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Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: a systematic review and meta-analysis

Molecular Psychiatry volume 27, pages 1350–1361 (2022)Cite this article

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Abstract

A meta-analysis showed a significant association between activated immune-inflammatory and nitro-oxidative (IO&NS) pathways and suicide attempts (SA). There is no data on whether recent suicidal ideation (SI) is accompanied by activated IO&NS pathways and whether there are differences between recent SA and SI. The current study searched PubMed, Google Scholar, and Web of Science, for articles published from inception until May 10, 2021, and systematically reviewed and meta-analysed the association between recent SA/SI (<3 months) and IO&NS biomarkers. We included studies which compared psychiatric patients with and without SA and SI and controls (either healthy controls or patients without SA/SI) and used meta-analysis (random-effect model with restricted maximum-likelihood) to delineate effect sizes with 95% confidence intervals (CI). Our search included 59 studies comprising 4.034 SA/SI cases and 12.377 controls. Patients with SA/SI showed activated IO&NS pathways (SMD: 0.299; CI: 0.200; 0.397) when compared to controls. The immune profiles were more strongly associated with SA than with SI, particularly when compared to healthy controls, as evidenced by activated IO&NS (SMD: 0.796; CI: 0.503; 1.089), immune (SMD: 1.409; CI: 0.637; 1.462), inflammatory (SMD: 1.200; CI: 0.584; 1.816), and neurotoxic (SMD: 0.904; CI: 0.431; 1.378) pathways. The effects sizes of the IO&NS, immune and inflammatory profiles were significantly greater in SA than in SI. In conclusion: activated IO&NS pathways are associated with recent SA and SI, and inflammation, T helper-1 activation, nitro-oxidative stress, lowered neuroprotection, and increased neurotoxicity explain at least in part why psychiatric patients show increased suicidal behaviours, especially SA.

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Fig. 1: PRISMA 2020 diagram.
Fig. 2: Forest plot with results of meta-analysis performed on 59 studies reporting immune-inflammatory and oxidative & nitrosative stress (IO&NS) biomarkers.
Fig. 3: Forest plot with results of meta-analysis (subgroup analysis) performed on 26 studies reporting on inflammation.

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Data availability

The dataset (CMA file) generated during and/or analysed during the current study will be available from MM upon reasonable request and once the dataset has been fully exploited by the authors.

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Funding

The study was funded by the 90th Anniversary of Chulalongkorn University Scholarship (Grant Batch#47 No. 3/2020).

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Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Asara Vasupanrajit, Ketsupar Jirakran, Chavit Tunvirachaisakul & Michael Maes

  2. Maximizing Thai Children’s Developmental Potential Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Ketsupar Jirakran

  3. Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Chavit Tunvirachaisakul & Michael Maes

  4. University of Ottawa, Psychiatry Department, Ottawa, ON, Canada

    Marco Solmi

  5. The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  6. Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  7. IMPACT Strategies Research Center, Deakin University, Geelong, VIC, Australia

    Michael Maes

  8. Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria

    Michael Maes

Authors
  1. Asara Vasupanrajit
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  2. Ketsupar Jirakran
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  3. Chavit Tunvirachaisakul
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  4. Marco Solmi
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  5. Michael Maes
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Contributions

All authors contributed to the writing up of the paper. The work was designed by MM and AV. Data were collected by AV and KJ. Statistical analyses were performed by MM and AV. All authors revised and approved the final draft.

Corresponding authors

Correspondence to Asara Vasupanrajit or Michael Maes.

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Competing interests

The authors declare no competing interests. MS received honoraria and has been a consultant for Angelini, Lundbeck.

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Vasupanrajit, A., Jirakran, K., Tunvirachaisakul, C. et al. Inflammation and nitro-oxidative stress in current suicidal attempts and current suicidal ideation: a systematic review and meta-analysis. Mol Psychiatry 27, 1350–1361 (2022). https://doi.org/10.1038/s41380-021-01407-4

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  • DOI: https://doi.org/10.1038/s41380-021-01407-4

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