Hostname: page-component-77f85d65b8-9nbrm Total loading time: 0 Render date: 2026-04-11T16:47:38.210Z Has data issue: false hasContentIssue false
  • English
  • Français

Increased burden of cardiovascular risk among youth suicide attempters

Published online by Cambridge University Press:  19 October 2020

Yongqi Zhong ,
Steven Pham ,
Giovanna Porta ,
Antoine Douaihy ,
Anna Marsland ,
David Brent  and
Nadine M. Melhem Open the ORCID record for Nadine M. Melhem [Opens in a new window]
Yongqi Zhong
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Department of Epidemiology, University of Pittsburgh, PA, USA
Steven Pham
Affiliation:
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
Giovanna Porta
Affiliation:
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Antoine Douaihy
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Anna Marsland
Affiliation:
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
David Brent
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
Nadine M. Melhem*
Affiliation:
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
*
Author for correspondence: Nadine M. Melhem, E-mail: melhemnm@upmc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Suicide and cardiovascular disease rank among the leading causes of disability and premature mortality worldwide. Young adult suicide attempters are at increased risk of mortality from cardiovascular disease even compared to those with major depressive disorder suggesting an increased burden of cardiovascular risk factors. We compared the cardiovascular risk burden between youth attempters and other high-risk individuals.

Methods

Participants were from the Collaborative Psychiatric Epidemiology Surveys (CPES), a U.S. population-based study, aged 18–30 years [suicide attempt (SA): n = 303; suicidal ideation (SI): n = 451; controls: n = 3671]; and psychiatric inpatients admitted for a SA (n = 38) or SI (n = 40) and healthy controls (n = 37) aged 15–30 years. We computed a cardiovascular risk score and high- and low-risk latent classes based on risk factors of high blood pressure, obesity, and smoking.

Results

Suicide attempters showed an increased cardiovascular risk score (CPES: B = 0.43, 95% confidence interval (CI) 0.31–0.54, p < 0.001; inpatient sample: B = 1.61, 95% CI 0.53–2.68, p = 0.004) compared to controls. They were also more likely to be classified in the high cardiovascular risk group (CPES: odds ratio (OR) 3.36, 95% CI 1.67–6.78, p = 0.001; inpatient sample: OR 9.89, 95% CI 1.38–85.39, p = 0.03) compared to those with SI (CPES: OR 1.15, 95% CI 0.55–2.39, p = 0.71; inpatient sample: OR 1.91, 95% CI 0.25–15.00, p = 0.53).

Conclusions

Youth attempters show an increased burden for cardiovascular risk compared to other high-risk individuals in inpatient and population-based samples. Clinicians should pay particular attention to cardiovascular risk factors among suicide attempters in order to reduce their risk for cardiovascular events.

Keywords

Cardiovascular riskhigh blood pressuresmokingobesitysuicide attemptsuicidal ideation

