depression

depression

People being treated for bipolar disorder, depression, and other mental illnesses are at greater risk of attempting suicide.

Doctors may soon have tools to predict which individuals will attempt suicide so they can intervene early to prevent tragedies from occurring.

Researchers at Indiana University School of Medicine recently published a paper in the Nature Publishing Group’s journal in psychiatry, Molecular Psychiatry, reporting that they have developed blood tests and questionnaires that can predict with more than 90 percent accuracy which patients will begin thinking about suicide, or attempt it.

Alexander B. Niculescu III, M.D., Ph.D., professor of psychiatry and medical neuroscience at the IU School of Medicine and attending psychiatrist and research and development investigator at the Richard L. Roudebush Veterans Affairs Medical Center, said of the innovation:

We believe that widespread adoption of risk prediction tests based on these findings during healthcare assessments will enable clinicians to intervene with lifestyle changes or treatments that can save lives.

Researchers, using RNA biomarkers from blood samples along with newly developed questionnaires in the form of an app, were able to predict which individuals in a group of patients being seen for a variety of psychiatric illnesses would experience significant suicidal ideation with approximately 92 percent accuracy.

Among patients with bipolar disorder, the accuracy reached 98 percent, Dr. Niculescu said. The biomarkers and app combination was also accurate in predicting which of the patients would be hospitalized for suicidality in the year following testing (71 percent across all diagnoses, 94 percent for bipolar disorder).

The questionnaires by themselves, implemented as apps on tablets, were able to predict the onset of significant suicidal thoughts with more than 80 percent accuracy.

In 2013,  Dr. Niculescu and colleagues reported that they identified a panel of biomarkers that were significantly elevated in bipolar disorder patients with suicidal thoughts or who were hospitalized as a result of suicide attempts. This new research expands upon that work.

Dr. Niculescu explained:

We now have developed a better panel of biomarkers that are predictive across several psychiatric diagnoses. Combined with the apps, we have a broader spectrum predictor for suicidality. In additional to reproducing and expanding our own previous work, we reproduce and expand other groups’ results in this burgeoning field.

The study began with a group of 217 male psychiatric participants with diagnoses of bipolar disorder, major depressive disorder, schizoaffective disorder, and schizophrenia who were followed by Dr. Niculescu and colleagues for several years.

The researchers identified 37 participants who switched from no suicidal ideation to high suicidal ideation at different testing visits. They were able to identify RNAs that were present at different levels in blood samples taken at those different testing visits, in common across these individuals. Those candidate biomarkers were then evaluated using the Niculescu group’s Convergent Functional Genomics approach, to prioritize the best markers.

Then the research team worked with the Marion County (Indianapolis, Ind.) Coroner’s Office to validate those prioritized biomarkers using blood samples from 26 men who had committed suicide.

Finally, the researchers used blood samples and medical records from a different group of patients with the same psychiatric diagnoses to confirm that the biomarkers and apps predicted suicidal ideation, and also examined their ability to predict future hospitalizations for suicidality in the first year following testing.

The app-based questionnaires were developed separately, said Dr. Niculescu.

One of the apps assesses measures of mood and anxiety, and the other asks questions related to life issues including physical and mental health, addictions, cultural factors, and environmental stress. Neither app asks whether the individual is thinking of committing suicide.

Dr. Niculescu said he believes the apps are ready to be distributed and tested by medical professionals, especially in emergency department settings. He added that the biomarkers could also be more widely tested in the near future.

There are two limitations that require additional research, however. First, all of the participants in this study were men. Studies in women are currently being conducted and so far are showing promising results. In addition, the research was based on work with people with psychiatric diagnoses. How well the biomarkers would work among people who have not been diagnosed with a psychiatric disease is not known.

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