News From the Web

April 29, 2020 Considering the Biology of Suicide in Autism

By Liz Bell
April is Autism Awareness Month (AAM), a time to showcase the one in 54 Americans living with this neurobiological condition that affects behavior and social communication to widely varying degrees. While AAM is an opportunity to celebrate acceptance and the unique gifts and contributions of people with autism spectrum disorders (ASD), it is also a time to highlight some important challenges and the need to improve outcomes and reduce suffering. One lesser known characteristic of autism is its association with a dramatically reduced life expectancy, including an increased risk of physical and mental health issues and suicide.

Increased Risk

While there was some general awareness of these concerns, a 2016 population based study utilizing national Swedish registries quantified the considerably reduced life expectancy (54 vs. 70 in the general population) and heightened risk of premature death: 2.5 times higher in autism from all categories of cause except infections. This study also revealed that the suicide death rate in ASD is more than seven times that of the general population. Furthermore, while premature death was significantly higher in those with autism and intellectual disability (‘low functioning’), in all other cause categories suicide was shown to be higher (9.4 times the general population) in those with autism and normal IQ (‘high functioning’).  Suicide in females on the spectrum was a dramatic 13 times the general population rate. In 2019, the publication of a 20-year study based on Utah surveillance data revealed an increasing rate of suicide in the ASD population over the last five years of the study (2012-2017), and a suicide death rate in women that was three times that of the general population. In young people with autism, suicide risk was doubled, and more than half of the ASD suicides occurred in those under the age of 30 (range 14-70). Other suicidal behaviors are also shown to be increased in ASD. A recent systematic review of studies on suicidal behaviors indicates a heightened risk in individuals with autism, with suicide attempts ranging from 1-35% and ideation in 11 to 66%. In the UK, a study in individuals with Asperger’s Syndrome showed self-reported suicidal ideation in 66% (exceeding both the general population and those with other medical and psychiatric disorders), suicide plans or past attempts in 35%, and depression in 31%. The scientific and community response to these findings rightfully includes a call for more investigation into the causes for the alarming statistics and guidance on how to reduce them. The 2016 Swedish paper suggested co-existing psychiatric disorders and depression, social and psychological vulnerability, and lack of usual protective factors that support resilience (e.g. social networks, coping skills and life satisfaction) as contributors to suicide risk in autism. As is customary in suicide, the focus on possible explanations and calls for investigation has been on autism’s skill deficits and psychosocial factors such as social anxiety, exclusion, and bullying, well described in Psychology Today, this article in The Atlantic, and this piece from Spectrum News. Spectrum News also reported unpublished research showing a history of self-harm, which occurs at high rates in autism (particularly in females), greatly increases risk of death by suicide. As these articles highlight, it is critical that suicide be on the radar for individuals with autism and their families, providers, and clinicians. As is true in suicide intervention, inquiry may help to unearth suicidal ideation and plans, and suggested adaptations to screening tools addressing the unique needs of the autism population may be helpful. However, suicide research also highlights that current tools are insufficient in predicting who is at risk, and when. What other potential indicators could be considered in assessing risk in those with autism, and perhaps addressed in reducing that risk in any given individual?

