Key result
High impulsivity and low depression in suicide attempters are linked to higher social stress cortisol responses.
Why the study?
Little is known about the emotional consequences of social stress in suicide attempters exposed to stress.
Does suicide attempt history and impulsivity influence cortisol and emotional responses to social stress in women with depression?
Case-Control (n=67)
Does suicide attempt history and impulsivity influence cortisol and emotional responses to social stress in women with depression?
p-value: p=<0.001
Impulsivity traits increase sensitivity to emotional distress and cortisol response during social stress in suicidal patients with low depression levels.
Should not change suicide risk assessment; leaves open cortisol reactivity as a potential mediator in high-impulsivity attempters.
INTRODUCTION: Suicide attempters (SA) are more vulnerable to social stress and show disturbed cortisol response in stressful conditions compared with psychiatric and healthy controls. Recent data suggest that this dysregulation might be related to impulsivity traits. However, little is known about the emotional consequences of social stress in SA exposed to stress. OBJECTIVES: The aim of our study was to evaluate the cortisol and emotional responses to social stress in patients with depression with and without suicide attempt, by taking into account impulsivity traits and depression severity. METHODS: 67 adult women (41 SA and 26 affective controls (AC,i.e. without suicide attempt history)) with lifetime history of major depressive episode were included. Patients performed the Trier Social Stress Test (TSST), a well-validated social stress task. Patients provided seven saliva samples, to measure the cortisol response, and filled in questionnaires to assess psychological pain, positive and negative mood, and anxiety at different time points (from 10 min before to 120 min after the TSST). Moderated regression models were used including suicide attempt history, depression severity, and impulsivity as independent variables and their interactions. RESULTS: In patients with low depression and high impulsivity, salivary cortisol response during the TSST was higher in SA than in AC (p < .001). Psychological pain, negative mood, and anxiety were increased in all patients just after the TSST, followed by a decrease at 120 min. Positive mood recovery was slower in SA, and in patients with high impulsivity and low depression level (p < .001). CONCLUSIONS: Impulsivity traits have an important role in suicidal vulnerability in stress conditions. Impulsivity traits might help to differentiate patients at risk of suicide who are highly sensitive to stress when depression level is low. Higher impulsiveness may increase the sensitivity to emotional distress that translates into inadequate physiological responses.
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Alacreu‐Crespo et al. (2022) conducted a case-control in Major depressive episode (n=67). Trier Social Stress Test (TSST) vs. Affective controls (without suicide attempt history) was evaluated on Salivary cortisol response during the TSST (p=<0.001). Suicide attempters with low depression and high impulsivity exhibited a significantly higher salivary cortisol response during social stress compared to affective controls (p < 0.001).
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