Gender-Specific Diagnostic Tools Can Help Identify Women at Highest Risk for Suicide

Alexander Bogdan Niculescu, M.D., Ph.D.
Dr. Alexander B. Niculescu

Research newly reported in the journal Molecular Psychiatry could help doctors identify women who are most at risk for suicide, using biological markers that can be measured in the blood and a newly developed clinical assessment.

Women attempt suicide more often—but die by suicide less often—than men. Despite these gender differences, women have been underrepresented in studies of suicide. The new study, led by NARSAD 2002 and 2005 Young Investigator Alexander Bogdan Niculescu, M.D., Ph.D., at Indiana University School of Medicine, focused exclusively on women. The research identified a panel of blood-based markers of suicide risk that is different from a set of suicide-associated markers that Dr. Niculescu and colleagues previously identified in men—although some markers are common to both groups.

To look for markers that could help predict suicide risk, the researchers followed a group of women who had been diagnosed with psychiatric disorders (bipolar disorder, depression, schizoaffective disorder*, or schizophrenia), and identified 12 who transitioned between having no thoughts of committing suicide to having severe suicidal thoughts. For each of these women, the researchers compared blood samples collected during periods of suicidal thoughts to samples collected when they weren’t having those thoughts. The objective was to find genes whose activity differed in the two states.

New biomarkers, combined with clinical assessments, can help doctors identify women at risk for suicide. Tweet >

The team in this way identified a set of biomarkers associated with suicidal thoughts, then used a bioinformatic approach (involving advanced math and data analysis tools) to prioritize which of those blood biomarkers had previous genetic or brain evidence for involvement in suicide.

 They tested the biomarkers thus prioritized in blood samples from six women who had committed suicide. These analyses yielded 50 “validated” biomarkers for suicidal behavior.

The researchers also determined that two clinical questionnaires in the form of apps, previously developed by the Niculescu group and tested in men (one assessing suicide risk, and the other assessing affective state – i.e., mood), are valid for female patients also. Neither questionnaire directly asks about suicidal thoughts; rather, one measures other risk factors for suicide (life issues, mental health, physical health, social isolation and environmental stress, addictions, and cultural factors), and the other measures mood and anxiety.

When applied together to blood samples from an independent group of thirty-three women with psychiatric disorders, the clinical assessments and blood marker tests identified with 82 percent accuracy which women had gone on to experience suicidal thoughts. They identified with 78 percent accuracy women who were later hospitalized for suicidal thoughts or attempts.

*in schizoaffective disorder, patients have symptoms of both schizophrenia and a mood disorder --usually bipolar disorder or depression—but do not meet all of the diagnostic criteria for either illness.

Takeaway: Biomarkers in the blood can help doctors identify women at high risk for suicidal thoughts or behavior. Some of these biomarkers have also been found to predict suicidal thoughts and behavior in men, but some suicide-associated biomarker changes are gender specific.