Potential Biological Risk Factors for Suicide and Autism

Physical and/or psychological pain, particularly chronic pain, is a factor associated with suicide risk. The pain response in individuals with autism can be significantly altered, ranging from neurologically excessive, as measured in a ‘high functioning’ population, to variable, and/or insufficient or misunderstood. Chronic pain can affect mental health and sleep, and promote the development of depression and anxiety. Recent research suggests pain, as well as impulsivity, is likely responsible for self-harm common in those with autism. Some individuals with autism report ongoing pain, and research indicates a likelihood that individuals with autism live with physical pain and illness that is not sufficiently evaluated or treated by the medical system. The 2016 Swedish study showed higher rates of premature death in autism as a result of neurological disorders, congenital malformations, and mental/behavioral disorders, health challenges that might be expected in autism’s related conditions. Additionally, premature death was also higher in those with autism as a result of endocrine, respiratory, digestive, and circulatory systems, as well as cancer. These findings are notable since accidents at a young age (e.g. drownings) also contribute significantly to the reduced average life expectancy in ASD.  This study also referenced another Swedish registry study from 2012 showing lower levels of medical care, lack of treatment, and increased ‘avoidable mortality’ for patients with a psychiatric diagnosis. Similarly, a 2014 study of adults with autism in the US shows that co-occurring medical conditions are common, and the authors advocate for more research into the social, healthcare access, and biological factors involved. They reported: ‘Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety, bipolar disorder, obsessive-compulsive disorder, schizophrenia, and suicide attempts. Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions, such as stroke and Parkinson's disease, were also significantly more common among adults with autism.’ These indicators are significant, since mind and body are connected, and suicide risk is increased by both mental and physical illness. The majority of those who die by suicide have a mental health condition, and while depression features prominently in suicidal ideation, agitation, anxiety, and impulsivity appear to be more highly associated with suicide deaths. As research delves further into the biology of autism, psychiatric illness, and suicide, focusing on shared mechanisms might highlight additional clues into physiological and potentially modifiable factors for suicide prevention. Of increasing interest in the emerging field of suicide biology are certain risk factors that also feature significantly in the characteristics of many individuals with ASD.
  • Sleep is notably disrupted in autism, often starting in early childhood and for many, continuing throughout life. As JKBF recently highlighted, disordered sleep upsets the circadian rhythm that sets myriad body processes in motion and is a risk factor for depression, anxiety, and suicide. Sleep mediates (bi-directionally) the immune system, pain response, and the microbiome. Sleep is also modifiable, but is often dismissed as a by-product of autism behaviors and not treated directly. Help designed for those with autism is available through a Practice Guideline from the American Academy of Neurology.
  • Impulsivity, impaired problem-solving, and aggression are Behavioral Traits gaining attention as risk factors in suicide research, and suicidal behavior can take years or go from idea to action in moments. These characteristics are often associated with executive function deficits in ASD. Cognitive Behavior Therapy (CBT) and other behavior therapies are often utilized in addressing these concerns, and frontal lobe function can also be influenced by diet, medication, sleep, substance use, and stress, as well as genes.
  • While often characterized in suicide as neglect or abuse, early life adversity (ELA) and stress occurs with autism due to communication/cognition/social issues of the disorder and a mismatch between abilities and others’ expectations. Biological investigations show later life changes to the Hypothalamic-Pituitary-Adrenal(HPA) Axis, responsible for the release of neurotransmitters serotonin, dopamine, and norepinephrine that regulate mood, stress, appetite and sleep. Of interest in both research communities, a recent report outlines the role of the HPA axis in anxiety, assessment, and intervention.
  • Inflammation and immune system involvement are of increasing interest in suicide and in autism, both neurological and in gut-brain interactions. Inflammation has been shown to be a downstream effect of ELA in suicide research, but can also be caused by stress (such as might come from chronic pain, or not understanding the world around you), as well as biological contributors such as diet, injury, and infection. A recent study suggests immune activation may be contributory to the anxiety prevalent in ASD.
  • Gastrointestinal (GI) disorders are increasingly recognized as co-occurring in a portion of individuals with autism, contributory to behavioral, social, and anxiety features, and worthy of evaluation and treatment. GI disorders can also exhibit neurologic or psychiatric features in some patients, such as described in this paper on Celiac Disease. The Gut-Brain Axis, operating through the bi-directional vagus nerve, has been under investigation in autism and is of increasing interest in psychiatric research.  Vagal tone reflects differences beginning in infancy, features in autonomic dysfunction in autism, and mediates neuro-endo-immune function as well as effects on sensory, motor, parasympathetic, cardiac, respiratory, inflammatory, mood, and pain regulation systems.  The Microbiomein particular, is of increasing focus in health and disease across many conditions, including psychiatric and developmental disorders and has been shown to influence severity and treatment effects in mental illness. Vagal tone can be influenced by implanted devices (used to treat epilepsy and depression), as well as through meditation, yoga, deep breathing and other stimulants of the parasympathetic nervous system essential to reducing the stress response and creating autonomic balance.  
  • Diet and nutrition are often challenging in autism, due to sensory issues and food selectivity. Chronic health conditions, especially if under-explored and un-treated, may lead to other suicide-associated risk factors including diabetes, low BMI, respiratory disease, hypertension and cancer. Likewise, eating disorders occur at higher rates in autism, may actually predict autistic characteristics prior to diagnosis, are accompanied by auto-immune, inflammatory and altered microbiome conditions, and are a risk factor for suicide.
  • Epilepsy, also tied to vagal function, raises the risk of suicidal behaviors in the general population and occurs in an estimated one-third of those with ASD. It has not been determined whether the suicide risk is from the condition itself or the psychiatric and behavioral effects of anti-epileptic medications, which are also often used as mood stabilizers in ASD and other mental health conditions.
  • Many medications are known to be risk factors for sleep disruption and a host of GI disturbances and disorders, common conditions in those with autism. SSRIs are used in individuals with autism and depression, but a black box warning for suicide is controversial and often ignored, despite recent data supporting the duty to warn and monitor, especially in young adults and during medication introduction and titration. Since individuals with autism have increased rates of allergies it is worth highlighting that seasonal allergies may increase suicide risk, and a popular asthma/allergy medication, Singulair, just received a black box warning for suicidal thoughts or actions. A 2018 study showed that one-third of the US population is on medications that have depression as a known side effect.  Not surprisingly, those individuals are more likely to be depressed, especially when multiple medications are utilized. Increasing consideration and monitoring of side effects of medication, in light of the added challenges of altered metabolism, sensory experiences, and communication in those with autism, appears to be warranted.
  • Metabolic Disturbances such as enzyme deficiencies and Cerebral Folate Disorder, recently found to be a factor in depression and suicide, occur in autism as well. These measurable and potentially modifiable conditions, which may develop as a result of commonly-used medications, are rarely evaluated or treated in either patient population.
  • Gender differences raise the risk of suicide and in autism there appears to be a heightened prevalence of gender variance but more research in this area is needed.

