Triglycerides as a biological marker of repeated re-hospitalization resulting from deliberate self-harm in acute psychiatry patients: a prospective observational study

BMC Psychiatry

Stål Bjørkly²  Olav M Linaker³  John O Roaldset¹ 

[1]Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Nydalen, Box 4956, Oslo 0424, Norway

[2]Institute of Health and Social Sciences, Molde University College, Box 2110, Molde 6402, Norway

[3]Psychiatric Department, Trondheim University Hospital, Lade, Box 3008, Trondheim 7441, Norway

关键词: Lipids;    MINI suicidal scale;    Self-report risk scale;    Triglycerides;    Bio-psychosocial;    Deliberate self-harm (DSH);    Suicidal behavior;    Prospective;   

Others  :  1123749
DOI  :  10.1186/1471-244X-14-54

 received in 2013-06-13, accepted in 2014-02-21,  发布年份 2014

【 摘 要 】

Background

Biological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments.

This study aimed to examine the incremental validity of lipid levels and platelet serotonin when combined with psychosocial factors in risk assessments for repeated admissions due to DSH.

Methods

In this prospective observational study of 196 acutely admitted patients, results of blood tests performed upon admission and the MINI Suicidal Scale and psychosocial DSH risk factor assessments performed at discharge were compared with the incidence of DSH recorded during the first 3 and 12 months after discharge.

Results

High triglyceride levels were found to be a significant marker for patients admitted 3 or more times due to DSH (repeated DSH, DSH-R) when tested against other significant risk factors. When all (9) significant univariate factors associated with 12-month post-discharge DSH-R were analyzed in a multivariate logistic regression, the MINI Suicidal Scale (p = 0.043), a lack of insight (p = 0.040), and triglyceride level (p = 0.020) remained significant. The estimated 12-month area under the curve of the receiver operator characteristic (ROC-AUC) for DSH-R was 0.74 for triglycerides, 0.81 for the MINI, 0.89 for the MINI + psychosocial factors, and 0.91 for the MINI + psychosocial factors + triglycerides. The applied multifaceted approach also significantly discriminated between 12-month post-discharge DSH-R patients and other DSH patients, and a lack of insight (p = 0.047) and triglycerides (p = 0.046) remained significant for DSH-R patients in a multivariate analysis in which other DSH patients served as the reference group (rather than non-DSH patients).

Conclusion

The triglyceride values provided incremental validity to the MINI Suicidal Scale and psychosocial risk factors in the assessment of the risk of repeated DSH. Therefore, a bio-psychosocial approach appears promising, but further research is necessary to refine and validate this method.

