Cortisol in violent suicidal behaviour: association with personality and monoaminergic activity

Background: According to recent theories, suicidal behaviour is associated with depressive disorders that are commonly induced by social stressors in persons with a trait-dependent vulnerability. Stressor-induced increased co rtisol secretion may interfere with this vulnerability that can be defined in terms of (possibly inter-related) biological and psychological or person ality-related characteristics. Delineation of such trait-like characteristi cs may increase the specificity in the prediction of suicidal behaviour and thus lead to new approaches to the treatment and prevention of suicidal be haviour. Methods: Psychiatric symptomatology, personality dimensions (Cloni nger's Temperament and Character), peripheral markers of serotonergic (whol e blood serotonin, platelet MAO activity) and noradrenergic (plasma MHPG) a ctivity, and urinary cortisol were measured in a random sample of patients with a history of violent suicidal behaviour and compared to those of patie nts without such a history. Results: When compared to patients without a hi story of violent suicidal behaviour (n = 23), patients with such a history (n = 17) were characterised by higher urinary cortisol levels, a significan tly lower mean score on Reward Dependence, a borderline significantly incre ased score on Novelty Seeking and a significantly lower mean plasma MHPG le vel. Urinary cortisol level correlated significantly with Reward Dependence and Novelty Seeking scores. There were no differences between patient grou ps regarding severity of anxiety or depressive symptomatology. No differenc es with regard to the biological parameters were found between patients who recently attempted suicide and those with a history of suicidal behaviour. Limitations: Limitations of this study included a relatively small number of study subjects and the use of peripheral markers to assess central neuro transmission functions. Conclusions: Violent suicidal behaviour is associat ed with increased cortisol secretion, a personality profile defined by low Reward Dependence (reflecting the degree of sensitivity to social stressors ) and a tendency of increased Novelty Seeking (related to impulsivity and t he regulation of anger), and reduced noradrenergic functioning (possibly re flecting an inability to adapt to stressors). (C) 2000 Elsevier Science B.V ; All rights reserved.