Biomarkers of suicide: Predicting the predictable?

Abstract

To date, the identification of individuals at risk of suicide is based on subjective reports. Given that individuals at risk often do not disclose their suicidal thoughts, the introduction of objective measures - Such as biomarkers - of suicide risk might help in predicting which individuals will eventually die by suicide. Biomarkers have a potentially relevant role in the prediction of suicide, as an adjunct to, rather than a substitute for, current clinical practice. Within the context of the stress-diathesis model of suicidal behavior, the most relevant biomarkers for estimating suicide risk are non-suppression in the dexamethasone suppression test (DST) - a biomarker of stress - and reduced concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF), a biomarker of diathesis. Given the multi-determined nature of suicide, a combination of biological, clinical, neuropsychological, and neuroimaging factors might yield a better estimate of suicide risk than using biomarkers alone and help overcome current limitations in the prediction of suicide.