【 授权许可】

   
2014 Roaldset et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Hawton K, van Heeringen K: Suicide. Lancet 2009, 373(9672):1372-1381.
• [2]Bryan CJ, Rudd MD: Advances in the assessment of suicide risk. J Clin Psychol 2006, 62(2):185-200.
• [3]Roaldset JO, Linaker OM, Bjørkly S: Predictive validity of the MINI suicidal scale for self-harm in acute psychiatry: a prospective study of the first year after discharge. Arch Suicide Res 2012, 16(4):287-302.
• [4]Blasco-Fontecilla H, Delgado-Gomez D, Ruiz-Hernandez D, Aguado D, Baca-Garcia E, Lopez-Castroman J: Combining scales to assess suicide risk. J Psychiatr Res 2012, 46(10):1272-1277.
• [5]Mellesdal L, Mehlum L, Wentzel-Larsen T, Kroken R, Jorgensen HA: Suicide risk and acute psychiatric readmissions: a prospective cohort study. Psychiatr Serv 2010, 61(1):25-31.
• [6]Waern M, Sjöström N, Marlow T, Hetta J: Does the suicide assessment scale predict risk of repetition? A prospective study of suicide attempters at a hospital emergency department. Eur Psychiatr 2010, 25(7):421-426.
• [7]Bilén K, Ponzer S, Ottosson C, Castrén M, Owe-Larsson B, Ekdahl K, Pettersson H: Can repetition of deliberate self-harm be predicted? A prospective multicenter study validating clinical decision rules. J Affect Disord 2013, 149(1-3):253-258.
• [8]Carballo JJ, Akarnnonu CP, Oquendo MA: Neurobiology of suicidal behavior. An integration of biological and clinical findings. Arch Suicide Res 2008, 12(2):93-110.
• [9]Mann JJ: Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003, 4(10):819-828.
• [10]Mann JJ, Currier D, Stanley B, Oquendo MA, Amsel LV, Ellis SP: Can biological tests assist prediction of suicide in mood disorders?[erratum appears in Int J Neuropsychopharmacol. 2006 Dec;9(6):777]. Int J Neuropsychopharmcol 2006, 9(4):465-474.
• [11]Coryell W, Schlesser M: Combined biological tests for suicide prediction. Psychiatry Res 2007, 150(2):187-191.
• [12]O'Donovan A, Rush G, Hoatam G, Hughes BM, McCrohan A, Kelleher C, O'Farrelly C, Malone KM: Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depress Anxiety 2013, 30(4):307-314.
• [13]Kunugi H, Takei N, Aoki H, Nanko S: Low serum cholesterol in suicide attempters. Biol Psychiatry 1997, 41(2):196-200.
• [14]Peres-Rodriguez B-G, Diaz-Sastre G-R, Ceverino S-R, Leon O: Low serun cholesterol may be associated with suicide attempt history. J Clin Psycihiatr 2008, 69(12):1920-1927.
• [15]Deisenhammer EA, Lechner-Schoner T, Kemmler G, Ober A, Braidt E, Hinterhuber H: Serum lipids and risk factors for attempted suicide in patients with alcohol dependence. Alcohol Clin Exp Res 2006, 30(3):460-465.
• [16]Olie E, Picot MC, Guillaume S, Abbar M, Courtet P: Measurement of total serum cholesterol in the evaluation of suicidal risk. J Affect Disord 2011, 133(1–2):234-238.
• [17]Deisenhammer EA, Kramer-Reinstadler K, Liensberger D, Kemmler G, Hinterhuber H, Fleischhacker W: No evidence for an association between serum cholesterol and the course of depression and suicidality. Psychiatry Res 2004, 121(3):253-261.
• [18]Fiedorowicz JG, Coryell WH: Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Res 2007, 152(1):11-20.
• [19]Roaldset JO, Bakken AM, Bjørkly S: A prospective study of lipids and serotonin as risk markers of violence and self-harm in acute psychiatric patients. Psychiatry Res 2011, 186(2–3):293-299.
• [20]Roaldset JO, Bjørkly S: Patients' own statements of their future risk for violent and self-harm behaviour: a prospective inpatient and post-discharge follow-up study in an acute psychiatric unit. Psychiatry Res 2010, 178(1):153-159.
• [21]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59(Suppl 20):22-33. quiz 34-57
• [22]Roaldset JO, Hartvig P, Bjørkly S: V-RISK-10: Validation of a screen for risk of violence after discharge from acute psychiatry. Eur Psychiatr 2011, 26(2):85-91.
• [23]Weishaar ME, Beck AT: Hopelessness and suicide. Int Rev Psychiatr 1992, 4(2):177-184.
• [24]Klonsky ED: The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2007, 27(2):226-239.
