Jul 2026· Journal of Affective Disorders· Vol 414, pp.
122285
· 0 citations· 67 references
Medicine
Abstract
Background
Distinguishing suicide attempters from those with only ideation remains a major clinical challenge. This study investigated whether heart rate variability (HRV) reactivity, a marker of autonomic regulation, moderates the relationship between behavioral disinhibition and suicide attempts.
Methods
We conducted a cross-sectional study of 61 inpatients with major depressive episodes, categorized into a Suicide Attempt group (SA, n = 23) and a Suicidal Ideation group (SI, n = 38). HRV was recorded during baseline and Go/No-Go task performance as a stress condition. We calculated HRV reactivity as the change in log-transformed high-frequency (HF) power from baseline to task. Logistic regression and interaction analyses were used to predict attempt status while adjusting for age, sex, and smoking.
Results
The SA group was significantly younger and had more lifetime attempts. Groups did not differ in depression, self-reported impulsivity, or aggression (all p > 0.05). Unadjusted analyses showed the SA group had fewer omission errors (Median: 4.0 vs. 9.0, p = 0.014) and higher resting HRV-HF Power (181.0 vs. 63.5 ms2, p = 0.033) compared to the SI group. However, these differences were attributable to younger age and became non-significant after adjustment. In exploratory interaction analyses, a significant effect emerged between Go/No-Go commission errors and HRV-HF reactivity (β = 0.12, p = 0.022). High commission errors were associated with suicide attempts only when coupled with blunted HRV reactivity.
Conclusion
Recent suicide attempt was associated with the coexistence of motor disinhibition and impaired HRV-HF reactivity. These exploratory findings highlight the importance of stress-related physiological reactivity over resting measures for risk stratification, providing preliminary proof-of-concept for differentiating high-risk subgroups.
BACKGROUND
Heart rate variability (HRV) is a non-invasive marker of autonomic regulation that may be related to suicide risk, but longitudinal evidence in inpatients is limited. This study examined one-week HRV dynamics and suicide-risk reduction in depressive inpatients.
METHODS
This retrospective one-week longitudinal study included 177 inpatients with major depressive disorder (MDD) or bipolar disorder (BD) during a depressive episode. Suicide risk was assessed using the Mini-International Neuropsychiatric Interview (MINI), and HRV was measured at admission and after one week. Patients were classified as low suicide risk (LSR, n = 96) or moderate-to-high suicide risk (MHSR, n = 81). Linear mixed-effects models and multivariable regression were used.
RESULTS
The MHSR group was younger (FDR-P = 0.003) and had higher Hamilton Depression Rating Scale scores (FDR-P = 0.005). At admission, the MHSR group showed higher average heart rate (AHR) and low-frequency/high-frequency ratio (LF/HF), and lower standard deviation of normal-to-normal intervals (SDNN), root mean square of successive RR interval differences (RMSSD), and high-frequency power (HF) (all FDR-P ≤ 0.05); these differences were no longer significant at week 1. RMSSD showed a significant time × group interaction (FDR-P = 0.026). Greater suicide-risk reduction was associated with decreased AHR (FDR-P = 0.041) and increased SDNN, RMSSD, total power (TP), low-frequency power (LF), and HF (all FDR-P < 0.001).
CONCLUSIONS
Higher suicide risk was associated with altered autonomic regulation at admission. HRV changes over one week were associated with suicide-risk reduction, suggesting that HRV may provide dynamic physiological information for longitudinal inpatient suicide-risk monitoring.
