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. 2019 Oct:280:112486.
doi: 10.1016/j.psychres.2019.112486. Epub 2019 Jul 16.

Suicidal subtypes, stress responsivity and impulsive aggression

Barbara Stanley  1 , Christina A Michel  2 , Hanga C Galfalvy  3 , John G Keilp  2 , Mina M Rizk  2 , Randall Richardson-Vejlgaard  4 , Maria A Oquendo  5 , J John Mann  6
Affiliations

Suicidal subtypes, stress responsivity and impulsive aggression

Barbara Stanley et al. Psychiatry Res. 2019 Oct.

Abstract

While prominent models of suicidal behavior emphasize the hypothalamic- pituitary-adrenal (HPA) axis dysregulation, studies examining its role have yielded contradictory results. One possible explanation is that suicide attempters are a heterogeneous group and HPA axis dysregulation plays a more important role only in a subset of suicidal individuals. HPA axis dysregulation also plays a role in impulsivity and aggression. We hypothesize subgroups of attempters, based on levels of impulsivity and aggression, will differ in HPA axis dysregulation. We examined baseline cortisol, total cortisol output, and cortisol reactivity in mood disordered suicide attempters (N = 35) and non-attempters (N = 37) during the Trier Social Stress Test. Suicide attempters were divided into four subgroups: low aggression/low impulsivity, high aggression/low impulsivity, low aggression/high impulsivity, and high aggression/high impulsivity. As hypothesized, attempters and non-attempters did not differ in any cortisol measures while stress response differed based on impulsivity/aggression levels in suicide attempters, and when compared to non-attempters. Specifically, attempters with high impulsive aggression had a more pronounced cortisol response compared with other groups. This is the first study to examine the relationship between cortisol response and suicidal behavior in impulsive aggressive subgroups of attempters. These findings may help to identify a stress responsive suicidal subtype of individuals.

Keywords: Aggression; Cortisol; Impulsivity; Stress; Suicide; TSST.

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Figures

Fig. 1.
Fig. 1.
Baseline cortisol, total cortisol output, and cortisol response during TSST for attempters and non-attempters. No differences between attempters and non-attempters in baseline cortisol, total cortisol output and cortisol response.
Fig. 2.
Fig. 2.
Baseline cortisol, total cortisol output, and cortisol response during TSST comparing non-attempters with suicide attempters categorized by levels of impulsive aggression and impulsivity. HiAgg/HiImp suicide attempters demonstrate a heightened cortisol response to the TSST compared with all other suicide attempter groups and non-attempters. No differences among groups in baseline cortisol and total cortisol output.
Fig. 3.
Fig. 3.
TSST cortisol response for four groups of impulsive aggressive suicide attempters and non-attempters. Cortisol values during and after the TSST in the non-attempters, low aggression/low impulsivity attempters, high aggression/low impulsivity attempters, low aggression/high impulsivity attempters, and high aggression/high impulsivity attempters. The curves have been shifted to a common baseline value to illustrate cortisol response to TSST, regardless of baseline level.
Fig. 3.
Fig. 3.
TSST cortisol response for four groups of impulsive aggressive suicide attempters and non-attempters. Cortisol values during and after the TSST in the non-attempters, low aggression/low impulsivity attempters, high aggression/low impulsivity attempters, low aggression/high impulsivity attempters, and high aggression/high impulsivity attempters. The curves have been shifted to a common baseline value to illustrate cortisol response to TSST, regardless of baseline level.
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