Kelly Houston

Deliberate self-harm is associated with allelic variation in the tryptophan hydroxylase gene (TPH A779C), but not with polymorphisms in five other serotonergic genes.

BACKGROUND There is a heritable component to suicidal behaviour, encouraging the search for the associated risk alleles. Given the putative role of the 5-HT (5-hydroxytryptamine; serotonin) system in suicidal behaviour, serotonergic genes are leading candidates. In particular, several studies have reported an association with variants in the tryptophan hydroxylase (TPH) gene. METHOD We studied six serotonergic gene polymorphisms in a well-characterized sample of 129 deliberate self-harm subjects and 329 comparison subjects. The polymorphisms were TPH (A779C), 5-HT transporter (5-HTT, LPR S/L), monoamine oxidase A (MAOA G941T), 5-HT1B receptor (HTR1B G861C), 5-HT2A receptor (HTR2A T102C), and 5-HT2C receptor (HTR2C Cys23Ser). Genotyping was done using polymerase chain reaction (PCR)-based assays. The primary analyses compared allele and genotype frequencies between cases and controls. There were a limited number of planned secondary analyses within the deliberate self-harm group. RESULTS The TPH A779 allele was more common in deliberate self-harm subjects than in controls (OR 1.38, 95% CI 1.02-1.88; P = 0.03). None of the other polymorphisms was associated with deliberate self-harm. Within the deliberate self-harm group there were no associations with impulsivity, suicide risk, lifetime history of depression, or family history of deliberate self-harm. CONCLUSIONS Our data extend the evidence that allelic variation in the TPH gene is a risk factor for deliberate self-harm. No evidence was found to implicate the other polymorphisms.

Deliberate Self-Harm Patients with Alcohol Disorders: Characteristics, Treatment, and Outcome

Deliberate self-harm (DSH) patients with alcohol problems present a considerable challenge for clinical services. In a study of a sample of 150 DSH patients who were representative of all such patients seen at a general hospital during the study period, 40 patients with an ICD-10 diagnosis of alcohol dependence or harmful use of alcohol were compared with the remainder of the sample. The treatment of the patients with alcohol disorders before and after the episode of DSH and the outcome 12-20 months later were also investigated. Compared with other DSH patients, those with an alcohol diagnosis were older and more often male, living alone, unemployed, sick, disabled, or with a past history of DSH. They also had higher scores on measures of anger, aggression, and impulsivity. Comorbid psychiatric disorder was present in 37 (92.5%) patients, this being depression in three-quarters of those cases. Fourteen (35.0%) patients were receiving treatment from the psychiatric services prior to DSH, and 33 (82.5%) were subsequently offered treatment. Of the patients who were followed up, 37.9% remained in contact with psychiatric services, 55.2% showed poor compliance with treatment and 44.8% reported a further episode of DSH. All patients presenting after DSH need to be carefully screened for alcohol disorders and for comorbid psychiatric diagnoses. Treatment of DSH patients with alcohol disorders should include the treatment of any comorbid depressive illness.

Psychological Autopsy Interviews in Suicide Research: The Reactions of Informants

Psychological autopsy studies in which in-depth interviews are conducted with relatives or other informants are a key method of investigation in suicide research. These interviews are likely to be emotive and potentially stressful for informants. We followed up 68 informants approximately one month after they were interviewed in three recent studies of suicide in high risk groups (young people, farmers and doctors) to determine their reactions to the interviews. Nearly all the informants (96.9%) said they preferred being approached through a letter from a member of the research team rather than by someone else. While some relatives (22.1%) understandably reported being upset during the interview and/or immediately afterwards, a month later only one informant reported feeling worse than usual. A beneficial effect was suggested in at least a third. Although only 30 informants accepted the offer of a bereavement information pack, probably because in many cases the interviews were conducted rather a long time after the deaths, 90% of these found the pack helpful. It is suggested that such a pack be included in future psychological autopsy studies and that follow-up evaluations of the kind reported here be conducted in order to ensure that potential negative effects of such studies be identified and avoided in further studies.

Family history of suicidal behaviour: prevalence and significance in deliberate self-harm patients.

Objective:  To investigate whether there are differences between the characteristics of deliberate self‐harm (DSH) patients with and without a family history of suicidal behaviour.