Yi Wang, Chaohua Huang, Bao-Yi Zhong et al.· Journal of Affective Disorde...· 0 citations
Objective Alterations in autonomic nervous system activity – measured by heart rate variability (HRV) and heart rate (HR) - have been proposed as a relevant biopsychological mechanism in several psychiatric disorders. However, only few studies have examined these parameters in OCD, and evidence from pediatric samples is particularly limited. The aim of this study was to investigate autonomic activity in pediatric OCD. Methods A five minute resting state electrocardiogram was recorded in adolescents with OCD (n = 64) and age- and IQ-matched healthy controls (HC, n = 52). Autonomic activity was compared using the logarithmized root mean square of differences between successive R-R intervals (logRMSSD), the logarithmized high-frequency HRV (logHF-HRV), the percentage of adjacent NN intervals differing from each other by more than 50 ms (pNN50) and HR. Associations with psychotropic medication status and symptom severity were assessed. Results Adolescents with OCD showed lower logRMSSD and higher HR than HC, whereas logHF-HRV and pNN50 did not differ between groups. No associations were found between cardiac measures and OCD symptom severity. Exploratory subgroup analyses suggested lower logHF-HRV and logRMSSD in medicated adolescents with OCD. Conclusions Our findings add to evidence for altered autonomic activity in pediatric OCD, reflected by elevated HR and lower RMSSD. The observed reduction in HRV did not increase with greater symptom severity and appeared most pronounced among medicated adolescents with OCD. Significance The autonomic imbalance observable in adolescents with OCD is common across anxiety disorders and has been linked to cardiovascular risk.
Manuel Burkart, Sophie P. Scheer, Lea L. Backhausen et al.· Clinical Neurophysiology Pra...· 0 citations
This study investigated the relationships between blood pressure parameters and suicide attempt risk in first-episode, drug-naive major depressive disorder (MDD) patients, and examined anxiety's mediating role. Blood pressure parameters were measured in 1,718 first-episode, drug-naive patients with MDD. Relationships with suicide attempt risk were analyzed using logistic regression with curve fitting and threshold effect analysis. Mediation analysis assessed anxiety's role. A U-shaped relationship existed between pulse pressure (PP) and suicide attempt risk (inflection point: 43 mmHg). Below this threshold, each 1 mmHg PP increase was associated with 6.5% lower risk (OR = 0.935, 95% CI: 0.897-0.974); above it, each 1 mmHg increase was associated with 7.1% higher risk (OR = 1.071, 95% CI: 1.036-1.107). Systolic (SBP) and diastolic blood pressure (DBP) showed J-shaped relationships with suicide risk (inflection points: 132 mmHg and 77 mmHg, respectively). No significant associations existed below these thresholds, while above them, each 1 mmHg increase in SBP and DBP was associated with 21.9% (OR = 1.219, 95% CI: 1.144-1.299) and 9.0% (OR = 1.090, 95% CI: 1.049-1.132) higher suicide attempt risk, respectively. Anxiety partially mediated the effects of PP (29.34%), SBP (31.89%), and DBP (35.75%) on suicide risk. Blood pressure parameters, particularly elevated SBP and DBP, significantly predict suicide attempt risk in MDD patients, with anxiety playing a partial mediating role. These findings highlight the importance of blood pressure monitoring and anxiety management in suicide prevention strategies for MDD patients.
Yongfeng Zheng, Yanshuang Jiang, Li Zhang et al.· Journal of Visualized Experi...· 0 citations
OBJECTIVE
While the association between suicide and sleep problems has been reported, the effect size and temporal directionality remain unclear. This study examined whether sleep problems prospectively predict suicidal ideation.
METHODS
In 2022, a self-administered online questionnaire including the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9, and the Suicidal Ideation Scale (SIS) was distributed to a stratified random sample from a web survey panel and to local city government officers. The same questionnaire was administered again after 3 months. Cross-lagged model analyses were conducted to assess temporal and directional associations.
RESULTS
A total of 652 participants (mean age, 49.7 years) provided valid responses at both time points. Weak suicidal ideation was observed in 25.2% of participants, and moderate-to-strong ideation in 3.7% (SIS Q1: "wish to die"). Sleep disturbance (PSQI ≥ 6) was observed in 32.8% of participants. Cross-lagged analyses showed that PSQI global score and sleep latency prospectively predicted suicidal ideation. These associations remained significant after adjusting for depressive symptoms. Bidirectional associations between sleep disturbance and suicidal ideation were also observed. The presence of sleep disturbance predicted future suicidal ideation in univariate analysis (OR = 3.97) and remained significant in the PHQ-9-adjusted model (OR = 1.59).