Suicide and Autism in Females

Surveillance data shows twice the rate of death by suicide in women than in men with autism. While statistics for the general population show more ideation and attempts by females, the risk of dying by suicide is significantly higher in men. Of note, the risk of suicide in females with autism tends to increase with cognitive ability. A study in Autism Research identified a doubling of risk for suicidal ideation and behaviors in adolescents with autism who reported they had been bullied, with higher risk in females, those diagnosed with affective disorders, and those with higher intellectual ability. Females with autism have specific challenges in getting a diagnosis and coping with the social aspects and strain of camouflaging (fitting in) as outlined in this story on The Lost Girls in Spectrum News. These personal stories reveal many of the related challenges, including depression, anxiety, and eating disorders. Disrupted sleep is mentioned, but not described as being addressed, even though it can contribute to a deterioration in mental health. Behavioral changes due to menstrual cycles are described in these girls and the role of hormones is worth consideration, since suicide is correlated with menstrual cycles, hormonal birth control use, the post-partum period, and menopause. And even as the troubling life story and insufficient medical care of Maya is outlined, there is no mention of the fact that the anti-psychotic quetiapine, the medication she was taking at the time of her suicide attempt, has a suicide warning.

Improving Outcomes, Reducing Stigma

Not so many years ago autism was viewed almost exclusively through a psychiatric lens, with researchers and clinicians asserting that parents, ‘refrigerator’ mothers specifically, had caused autism in their offspring due to cold and unloving practices—even as biological causes such as infections (maternal Rubella), toxins (Thalidomide exposure), and certain genetic conditions (Fragile X) were identified. Thankfully, due to biological findings, this view is no longer accepted and the stigma of autism has reduced considerably. However, even as physiological features continue to emerge with research, autism primarily remains an enigma and much of the treatment framework remains educational and psychological. Gastrointestinal issues, like sleep, are often dismissed as autism’s partners instead of biological processes that might be addressed, and potentially change the course of a person’s learning, behavior, mood, and outlook. There is great opportunity for investigation of the biological factors contributing to suicide in general, as well as suicide in autism, and the possibility of moving both fields farther together, saving lives, and reducing stigma. Research matters. Biology matters. Reviewed 4/20 by Clara Lajonchere, PhD
Subsequent Publications:
JAMA Network Open, January 12, 2021, Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark

April 13, 2020 Sleep Matters

By Alison Brown, MSc.

