Background

Patients with major depressive disorder (MDD) are at high risk for suicide. As the worst outcome of MDD and common self-concealment in patients with suicide risk, studies of biomarkers may provide useful tools for suicide prevention and treatment.

Methods

This study recruited 168 patients with MDD from the Objective Diagnostic Markers and Personalized Intervention in MDD patients (ODMPIM), including 50 patients with suicide risk. Based on previous evidence and hypothesis, 23 targeted serum biomarkers involving immune-inflammation, neurotrophins, hypothalamic–pituitary–adrenal (HPA) axis and metabolism, were measured. We used path analysis and principal components analysis (PCA) to clarify the associations among serum biomarkers, childhood adversities, adulthood life events, severity of depression and suicide risk.

Results

We identified that patients with suicide risk had a higher level of inflammatory markers in serum than patients without suicide risk (P < 0.001), especially chemokine (C-X-C motif) ligand 1 (CXCL-1). After using the Bonferroni correction, there were no differences in biomarkers related to neurotrophins, HPA-axis and metabolism. In addition, a higher proportion of patients with suicide risk had adulthood adversity (assessed by Life Events Scale) (P = 0.003). Intriguingly, path analysis demonstrated that the association between adulthood adversity and suicide risk mainly depended on severity of depression and inflammatory index.

Conclusion

This study highlights the possible role of inflammation involved in suicide risk of MDD patients. Inflammatory markers have the potential for early identification and then reducing suicidal behaviors or becoming novel treatment targets in suicide risk management.

中文翻译：

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重度抑郁症患者的炎症，生活压力和自杀风险血清标志物之间的关联。

背景

患有严重抑郁症（MDD）的患者自杀的风险很高。由于存在自杀风险的患者MDD和常见的自我隐匿性最差，生物标记物的研究可能为自杀的预防和治疗提供有用的工具。

方法

这项研究从客观诊断标记物和MDD患者的个性化干预（ODMPIM）中招募了168例MDD患者，其中包括50名有自杀风险的患者。根据先前的证据和假设，对涉及免疫炎症，神经营养蛋白，下丘脑-垂体-肾上腺（HPA）轴和代谢的23种靶向血清生物标志物进行了测量。我们使用路径分析和主成分分析（PCA）来阐明血清生物标志物，童年逆境，成年生活事件，抑郁严重程度和自杀风险之间的关联。

结果

我们确定，具有自杀风险的患者血清中的炎症标记物水平高于没有自杀风险的患者（P  <0.001），尤其是趋化因子（CXC基序）配体1（CXCL-1）。使用Bonferroni校正后，与神经营养蛋白，HPA轴和代谢相关的生物标志物没有差异。此外，自杀风险较高的患者有成年逆境（通过生活事件量表评估）（P  = 0.003）。有趣的是，路径分析表明，成年逆境与自杀风险之间的关系主要取决于抑郁症的严重程度和炎症指数。

结论

这项研究强调了炎症可能与MDD患者的自杀风险有关。炎症标记物有可能及早发现，然后减少自杀行为或成为自杀风险管理中的新型治疗目标。