• [25]Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE: Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007, 37(3):264-277.
• [26]Deeks JJ, Altman DG: Diagnostic tests 4: likelihood ratios.[comment]. BMJ 2004, 329(7458):168-169.
• [27]Maimanee TA: The impact of exams anxiety on the level of triglycerides in university female students. J Egypt Soc Parasitol 2010, 40(1):259-270.
• [28]Agarwal V, Gupta B, Singhal U, Bajpai SK: Examination stress: changes in serum cholesterol, triglycerides and total lipids. Indian J Physiol Pharmacol 1997, 41(4):404-408.
• [29]Chikani V, Reding D, Gunderson P, McCarty CA: Wisconsin rural women's health study psychological factors and blood cholesterol level: difference between normal and overweight rural women. Clin 2004, 2(1):47-53.
• [30]Bachen EA, Muldoon MF, Matthews KA, Manuck SB: Effects of hemoconcentration and sympathetic activation on serum lipid responses to brief mental stress. Psychosom Med 2002, 64(4):587-594.
• [31]Kuczmierczyk AR, Barbee JG, Bologna NA, Townsend MH: Serum cholesterol levels in patients with generalized anxiety disorder (GAD) and with GAD and comorbid major depression. Can J Psychiatr Rev Can Psychiatr 1996, 41(7):465-468.
• [32]Albrink MJ, Krauss RM, Lindgren FT, Groeben J, Pan S, Wood PD: Intercorrelations among plasma high density lipoprotein, obesity and triglycerides in a normal population. Lipids 1980, 15(9):668-676.
• [33]Sinha R, Jastreboff AM: Stress as a common risk factor for obesity and addiction. Biol Psychiatry 2013, 73(9):827-835.
• [34]May AM, Klonsky ED, Klein DN: Predicting future suicide attempts among depressed suicide ideators: a 10-year longitudinal study. J Psychiatr Res 2012, 46(7):946-952.
• [35]Fisher HL, Moffitt TE, Houts RM, Belsky DW, Arseneault L, Caspi A: Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ (Clin Res Ed) 2012, 344:e2683.
• [36]Noll JG, Horowitz LA, Bonanno GA, Trickett PK, Putnam FW: Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study. J Interpers Violence 2003, 18(12):1452-1471.
• [37]Boenisch S, Bramesfeld A, Mergl R, Havers I, Althaus D, Lehfeld H, Niklewski G, Hegerl U: The role of alcohol use disorder and alcohol consumption in suicide attempts-a secondary analysis of 1921 suicide attempts. Eur Psychiatr 2010, 25(7):414-420.
• [38]Bjerkeset O, Romundstad P, Evans J, Gunnell D, Bjerkeset O, Romundstad P, Evans J, Gunnell D: Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. Am J Epidemiol 2008, 167(2):193-202.
• [39]Magnusson PKE, Rasmussen F, Lawlor DA, Tynelius P, Gunnell D: Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. Am J Epidemiol 2006, 163(1):1-8.
• [40]Chang S-S, Wen CP, Tsai MK, Lawlor DA, Yang YC, Gunnell D: Adiposity, its related biologic risk factors, and suicide: a cohort study of 542,088 Taiwanese adults. Am J Epidemiol 2012, 175(8):804-815.
• [41]de Leon J, Mallory P, Maw L, Susce MT, Perez-Rodriguez MM, Baca-Garcia E: Lack of replication of the association of low serum cholesterol and attempted suicide in another country raises more questions. Ann Clin Psychiatry 2011, 23(3):163-170.
• [42]Wannamethee G, Shaper AG: Blood lipids: the relationship with alcohol intake, smoking, and body weight. J Epidemiol Community Health 1992, 46(3):197-202.
• [43]Willett W, Hennekens CH, Castelli W, Rosner B, Evans D, Taylor J, Kass EH: Effects of cigarette smoking on fasting triglyceride, total cholesterol, and HDL-cholesterol in women. Am Heart J 1983, 105(3):417-421.
• [44]Freeman DJ, Griffin BA, Murray E, Lindsay GM, Gaffney D, Packard CJ, Shepherd J: Smoking and plasma lipoproteins in man: effects on low density lipoprotein cholesterol levels and high density lipoprotein subfraction distribution. Eur J Clin Invest 1993, 23(10):630-640.
• [45]Parks EJ, Krauss RM, Christiansen MP, Neese RA, Hellerstein MK: Effects of a low-fat, high-carbohydrate diet on VLDL-triglyceride assembly, production, and clearance. J Clin Invest 1999, 104(8):1087-1096.