“O sleep, O gentle sleep, Nature’s soft nurse."   - William Shakespeare, Henry IV, Part 2

Sleep is an elusive, enigmatic activity. According to award-winning author Bill Bryson’s The Body, no one knows exactly why we sleep — to consolidate memories, reset the immune system, restore hormonal balance, or clear metabolic waste and neurotoxins? While all of these processes do happen while we sleep, science still cannot say for certain why we need it so. One thing we do know is that sleep is vital to every living creature. In humans, you would be hard-pressed to find any part of the body that does not suffer from the absence of sleep or benefit from the correct amount of it. Established advantages of good sleep include reduced stress, better immune function, lower blood pressure, and better mood. But sleep is perhaps most important for the normal functioning of our brains and is highly correlated to mental, as well as physical, health. It is reported that a person with inadequate sleep is ten times more likely to experience symptoms of depression and 17 times more likely to experience symptoms of anxiety. A growing body of research suggests poor sleep raises the risk for suicidal behavior, independent of any other mental health problems.  A review paper on sleep in college students from Dr. Roxanne Prichard of the Center for College Sleep reveals effects in many functional areas, including evidence from one study that sleep variability was a better predictor of suicidal ideation than depressive symptoms. Another study of nonfatal suicide attempts found that 92% of adult survivors reported difficulties with insomnia and 89% reported sleep disturbances. And doctors treating patients in menopause highlight the need for greater attention to sleep in reducing suicide among women in the highest risk age group of 45-64. Despite this, sleep intervention is not often thought of as a first line of defense against mental health conditions, whether they are chronic or episodic. This may be partly due to the fact that physicians get only a few hours of sleep education during medical school (and not enough sleep themselves). Yet studies have found that if a patient presents with both insomnia and anxiety or insomnia and depression, and just the insomnia is treated, the anxiety and the depression will get better. Sleep is an essential biological function, and with treatment approaches available, a potentially modifiable way to address mental health conditions and reduce suicidal behavior. Why good sleep matters Poor sleep affects mental health by disrupting our circadian rhythms and interfering with our normal sleep stages, thereby throwing our bodies and our brains off kilter. A sleep-deficient brain has a decreased ability to make emotional judgements and to incorporate multiple pieces of information into a decision. Studies show that merely being awake at night confers increased risk, and one paper suggests that whatever the cause, being awake when our bodies are not biologically prepared to be awake impedes the brain’s frontal lobe function and impairs reason and decision-making. The diminished problem-solving skills and increased impulsivity of a sleep-deprived brain are also characteristics associated with suicidal behaviors. When we are tired, we also react more emotionally, tend to think negatively about ourselves, and are more vulnerable to stress. We are less able to use good judgement and coping skills, less physically and mentally resilient, and we are agitated, restless, and fatigued. These consequences of sleep deprivation happen regardless of any other underlying mental health conditions, which makes the knowledge of these vulnerabilities important to every one of us;the CDC reports that more than half of people who died by suicide do not have a known mental health condition. Poor sleep and mental health concerns are bi-directionally related; it is evident that improving or worsening of either one can affect the other. For those with depression, commonly co-occurring insomnia and nightmares significantly raise the risk for suicide. Having a mental health condition such as depression or anxiety makes it more difficult to deal with the consequences of being awake at night and may contribute to difficulties with falling asleep and staying that way. Stress, whether chronic or in response to a distressing life event, can disrupt sleep and the mental clarity it fosters. What’s more, poor sleep can manifest as symptoms of depression and anxiety, because when you’re not sleeping, you feel more anxious and physically uncomfortable as stress hormones and altered neuroendocrine responses affect cognition and mood. Furthermore, sleep loss is associated with an increased pain response, and both physical and mental pain are highly correlated with suicidal behaviors. Sleep also sets the biological clock for our body’s immune system, detoxification, cell repair, and more. As research increasingly shows complex relationships between physical and mental health concerns, it is possible that sleep has numerous compounding impacts as a mediator of many systems.  One surprising system that may have a large (bi-directional) effect on sleep quality is our gut microbiome. Studies have shown that the bacteria in our gastrointestinal tract communicate with our neural, endocrine, and immune systems through our central nervous system, affecting neurotransmitters, hormones, and immune system modulators.The type and amount of sleep we are getting may affect, or be affected by, our gut microbiome, as a study found that a diverse gut microbiome correlates to healthier sleep and increased cognitive flexibility and that certain organisms in our microbiome modulate circadian rhythm and food intake. What is good sleep? Let’s talk about what good sleep means. According to Dr. Prichard, there are three foundations of good sleep. First, sleep should be sufficient and needs vary by age. As a college student that means 7-9 hours of sleep a night and ideally you do not need an alarm clock to wake up. Second, sleep should be consistent, so the