Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: A meta-analysis

Rishi Sharma; Sai Krishna Tikka; Arun Kumar Yadav; Ashish Ramesh Bhute; Puneet Dhamija; Binaya Kumar Bastia

doi:10.1016/j.ajp.2021.102711

Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: A meta-analysis

Asian J Psychiatr. 2021 Aug:62:102711. doi: 10.1016/j.ajp.2021.102711. Epub 2021 Jun 2.

Authors

Rishi Sharma¹, Sai Krishna Tikka², Arun Kumar Yadav³, Ashish Ramesh Bhute⁴, Puneet Dhamija⁵, Binaya Kumar Bastia⁴

Affiliations

¹ Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India. Electronic address: sharmarishi1991@yahoo.com.
² Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad Metropolitan Region, Telangana, India.
³ Department of Community Medicine, Armed Forces Medical College (AFMC) Pune, Maharashtra, India.
⁴ Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India.
⁵ Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India.

PMID: 34090249
DOI: 10.1016/j.ajp.2021.102711

Abstract

Aim: The purpose of this meta-analysis was to critically examine the data from individual studies on CSF neurotransmitter metabolites to see whether there were consistencies in the results of the comparison of suicide attempters and psychiatric controls and of the comparison of attempted suicides using violent versus nonviolent methods.

Method: Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Cochrane library was conducted for studies that reported concentration of CSF-neurotransmitter metabolites: 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy phenylglycol (MHPG) in suicide attempters, from January'1981 to November'2020. Standardized mean differences (SMDs) and corresponding 95 % confidence interval (CIs) were deduced for outcome measures. I² statistics were used to assess heterogeneity within studies. Data were analyzed using STATA software.

Results: A total of 36 studies (N = 1987 attempted suicide and N = 1235 psychiatry control) were included for the meta-analysis. We found CSF levels of all the 3 metabolites i.e. 5-HIAA (SMD= -0.43; 95 %CI: -0.61, -0.24), HVA (SMD= -0.16; 95 %CI: -0.33, -0.00) and MHPG (SMD= -0.33; 95 %CI: -0.71, -0.05) were lower in suicide attempters. While the findings were consistent for 5-HIAA, they were inconsistent for the HVA and MHPG. CSF levels of 5-HIAA (SMD= -0.66; 95 %; CI: -1.01, -0.31), HVA (SMD= -0.14; 95 %CI: -0.45, 0.16) and MHPG (SMD= -0.12; 95 %CI: -0.56, 0.31) were significantly lower in violent suicide attempters than non-violent attempters. No significant publication bias found in any study.

Conclusion: We found a significant association between lower levels of CSF 5-HIAA in suicide attempters, particularly the violent ones, compared to psychiatric controls, whereas findings from CSF HVA and MHPG were inconsistent.

Keywords: Cerebrospinal fluid; Homovanillic acid; Hydroxyindoleacetic acid; Methoxyhydroxyphenylglycol; Psychiatric disorder; Suicide.

Publication types

Meta-Analysis

MeSH terms

Aggression
Homovanillic Acid
Humans
Hydroxyindoleacetic Acid
Methoxyhydroxyphenylglycol*
Suicide, Attempted*

Substances

Methoxyhydroxyphenylglycol
Hydroxyindoleacetic Acid
Homovanillic Acid