CONCLUSION
Sleep problems were identified as prospective predictors of suicidal ideation. Sleep disturbances may represent modifiable targets for intervention in suicide prevention.
A. Shimura, Masako Iida, Yuta Takada et al.· Archives of Suicide Research· 0 citations
Abstract Background and Hypothesis Sleep disturbance is a well-established risk factor for suicide, though few studies to date have examined whether sleep disturbance contributes to suicide risk among individuals at clinical high risk for psychosis (CHR). The current study addressed this gap in the literature. We hypothesized that sleep disturbance would have a unique relationship with suicidal ideation/attempts when accounting for other variables in the model. We also hypothesized that the interaction between sleep disturbance/attenuated positive symptoms and sleep disturbance/stress would be related to suicidal ideation/attempts in CHR. Study Design The current study used data generated by the Accelerating Medicines Partnership® Schizophrenia Observational Study. The total sample included 1,048 participants (827 CHR and 221 community controls). Participants completed measures of suicidal ideation/attempts, attenuated positive symptoms, depressive symptoms, perceived stress, and sleep disturbance. Study Results Results supported a relationship between sleep disturbance and suicidal ideation/attempts in CHR, with participants who had lifetime ideation and attempts experiencing more sleep disturbance than those with no ideation or attempts. We also found small, but significant positive correlations between sleep disturbance and suicide risk in CHR. When accounting for other variables in the model, the effect of sleep disturbance remained significant for past month ideation, but not lifetime ideation or attempts. Both interaction models were non-significant. Conclusions Our findings highlight the potential value of sleep measures in early identification and treatment of suicide risk in CHR. Further research in this area is warranted.
H. Wastler, Aubrey M. Moe, Alexandra M Blouin et al.· Schizophrenia Bulletin Open· 0 citations
BACKGROUND
Childhood trauma (CT) is robustly associated with suicide ideation (SI) and attempts (SA) in individuals with depressive and/or anxiety disorders. However, pathways underlying these associations and whether they differ between suicide ideation only (SI + SA-) and suicide ideation with attempt (SI + SA+) remain unclear. Variables that may statistically account for CT-SI + SA- and CT-SI + SA+ associations were examined.
METHODS
Data from 1572 respondents with a 12-month depressive and/or anxiety disorder from the Netherlands Study of Depression and Anxiety were used. The NEMESIS childhood trauma interview (0-8 score) measured CT severity. Single and multiple-mediator models via generalized structural equation modeling (GSEM) were used to investigate whether psychosocial, personality, lifestyle and biological variables showed indirect associations consistent with mediation of the association between CT and suicide outcomes.
RESULTS
Higher CT scores were associated with SI + SA- (OR = 1.51, 95% CI: 1.32-1.73) and SI + SA+ (OR = 2.68, 95% CI: 2.21-3.27). In single mediator models, personality traits, insomnia, low social support and loneliness statistically accounted for a part of the association between CT and both outcomes. Interleukin-6 statistically accounted for a small portion of the CT-SI + SA+ link. In multiple-mediator models, direct effects reduced by 65.6% (SI + SA-) and 39.1% (SI + SA+) and aggression, insomnia, social support (both outcomes), neuroticism, introversion, hopelessness (SI + SA-) and locus of control (SI + SA+) remained significant.
LIMITATIONS
The cross-sectional design limits causal inferences.
CONCLUSION
Multiple personality traits, insomnia and lower social support statistically accounted for a portion of the association between CT and suicide outcomes. Especially aggression, insomnia and social support may represent actionable suicide prevention targets, pending longitudinal validation.
J. Wiebenga, L. Lokhorst, Adriaan W. Hoogendoorn et al.· Journal of Affective Disorde...· 0 citations