time you wake up and the time you go to bed should not vary by more than an hour day to day. Third, sleep should be restorative. You should get high quality sleep that makes you feel rested upon awakening. It is important to note that too much sleep can also be problematic. One study found that less than 5 hours but also more than 9 hours a night in adults is associated with increases in psychiatric and substance use disorders as well as suicide attempts. When we sleep 7-9 hours a night on a regular schedule, our bodies cycle through four sleep stages, four to five times each night. The first stage is categorized by the business of actually falling asleep, which takes from eight to twenty minutes. Our sleep in this first stage is shallow, and we can be easily awakened by external stimuli. In the second stage, lasting about twenty minutes, we fall into a light, restorative slumber not unlike a nap. Sleep in the third stage is deeper, and awakenings or arousals are rare. This stage lasts about an hour, until we enter the fourth stage, or the rapid eye movement (REM) stage, which is a lighter stage of sleep characterized by dreaming. It is normal for us to awaken a few times a night, and sleep can still be sufficient if those periods are short. If our sleep is restricted in length or fragmented in schedule, our bodies do not benefit from the four to five cycles through the sleep stages.    These stages, as well as when we feel sleepy or when we awaken each day, are governed by our own personal circadian rhythms and habits and vary by person. Circadian rhythms are regulated by genes, as well as by the amount of light that our brains detect. Nerve cells in our retinas act as brightness detectors (even in blind people!), and the light detected by these cells tells our brain when to secrete melatonin, which makes us feel tired. Our circadian rhythm is basically a 24 hour clock that cycles between sleepiness and alertness to guide our sleep cycle and to regulate many bodily functions, hormone release, and the activities of our organs. How to get good sleep The obvious question is how do we get good sleep? Many of the sleep interventions suggested by experts revolve around good behavioral habits, also known as sleep hygiene. According to Dr. Prichard and the American Academy of Sleep Medicine, the first step to getting a good night of sleep is to wake up around the same time every day, even on the weekends. If you wake up at 7 AM on weekdays but sleep in until 10 AM on Saturday and Sunday, you’re essentially experiencing three hours of jet lag every weekend. Your circadian rhythm can’t keep up with that kind of change and keep your body functioning in a normal and healthy way. Another good tip: avoid stimulants such as caffeine, including foods and medications, for at least three hours before bedtime. Caffeine can last in your system for six to eight hours (even longer if you are pregnant, post-partum or your liver is impaired) and delays your natural sleep cycle by counteracting how drowsy you feel. That matters, as experts suggest that you should only go to bed when you feel sleepy because there is a higher probability that you will fall asleep quickly. Caffeine misuse and sleep disruption can become a challenging interactive problem. Experts also advise to avoid eating too close to bedtime, as digestion slows down during sleep and undigested food can cause indigestion. Diet matters, alcohol affects sleep duration, and certain foods can be sleep promoting! There is also evidence that a good work out, as little as ten minutes of exercise done on a regular basis, can dramatically improve the quality of your sleep and help stave off the development of sleep disorders such as sleep apnea and restless leg syndrome. Dr. Prichard recommends creating a relaxing atmosphere, which includes keeping your bedroom dark, cool, and quiet. She suggests sticking to a consistent bedtime routine that incorporates calming activities like light reading or meditation and staying away from screens. Most screens emit blue light, which mimics sunlight, confusing our brightness detectors, and interfering with melatonin production. Reconsider an alarm clock with a lighted time display, as seeing this can create unneeded anxiety about the sleep you may be missing out on. By practicing good sleep hygiene, we can often actively change our behavior to optimize a full and restful night’s sleep. That’s the greatest thing about sleep—it’s a behavior you can often modify of your own volition, without the need for anything other than your own dedication to a routine. Sleep Medicine However, sometimes we need extra support for sleep issues, and there are more options that may be addressed by a doctor or an expert in the sleep medicine field. Treatment of restless leg syndrome, apnea and breathing problems can improve sleep quality and mental health. Reviewing with your doctor the sleep disrupting effects of other medications might be helpful. For severe problems, such as insomnia and nightmares, especially in relation with suicidal thoughts and behavior, cognitive behavioral therapy (CBT) is generally recommended. CBT includes strategies on managing sleep depriving thoughts before bed and calming an active mind. Medicines and over the counter pills to promote sleep should be used with medical guidance and care. Some sleep experts suggest short term use to help establish good habits, as certain medications come with associated suicide warnings and risks for specific individuals. It’s good to know that getting a good night’s sleep is attainable. And whether you are a college student, a parent, a professional, or a patient, it is important to consider the role of effective sleep in optimizing mental and physical health for you and those in your care.
Alison Brown, MSc., is a freelance writer with a background in cognitive science and evolutionary and comparative psychology. She also occasionally works as an educational mermaid at the local aquarium.   Reviewed 4/20 by Roxanne Prichard, PhD
Post Publication Resources:
Sleep 101 by Jade Wu, PhD

