals aged ≤ 45 years (OR = 0.561; 95% CI: 0.394–0.799; = 0.001). Furthermore, lower HCY levels (≤ 11.1 µmol/L) were positively associated with suicide risk among individuals aged ≤ 45 years (OR = 0.617; 95% CI: 0.409–0.931; = 0.022). No significant associations were found between CRP, ACTH, or testosterone levels and suicide risk.
Serum folate and HCY levels may serve as potential biomarkers for assessing suicide risk in patients with MDD, particularly in specific demographic subgroups. Further longitudinal studies are needed to validate these findings and explore the underlying mechanisms.
The online version contains supplementary material available at 10.1186/s12888-025-07183-7.
重度抑郁症（MDD）是全球疾病负担的主要促成因素，自杀是一种关键并发症。当前的临床评估工具受主观性和诊断延迟的限制，凸显了对客观生物标志物的迫切需求，以实现自杀风险的早期检测。
我们通过从北京安定医院医院信息系统中提取电子健康记录（EHR）进行了一项回顾性观察研究。共确定了2013年1月1日至2020年12月31日期间诊断为MDD的1115例患者。使用倾向得分匹配（PSM），将483例有自杀意念或行为的患者（MDS）与483例无自杀倾向的对照者（MDNS）进行匹配。进行二元逻辑回归分析，以评估自杀风险与血清叶酸、同型半胱氨酸（HCY）、C反应蛋白（CRP）、促肾上腺皮质激素（ACTH）和睾酮水平之间的关联。
PSM后，较高的血清叶酸水平（>6 ng/mL）与自杀意念或行为风险降低显著相关（OR = 0.648；95% CI：0.496–0.847；P = 0.001）。这种关联在男性患者（OR = 0.569；95% CI：0.338–0.959；P = 0.034）和年龄≤45岁的个体（OR = 0.561；95% CI：0.394–0.799；P = 0.001）中尤为明显。此外，较低的HCY水平（≤11.1 µmol/L）与年龄≤45岁个体的自杀风险呈正相关（OR = 0.617；95% CI：0.409–0.931；P = 0.022）。未发现CRP、ACTH或睾酮水平与自杀风险之间存在显著关联。
血清叶酸和HCY水平可能作为评估MDD患者自杀风险的潜在生物标志物，尤其是在特定的人口亚组中。需要进一步的纵向研究来验证这些发现并探索潜在机制。
在线版本包含可在10.1186/s12888-025-07183-7获取的补充材料。