Information

Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 10 , July 2022 , pp. 1901 - 1909
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abubakar, I. I., Tillmann, T., & Banerjee, A. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England), 385(9963), 117–171.Google Scholar
Alegria, M., Jackson, J. S., Kessler, R. C., & Takeuchi, D. (2007). Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003 [United States]. Inter-university Consortium for Political and Social Research.Google Scholar
Andreasen, N. C. (1986). The family history approach to diagnosis: how useful is it? Archives of General Psychiatry, 43(5), 421. doi: 10.1001/archpsyc.1986.01800050019002.CrossRefGoogle Scholar
Armstrong, C. (2018). High blood pressure: ACC/AHA releases updated guideline. American Family Physician, 97(6), 413–415.Google ScholarPubMed
Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2018). Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation, 137(12), e67–e492. doi: 10.1161/CIR.0000000000000558.CrossRefGoogle ScholarPubMed
Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature death after self-harm: a multicentre cohort study. Lancet, 380(9853), 1568–1574. doi: doi: 10.1016/S0140-6736(12)61141-6.CrossRefGoogle ScholarPubMed
Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Lovejoy, M., Wenzel, K., … Ruggiero, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry, 151(8), 1132–1136.Google ScholarPubMed
Bose, J. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (p. 124). Substance Abuse and Mental Health Services Administration (SAMHSA).Google Scholar
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3–4), 372–394. doi: 10.1111/j.1469-7610.2006.01615.x.CrossRefGoogle ScholarPubMed
Casey, D. E. (2005). Metabolic issues and cardiovascular disease in patients with psychiatric disorders. American Journal of Medicine Supplements, 118, 15–22. doi: 10.1016/j.amjmed.2005.01.046.CrossRefGoogle ScholarPubMed
Chang, S.-S., Bjørngaard, J. H., Tsai, M. K., Bjerkeset, O., Wen, C. P., Yip, P. S. F., … Gunnell, D. (2016). Heart rate and suicide: Findings from two cohorts of 533 000 Taiwanese and 75 000 Norwegian adults. Acta Psychiatrica Scandinavica, 133(4), 277–288. doi: 10.1111/acps.12513.CrossRefGoogle ScholarPubMed
Chang, H. B., Munroe, S., Gray, K., Porta, G., Douaihy, A., Marsland, A., … Melhem, N. M. (2019). The role of substance use, smoking, and inflammation in risk for suicidal behavior. Journal of Affective Disorders, 243, 33–41. doi: 10.1016/j.jad.2018.09.005.CrossRefGoogle ScholarPubMed
Cole, T. J., & Lobstein, T. (2012). Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatric Obesity, 7(4), 284–294. doi: 10.1111/j.2047-6310.2012.00064.x.CrossRefGoogle ScholarPubMed
Doran, N., McChargue, D., & Spring, B. (2008). Effect of impulsivity on cardiovascular and subjective reactivity to smoking cues. Addictive Behaviors, 33(1), 167–172. doi: 10.1016/j.addbeh.2007.05.009.CrossRefGoogle ScholarPubMed
Flegal, K. M., & Williamson, D. F. (2010). Incident CHD and excess body weight in the US population. Obesity, 18(6), 1069; author reply 1069–70. doi: 10.1038/oby.2010.37.CrossRefGoogle ScholarPubMed
Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Blowey, D., Carroll, A. E., & Daniels, S. R., … Children, S. on S. and M. of H. B. P. I. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904. doi: 10.1542/peds.2017-1904.CrossRefGoogle ScholarPubMed
Goldman-Mellor, S. J., Caspi, A., Harrington, H., Hogan, S., Nada-Raja, S., Poulton, R., & Moffitt, T. E. (2014). Suicide attempt in young people: a signal for long-term health care and social needs. JAMA Psychiatry, 71(2), 119–127. doi: 10.1001/jamapsychiatry.2013.2803.CrossRefGoogle ScholarPubMed
Goldstein, B. I., Carnethon, M. R., Matthews, K. A., McIntyre, R. S., Miller, G. E., Raghuveer, G., … McCrindle, B. W. (2015). Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation, 132(10), 965–986. doi: 10.1161/CIR.0000000000000229.CrossRefGoogle ScholarPubMed
Greenland, P., Knoll, M. D., Stamler, J., Neaton, J. D., Dyer, A. R., Garside, D. B., & Wilson, P. W. (2003). Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA, 290(7), 891–897. doi: 10.1001/jama.290.7.891.CrossRefGoogle ScholarPubMed
Hamer, M., Batty, G. D., Seldenrijk, A., & Kivimaki, M. (2011). Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey. European Heart Journal, 32(4), 437–442. doi: 10.1093/eurheartj/ehq438.CrossRefGoogle ScholarPubMed
Hawton, K., Harriss, L., & Zahl, D. (2006). Deaths from all causes in a long-term follow-up study of 11583 deliberate self-harm patients. Psychological Medicine, 36(3), 397–405. doi: 10.1017/S0033291705006914.CrossRefGoogle Scholar
Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript, Yale University, New Haven, CT.Google Scholar
Islam, A. H., Metcalfe, A. W. S., MacIntosh, B. J., Korczak, D. J., & Goldstein, B. I. (2018). Greater body mass index is associated with reduced frontal cortical volumes among adolescents with bipolar disorder. Journal of Psychiatry & Neuroscience, 43(2), 120–130. doi: 10.1503/jpn.170041.CrossRefGoogle ScholarPubMed
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., & Donato, K. A., … Obesity Society. (2014). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 129(25 Suppl 2), S102–138. doi: 10.1161/01.cir.0000437739.71477.ee.CrossRefGoogle Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. doi: 10.1001/archpsyc.62.6.593.CrossRefGoogle ScholarPubMed
Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56(7), 617–626. doi: 10.1001/archpsyc.56.7.617.CrossRefGoogle ScholarPubMed
Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121. doi: 10.1002/mpr.168.CrossRefGoogle Scholar
Kirisci, L., Mezzich, A., & Tarter, R. (1995). Norms and sensitivity of the adolescent version of the drug use screening inventory. Addictive Behaviors, 20(2), 149–157. doi: 10.1016/0306-4603(94)00058-1.CrossRefGoogle ScholarPubMed
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515. doi: 10.3928/0048-5713-20020901-06.CrossRefGoogle Scholar
Lee, J., Taneja, V., & Vassallo, R. (2012). Cigarette smoking and inflammation. Journal of Dental Research, 91(2), 142–149. doi: 10.1177/0022034511421200.CrossRefGoogle ScholarPubMed
Lemogne, C., Thomas, F., Consoli, S. M., Pannier, B., Jégo, B., & Danchin, N. (2011). Heart rate and completed suicide: evidence from the IPC cohort study. Psychosomatic Medicine, 73(9), 731. doi: 10.1097/PSY.0b013e3182365dc7.CrossRefGoogle ScholarPubMed
Li, D., Yang, X., Ge, Z., Hao, Y., Wang, Q., Liu, F., … Huang, J. (2012). Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies. Journal of Psychiatric Research, 46(10), 1257–1266. doi: 10.1016/j.jpsychires.2012.03.013.CrossRefGoogle ScholarPubMed
McCusker, M. E., Yoon, P. W., Gwinn, M., Malarcher, A. M., Neff, L., & Khoury, M. J. (2004). Family history of heart disease and cardiovascular disease risk-reducing behaviors. Genetics in Medicine, 6(3), 153–158. doi: 10.1097/01.GIM.0000127271.60548.89.CrossRefGoogle ScholarPubMed
Melhem, N. M., Keilp, J. G., Porta, G., Oquendo, M. A., Burke, A., Stanley, B., … Brent, D. A. (2016). Blunted HPA axis activity in suicide attempters compared to those at high risk for suicidal behavior. Neuropsychopharmacology, 41(6), 1447–1456. doi: 10.1038/npp.2015.309.CrossRefGoogle ScholarPubMed
Melhem, N. M., Munroe, S., Marsland, A., Gray, K., Brent, D., Porta, G., … Gopalan, P. (2017). Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters. Psychoneuroendocrinology, 77, 284–294. doi: 10.1016/j.psyneuen.2017.01.001.CrossRefGoogle ScholarPubMed
Mokdad, A. H., Ballestros, K., Echko, M., Glenn, S., Olsen, H. E., Mullany, E., … Murray, C. J. L. (2018). The state of US health, 1990–2016: burden of diseases, injuries, and risk factors Among US states. JAMA, 319(14), 1444–1472. doi: 10.1001/jama.2018.0158Google ScholarPubMed
Naiberg, M. R., Newton, D. F., Collins, J. E., Bowie, C. R., & Goldstein, B. I. (2016b). Impulsivity is associated with blood pressure and waist circumference among adolescents with bipolar disorder. Journal of Psychiatric Research, 83, 230–239. doi: 10.1016/j.jpsychires.2016.08.019.CrossRefGoogle Scholar
Naiberg, M. R., Newton, D. F., Collins, J. E., Dickstein, D. P., Bowie, C. R., & Goldstein, B. I. (2016a). Elevated triglycerides are associated with decreased executive function among adolescents with bipolar disorder. Acta Psychiatrica Scandinavica, 134(3), 241–248. doi: 10.1111/acps.12603.CrossRefGoogle Scholar
Park, D., Lee, J.-H., & Han, S. (2017). Underweight: Another risk factor for cardiovascular disease? Medicine, 96(48), e8769. doi:10.1097/MD.0000000000008769..CrossRefGoogle ScholarPubMed
Piirtola, M., Jelenkovic, A., Latvala, A., Sund, R., Honda, C., Inui, F., … Silventoinen, K. (2018). Association of current and former smoking with body mass index: a study of smoking discordant twin pairs from 21 twin cohorts. PLoS One, 13(7), e0200140. doi: 10.1371/journal.pone.0200140.CrossRefGoogle ScholarPubMed
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia–suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. doi: 10.1176/appi.ajp.2011.10111704.CrossRefGoogle ScholarPubMed
Shah, A. J., Veledar, E., Hong, Y., Bremner, J. D., & Vaccarino, V. (2011). Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Archives of General Psychiatry, 68(11), 1135–1142. doi: 10.1001/archgenpsychiatry.2011.125.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. doi: 10.1001/archinte.166.10.1092.CrossRefGoogle ScholarPubMed
Suglia, S. F., Koenen, K. C., Boynton-Jarrett, R., Chan, P. S., Clark, C. J., Danese, A., … American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Functional Genomics and Translational Biology; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. (2018). Childhood and adolescent adversity and cardiometabolic outcomes: a scientific statement from the American Heart Association. Circulation, 137(5), e15–e28. doi: 10.1161/CIR.0000000000000536.CrossRefGoogle ScholarPubMed
Swahn, M. H., Bossarte, R. M., Choquet, M., Hassler, C., Falissard, B., & Chau, N. (2012). Early substance use initiation and suicide ideation and attempts among students in France and the United States. International Journal of Public Health, 57(1), 95–105. doi: 10.1007/s00038-011-0255-7.CrossRefGoogle ScholarPubMed
Tadic, M., Cuspidi, C., & Grassi, G. (2018). Heart rate as a predictor of cardiovascular risk. European Journal of Clinical Investigation, 48(3), e12892. doi: 10.1111/eci.12892.CrossRefGoogle ScholarPubMed
Williams, C. L., Hayman, L. L., Daniels, S. R., Robinson, T. N., Steinberger, J., Paridon, S., & Bazzarre, T. (2002). Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation, 106(1), 143–160. doi: 10.1161/01.cir.0000019555.61092.9e.CrossRefGoogle Scholar
Wu, J.-S., Lu, F. H., Yang, Y.-C., Lin, T.-S., Huang, Y.-H., Wu, C.-H., … Chang, C.-J. (2008). Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects. International Journal of Obesity, 32(5), 788–794. doi: 10.1038/sj.ijo.0803791.CrossRefGoogle Scholar
Supplementary material: File

Zhong et al. supplementary material

Zhong et al. supplementary material

Download Zhong et al. supplementary material(File)
File 4.1 MB