Predicting Suicide Risk – Identifying Biological Factors that Interact with Environmental Stressors

J. John Mann, M.D. - Brain & behavior research expert on general mental illness
J. John Mann, M.D.

J. John Mann, M.D., Foundation Scientific Council member and 2008 NARSAD Distinguished Investigator Grantee, a longtime leader in studies on suicide, co-authored a state-of-the-art review, “The Neurobiology of Suicide,” that was published online on May 2nd in the inaugural issue of the journal The Lancet Psychiatry. The article presents a case for suicide being the result of environmental stressors that activate a biological predisposition (or “diathesis”) to suicide. This is called the “stress-diathesis theory.”

Stressful life events and psychiatric illness are important risk factors for suicide, but the co-authors explain that “the diathesis concept explains why only few individuals [even with a psychiatric illness] exposed to these stressors will take their own life.” Dr. Mann is the Paul Janssen Professor of Translational Neuroscience and Director of the Molecular Imaging and Neuropathology Division at Columbia University and his co-author Kees van Heeringen, M.D., Ph.D., is Director of the Unit for Suicide Research at Ghent University in Belgium.

The authors outline the causes of the diathesis, or predisposition, to suicide which can include genetic effects as well as the long-term impact of early life adversity (e.g., physical and sexual abuse) on the brain and behavior. Post-mortem and imaging studies of the brains of people with a history of suicidal behavior show structural and functional changes in their brains. The biological roots of these changes can include deficits in the serotonin neurotransmitter system and the hypothalamic pituitary adrenal axis (HPA), the body’s natural stress-response system, the paper reports.

According to Professor van Heeringen, "Worldwide, over a million people each year die from suicide. Given that there are no reliable clinical tests to identify people who may be more predisposed to suicide, genetic and brain imaging biomarkers offer the most promising new directions for detecting high risk individuals and to identify more personalized treatments for preventing suicidal behavior."

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