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technique to a cheaper, more clinic-
friendly technology than MRI, such as
electroencephalography (EEG).
Melhem says she’s hopeful that com-
bining techniques will improve predic-
tive approaches in the coming years. In
2019, she and colleagues published a
model that improved on the accuracy
and performance of existing models to
predict suicide attempts based on fac-
tors such as the severity and variability
of a person’s depression symptoms over
time.^21 Integrating this sort of easy-
to-collect clinical data with biological
information from brain scans or other
diagnostic tests should lead to more-
accurate predictions, she says.
The search for such tests has impor-
tant consequences for suicide prevention
even beyond their potential to assess
risk. “When we introduce biological
markers, just like [for] any other areaof medicine, then stigma will be reduced
at the level of the patient,” Melhem says.
Patients are often surprised to hear that
researchers are studying the biology
underlying suicide “because they’ve been
thinking that this is a behavioral flaw
in their character, and they feel guilty
about it. That’s part of the stigma that
we want to break.” gReferences- I.C.G. Weaver et al., “Epigenetic programming
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Neurosci, 12:342–48, 2009. - J. Jokinen et al., “Epigenetic changes in the
CRH gene are related to severity of suicide
attempt and a general psychiatric risk score in
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activity in suicide attempters compared to
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Psychiatry Res, 280:112486, 2019. - D.B. O’Connor et al., “Cortisol levels
and suicidal behavior: A meta-analysis,”
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psychopathology alter methylation of the serotonin
receptor 2A (HTR2A) gene in preschoolers,” Dev
Psychopathol, 29:1619–26, 2017. - I. Ouellet-Morin et al., “Increased serotonin
transporter gene (SERT) DNA methylation
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and in vivo PET imaging of human brain
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10. G.M. Sullivan et al., “Positron emission
tomography quantification of serotonin1A
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11. M.D. Underwood et al., “Serotonin receptors
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12. H. Lund-Sørensen et al., “A nationwide cohort
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13. J. Bak et al., “The association between suicide
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14. E.E.M. Knowles et al., “Family-based analyses
reveal novel genetic overlap between cytokine
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Brain Behav Immun, 80:292–99, 2019.
15. C.M. McHugh et al., “Association between
suicidal ideation and suicide: meta-analyses of
odd ratios, sensitivity, specificity and positive
predictive value,” BJPsych Open, 5:e18, 2019.
16. A. Shalev et al., “Cortisol response to stress as
a predictor for suicidal ideation in youth,” J
Affect Disord, 257:10–16, 2019.
17. T.A. Eisenlohr-Moul et al., “HPA axis
response and psychosocial stress as interactive
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in adolescent females: a multilevel diathesis-
stress framework,” Neuropsychopharmacology,
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18. M.A. Oquendo et al., “Positron emission
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19. M.T. Davis et al., “In vivo evidence for
dysregulation of mGluR5 as a biomarker of
suicidal ideation,” PNAS, 116:11490–95, 2019.
20. M.A. Just et al., “Machine learning of neural
representations of suicide and emotion
concepts identifies suicidal youth,” Nat Hum
Behav, 1:911–19, 2017.
21. N.M. Melhem et al., “Severity and variability
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Psychiatry, 76:603–13, 2019.
PREVENTING SUICIDE
Medical professionals consider suicide a preventable public health problem. In the US, agencies such as the Centers for Disease Control and
Prevention and the Substance Abuse and Mental Health Services Administration oversee initiatives designed to help assess and respond to
suicide risk in the general population, and particularly in communities considered to be at high risk, including among people with mood disor-
ders, substance abuse problems, or a family history of suicide.
Many nonprofi t organizations also work to raise awareness of the problem, fund research on suicide, and provide resources for people
aff ected by suicide. Find information about suicide warning signs, treatment, and other resources at the American Foundation for Suicide
Prevention website, http://www.afsp.org. For help, call the confi dential, free 24/7 National Suicide Prevention Lifeline at 1-800-273-8255.UP TO 90 PERCENT OF
PEOPLE WHO DIE BY
SUICIDE ARE THOUGHT
TO HAVE HAD A
DIAGNOSABLE MENTAL
HEALTH CONDITION
PRIOR TO THEIR
DEATH.
Source: NATIONAL ALLIANCE ON MENTAL
ILLNESS, various datasetsHEALTH CONDITION
PRIOR TO THEIR
DEATH.
Source: NATIONAL ALLIANCE ON MENTAL
ILLNESS, various datasetsTO HAVE HAD A
DIAGNOSABLE MENTALUP TO 90 PERCENT
PEOPLE WHO DIE BY
SUICIDE ARE THOUGHT90 PERCENT
PEOPLE WHO DIE BY
SUICIDE ARE THOUGHT90 PERCENT