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2019 Highlights of Hope: Fall/Winter

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RESEARCH COLLABORATIVE TEAM SEEKS TO DETECT SUICIDE RISK IN THE BLOOD A Grand Rapids-based study aims to identify blood-based biomarkers for suicide risk, laying the foundation for a test that could help physicians identify people who are likely to self-harm and allow for earlier, life-saving intervention. The project is the first study of its kind, and is a collaboration between Van Andel Institute’s Dr. Lena Brundin, Pine Rest Christian Mental Health Services’ Dr. Eric Achtyes and Columbia University Department of Psychiatry’s Dr. J. John Mann. It is supported by a newly awarded fiveyear, .6 million grant from the National Institute of Mental Health (NIMH) of the National Institutes of Health. “Suicide is a leading cause of death in the U.S. and, unfortunately, rates continue to increase,” Brundin said. “Suicidal ideation is more than mental — there are measurable biological contributors such as byproducts of chronic inflammation that influence a person’s likelihood for self-harm. Leveraging these markers could hold the key to helping people before it is too late.” The study comes at a critical time. Despite growing awareness and the best efforts of mental health professionals, suicide rates are climbing. In 2017, suicide was the 10th leading cause of death overall in the U.S. and the second leading cause of death among people ages 10–34. From 2001 to 2017, suicide rates in the U.S. grew 31%, from 10.7 to 14 people per 100,000, according to NIMH. Pinpointing the cause Recent findings suggest that sustained inflammation may cause a toxic imbalance that alters brain chemistry and elevates suicide risk. Inflammation is the immune system’s normal reaction to harmful stimuli, such as infection, injury or chronic disease, or even stress. Following one of these insults, the body releases a cascade of white blood cells, which produce chemicals that attempt to remove the cause of the problem and start the healing process. The results, though designed to help us, aren’t always pleasant. They include increased blood flow, leading to redness and increased heat; fluid rushing to the area, causing swelling; and pain, the result of a flood of chemicals to stimulate nerves. Once their job is done, cells stop pumping out these chemicals and the symptoms of inflammation wear off. Occasionally, however, something goes awry and the body overproduces inflammatory chemicals or continues producing them long after it should have stopped. If left unchecked, this can disrupt the body’s ability to function normally and contribute to a number of issues, including depression. Searching for answers During the five-year study, which is slated to begin enrolling at Pine Rest in October, 160 people will be followed for one year and provide blood specimens along with clinical information. Participants will be selected from those who are admitted to the inpatient hospital or the outpatient clinics and divided into two groups — those who are depressed with suicidal thoughts or behaviors and those who present with depression alone. In addition to searching for markers, the team will work to identify the inflammatory mechanisms that give rise to depressive and suicidal symptoms with the goal of developing ways to stop them. “Clinicians are looking for tools to help them identify individuals who are at highest risk for suicide among those who are depressed,” Achtyes said. “We are hopeful this study will help us develop these tools to better understand who is at imminent risk.” In tandem with the clinical study, the team will search for inflammatory markers in brain tissue samples from people who have died by suicide. The samples are housed at the New York State Psychiatric Institute Brain Bank at Columbia University. “Suicidal behavior often occurs during an acute crisis or stress affecting a person with a psychiatric illness,” Mann said. “Similarly, inflammation can be triggered by life stress or an acute psychiatric illness and can alter brain function, which may result in depression, fatigue and irritability. In some cases, this can lead to a suicide attempt. We plan to track stress and inflammation in psychiatric patients and link fluctuations in their levels to suicidal thoughts and actions in order to find ways to help prevent suicidal behavior.” The confidential National Suicide Prevention Lifeline is free and available 24/7 at 1-800-273-TALK (8255). Research reported in this publication is supported by the National Institute of Mental Health of the National Institutes of Health under award no. 1R01MH118221 (Brundin, Achtyes, Mann). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. DR. ERIC ACHTYES & DR. LENA BRUNDIN 10 | VAN ANDEL INSTITUTE HIGHLIGHTS OF HOPE VAN ANDEL INSTITUTE HIGHLIGHTS OF HOPE | 11

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