Table 1 Summary of studies examining gonadal and adrenal hormones in relation to suicide attempts and suicidal ideation.
Publication | Sample size and characteristics | Age (years) | Sex | Psychiatric condition | Suicide-related outcome | Study design and methods | Findings | Additional notes |
|---|---|---|---|---|---|---|---|---|
Afzali et al. 2012 | 81 suicide attempters | Mean = 23.63 SD = 8.41 Range = 15–55 | F | Assorted (25 Past mental disorder, 22 Previous suicide attempt) | History of Suicide Attempts | Structured interview over 6 months after attempt | Suicide attempts were not associated with menstrual cycle phase. | Patients with irregular menstrual cycles were excluded. |
Baca-Garcia et al. 2010a | 281 suicide attempters 176 healthy controls | Mean = 30.8 SD = 8.8 Range = 18–92 | F | Assorted (229 Mood disorder, 229 SUD, 275 Previous psychiatric treatment) | Recent Suicide Attempts and Recent Suicidal Ideation | Blood sample within 24 h of attempt: estradiol, progesterone, LH, FSH | Suicide attempts were was more likely during the follicular phase. Suicide intent severity was elevated during low-estrogen/low-progesterone states (pre-menstrual phase, amenorreha, menopause) | |
Butterfield et al. 2005 | 130 inpatients | Mean = 49.4 SD = 8.13 | M | PTSD | Recent History of Suicide Attempts (past 6 months) and Suicidal Ideation | Blood: DHEA, androstenedione, testosterone, estradiol | Suicide attempters had higher DHEA than nonattempters | |
Cayköylü et al. 2004a | 52 suicide attempters 50 healthy controls | Mean = 26.51 SD = 7.82 Range = Not Reported | F | Assorted (8 PMDD, 1 SCZ, 2 MDD, 1 OCD) | Recent Suicide Attempts | Blood sample within 12 h of attempt: estradiol, progesterone Menstrual status determined with self-report. | Suicide attempts were more frequent during the follicular phase. Estradiol and progesterone levels were not different in suicide attempters compared to healthy controls. | Patients attempting suicide with OD or admitted to the ICU were excluded. |
Chatzittofis et al. 2013 | 28 suicide attempters (10 female, 18 male) 19 healthy controls (7 female, 12 male) | SA: Mean = 44 SD = 14.6 Range = 26–66 HC: Mean = 30 SD = Not Reported range = 23–48 | Both | Assorted (14 Mood disorder, 4 Anxiety Disorder, 9 SUD, 19 PD) | History of Suicide Attempts | CSF: DHEA-S, DHEA, cortisol, and 5-HIAA | In males, suicide attempters had higher CSF DHEA-S levels compared to healthy controls. In females, no significant differences. | Exposure to early adversity (e.g., interpersonal violence) correlated negatively with cortisol/DHEA-S ratio |
Dogra et al. 2007a | 217 suicide decedents 237 non-suicide decedents | 45% of suicide dececents ages 21–30 Bimodal distribution in the non-suicide decedents: 23% ages 20–25, 23% ages 30–35 Range = 11–45 | F | Not Reported | Suicide Death | Autopsy Menstrual status determined by visual examination of the uterine cavity | 54.46% of non-pregnant women who died by suicide were menstruating versus 6.75% in the non-suicide decedent group | |
Fouriestié et al. 1986a | 108 suicide attempters | Mean = 25.3 SD = 4.0 Range = Not Reported | F | Assorted (9 with previous psychiatric admission, 15 treated with neuroleptic and/or antidepressant medication, 9 treated with anxiolytics, 15 with previous suicide attempts) | Recent Suicide Attempts | Blood sample within 12 h of attempt: estradiol and progesterone | Suicide attempts were more likely to happen during phases with low estradiol, during the first week of the menstrual cycle (42%) and after the fourth week (12%). Frequency of suicide attempts did not vary significantly during the menstrual cycle in OC users. | Patients admitted to the ICU were excluded. |
Gustavsson et al. 2003 | 43 suicide attempters | Mean = 38.0 SD = 12.0 Range = Not Reported | M | Assorted (14 SUD, 9 DDNOS, 10 MDD, 4 Dysthymia, 9 Adjustment disorder, 4 Anxiety disorder, 2 Psychosis) | Recent Suicide Attempts | CSF in days (5–57 days, mean = 16) following suicide attempt: testosterone | Suicide attempters with depressive disorders showed higher CSF testosterone than those with other psychiatric diagnoses. | CSF testosterone positively correlated with irritability and negatively correlated with social desirability. |
Papadopoulou et al. 2018a | 70 suicide attempters | Mean = 35.5 SD = 8.9 Range = 18–52 | F | Assorted (28 MDD, 13 BD, 14 Psychosis, 15 PD or adjustment disorder) | Recent Suicide Attempts | Blood sample within 72 h of suicide attempt or within 48 h after transfer to the ICU: progesterone, LH, FSH Menstrual status determined with progesterone levels, LH and FSH were used to rule out menopausal status | Suicide attempts were more frequent in the last 4 days of days of luteal phase and during the 4 days of menses. | No effect of menstrual status on lethality (violent vs non-violent mode of attempt) or psychiatric diagnosis. |
