ABSTRACT
Findings that link hypothalamic-pituitary-adrenal (HPA) axis hyperactivity to risks for later suicide date to 1965 when Bunney and Fawcett1 described 36 depressed patients who had supplied serial 24 h urine samples for 17-hydroxycorticosteroid (17-OHCS) determinations during extended stays on a research ward. Three committed suicide on pass or shortly after discharge, two made serious attempts, and all ”ve were among the 18 who had had consistently or intermittently high 17-OHCS values (Fisher’s exact test, p = 0.023). In a subsequent series of 145 patients assessed in similar fashion, the ”ve who committed suicide all had had mean 17-OHCS values that fell in the top 10% of the values for the overall group.2 At least two more reports also associated high urinary corticosteroid measures with later suicide.3,4
Subsequent lines of evidence likewise showed HPA axis hyperactivity to be a risk factor for a completed suicide. In postmortem studies, suicide victims had,
7.1 Suicide and HPA Axis Hyperactivity ........................................................... 125 7.1.1 General Measures of HPA Axis Hyperactivity ................................ 125 7.1.2 Dexamethasone Suppression Test ..................................................... 126
7.2 Suicide and Serum Cholesterol ..................................................................... 129 7.2.1 Early Findings ................................................................................... 129 7.2.2 Case-Control Studies ....................................................................... 129 7.2.3 Serum Cholesterol, Suicide, and the Serotonin System ................... 131
7.3 Are Serum Cholesterol and DST Results Orthogonal Predictors of Suicide? .....132 7.4 Caveats and Conclusions .............................................................................. 132 References .............................................................................................................. 134
in comparison to control subjects, greater adrenal weights,5-7 greater adrenal cholesterol concentrations,8 and greater adrenal volumes.9 Others showed suicide victims to have higher cerebrospinal ›uid (CSF) concentrations of corticotropin-releasing hormone (CRH),10,11 higher amounts of CRH immunoreactivity in speci”c brain regions,12,13 and lower numbers of CRF binding sites.14 Some, though, found no differences in CRF receptor number15 or in levels of immunoreactivity16 between individuals dead by suicide and control subjects dead from other causes.
