The impulsiveness level influences the salivary cortisol response and social stress sensitivity in suicidal patients

A Alacreu-Crespo; V Hidalgo; C Girod; E Olié; Ph Courtet

doi:10.1016/j.jpsychires.2022.10.008

The impulsiveness level influences the salivary cortisol response and social stress sensitivity in suicidal patients

J Psychiatr Res. 2022 Dec:156:159-167. doi: 10.1016/j.jpsychires.2022.10.008. Epub 2022 Oct 8.

Authors

A Alacreu-Crespo¹, V Hidalgo², C Girod³, E Olié⁴, Ph Courtet⁴

Affiliations

¹ IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France / Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France; Department of Psychology and Sociology, Area of Personality, Assesment and Psychological Treatment, University of Zaragoza, Teruel, Spain; Laboratory of Cognitive Social Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain. Electronic address: aalacreu@unizar.es.
² Laboratory of Cognitive Social Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain; Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, Aragon Health Research Institute, Aragon, Teruel, Spain.
³ Etablissement Public de Santé Mentale de la Reunion, Saint Paul, Ile de la Reunion, France.
⁴ IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France / Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.

PMID: 36252345
DOI: 10.1016/j.jpsychires.2022.10.008

Abstract

Introduction: Suicide attempters (SA) are more vulnerable to social stress and show disturbed cortisol response in stressful conditions compared with psychiatric and healthy controls. Recent data suggest that this dysregulation might be related to impulsivity traits. However, little is known about the emotional consequences of social stress in SA exposed to stress.

Objectives: The aim of our study was to evaluate the cortisol and emotional responses to social stress in patients with depression with and without suicide attempt, by taking into account impulsivity traits and depression severity.

Methods: 67 adult women (41 SA and 26 affective controls (AC,i.e. without suicide attempt history)) with lifetime history of major depressive episode were included. Patients performed the Trier Social Stress Test (TSST), a well-validated social stress task. Patients provided seven saliva samples, to measure the cortisol response, and filled in questionnaires to assess psychological pain, positive and negative mood, and anxiety at different time points (from 10 min before to 120 min after the TSST). Moderated regression models were used including suicide attempt history, depression severity, and impulsivity as independent variables and their interactions.

Results: In patients with low depression and high impulsivity, salivary cortisol response during the TSST was higher in SA than in AC (p < .001). Psychological pain, negative mood, and anxiety were increased in all patients just after the TSST, followed by a decrease at 120 min. Positive mood recovery was slower in SA, and in patients with high impulsivity and low depression level (p < .001).

Conclusions: Impulsivity traits have an important role in suicidal vulnerability in stress conditions. Impulsivity traits might help to differentiate patients at risk of suicide who are highly sensitive to stress when depression level is low. Higher impulsiveness may increase the sensitivity to emotional distress that translates into inadequate physiological responses.

Keywords: Anxiety; Depression; HPA axis; Impulsivity; Suicide; TSST.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Depressive Disorder, Major*
Female
Humans
Hydrocortisone*
Pain
Suicide, Attempted

Substances

Hydrocortisone