Markianos et al. 2009a | 15 suicide attempters (intentional jumps) 18 accident victims (falling from a height) 40 healthy controls | SA: Mean = 39.9, SD = 14.3, Range = 22–62 Non-SA: Mean = 37.6 SD = 15.2 Range = 20–66 HC: Mean = 31.6 SD = 9.0 Range = 25–59 | M | Assorted (10 SCZ, 5 MDD) | History of Suicide Attempts | Blood: testosterone, LH, FSH | Suicide attempters had lower levels of testosterone (trending, p = 0.065) and LH compared to accident victims. Both suicide attempters and accident victims had lower levels of testosterone and LH compared to HC. | |
Martin et al. 1997b | 81 female and 79 male adolescents | Mean = 16.0 SD = 1.0 Range = 15–19 | Both | Not Reported | History of Suicide Attempts and Suicidal Ideation | Blood: progesterone | In males, progesterone was higher in those with past suicide attempts and with suicide ideation. In females, progesterone levels negatively correlated with past suicide attempts and disclosed suicide ideation | SUD excluded from analyses. |
Roland et al. 1986 | 39 suicide decedents 48 non-suicide (sudden death) decedents | SA: Mean = 39.1 SD = 18.3 Range = 15–76 HC: Mean = 51.5 SD = 13.8 Range = 12–79 | M | Not Reported | Suicide Death | Autopsy Blood: testosterone | Suicide decedents showed higher levels of testosterone compared to non-suicide decedents. | |
Sher et al. 2012 | 67 patients with bipolar disorders and at least one past suicide attempt (51 female, 16 male) | Mean = 34.5 SD = 9.9 Range = 18–75 | Both | Bipolar Disorder | History of Suicide Attempts | Blood: testosterone | Testosterone levels positively correlated with the number of past suicide attempts, while controlling for sex. | Testosterone levels were also positively correlated with number of manic episodes, while controlling for sex. |
Sher et al. 2014 | 51 patients with bipolar disorder and at least one past suicide attempt | Mean = 33.2 SD = 9.6 | F | Bipolar Disorder | History of and Prospective Suicide Attempts (prospective follow-up for up to 2.5 years) | Blood: testosterone | At baseline, testosterone levels positively correlated with the number of suicide attempts and past major depressive episodes. Higher testosterone levels predicted suicide attempts in the follow-up period. | |
Sher et al. 2018a | 17 combat veterans with post-deployment suicide attempt (0 female, 17 male) and 17 non-suicidal combat veterans (2 female, 15 male) | SA: Mean = 37.5 SD = 11.6 Non-SA: Mean = 35.7 SD = 10.8 | Both | PTSD | History of Suicides Attempt and Suicidal Ideation | Blood: DHEA, DHEA-S | Suicide attempters had lower levels of DHEA and DHEA-S compared with nonattempters. Suicidal ideation negatively correlated with DHEA and DHEA-S levels across all participants. Suicidal ideation negatively correlated with DHEA-S levels in nonattempters. | DHEA/DHEA-S ratios positively correlate with adolescent and adult aggresion scores in suicide attempters. |
Stefansson et al. 2016 | 28 suicide attempters (10 female, 18 male) 19 healthy controls (7 female, 12 male) | SA: Mean = 44.0 SD = 14.6 Range = 23–66 HC: Mean = 30.0 SD = Not Reported Range = 23–48 | Both | Assorted (MDD, PTSD, SUD) | Recent Suicide Attempts and Prospective Suicide Death (prospective 21-year follow-up) | CSF and blood in days (mean = 8.6, range = 2–17 days) following suicide attempt: testosterone, cortisol | In males, CSF and blood testosterone levels were higher in suicide attempters compared to healthy controls. In females, no differences. | In males, CSF testosterone/cortisol ratio positively correlated with impulsivity and aggressiveness in the suicide attempters. No differences associated with MDD, PD, or SUD |
Tripodianakis et al. 2006 | 80 suicide attempters (29 with schizophrenia) 56 healthy controls 29 nonattempters with schizophrenia | SA: Mean = 34.4 SD = 12.6 HC: Mean = 35.3 SD = 8.7 | M | Schizophrenia | History of Suicide Attempts | Blood: testosterone, LH, FSH | Suicide attempters had lower blood testosterone compared to healthy controls. Attempters with schizophrenia had lower levels of testosterone compared to nonattempters with schizophrenia. | Attempters who used a violent method had lower testosterone levels than non-violent attempters. |
Zhang et al. 2015 | 245 suicide attempters (172 female, 73 male) 245 healthy controls (172 female, 73 male) | SA: Mean = 42.9 SD = Not Reported Range = 16–50 HC: Mean = 37 SD = Not Reported Range = 14–53 | Both | Not Reported | History of Suicide Attempts | Blood: testosterone | In males, testosterone was higher in male suicide attempters compared to healthy controls. In females, no significant differences. |