April 13, 2020 Why we are talking about Sleep and Suicide

At JKBF we’ve been following the topic of sleep closely, as increasing evidence shows disordered sleep may be a modifiable, biological risk factor for suicide. Since we know that college students often have poor sleep patterns and show increasing levels of mental health concerns, we were pleased to partner with Active Minds to bring sleep to their February conference. In presentations by the Center for College Sleep’s Roxanne Prichard, PhD and Birdie Cunningham we learned valuable information about sleep, and a follow-up survey of workshop attendees showed that they did too. Attendees reported acquiring new skills or knowledge, confirmed relevance, and agreed that this topic should be repeated. One respondent commented, "This talk was at the top of my list to attend because sleep is a modifiable way we can improve our mental health. This talk was so important to the targeted audience of conference, young adults. I would love to see more evidenced based, research presentations at conference in the future!" In Sleep Matters we bring you highlights of Dr. Prichard’s presentations and additional insights from our reading. You can learn more by selecting the topic of sleep in our News From the Web And while college students may have some not-so-great sleep habits, the biological role of sleep in mental health applies to all of us. The lifestyle impacts of 24-hour stores, TV and internet, caffeine, and constantly available screens can disrupt a necessary biological function in each of us, as can medications, stress, life experiences, and other health conditions. Menopause and changing biology affect our sleep patterns as we age. The good news is that there are effective interventions for sleep issues, and awareness of sleep as something worth addressing is the first place to start. As research continues to grow on the intersection of sleep, mental health, and suicide, we are hopeful that better understanding of the functions of this mind-body connection will increase treatment of sleep concerns and reveal additional tools for suicide prevention. From another workshop attendee: "This breakout session has definitely stuck with me and encouraged a routine change in my own sleeping habits." Now, while sheltering at home, this might be an ideal time to consider the things that might be interfering with sleep in your life, and start a practice of good sleep habits to test out how sleep affects your cognition and mood.

November 04, 2019 JKBF bestows first Biological Research Award

At the 2019 International Summit on Suicide Research in Miami, FL, the International Academy of Suicide Research (IASR) and JKBF presented the first James Kirk Bernard Foundation Award for Excellence in the Biological Exploration of Suicide to Arthur Ryan, Ph.D. Selected by an IASR committee as a finalist in a pool of early career researchers presenting innovative biological studies, Dr. Ryan was chosen by JKBF for his work investigating fatty acid profiles associated with suicide. Dr. Ryan’s research was done in collaboration with co-authors and mentors from several leading research institutions, including the Uniformed Services University of the Health Sciences, The Johns Hopkins Bloomberg School of Public Health, and the Washington D.C. VA hospital. Dr. Ryan is an advanced postdoctoral research fellow studying the biology of suicidal behavior in U.S. Veterans at the Mental Illness Research, Education, and Clinical Center, a research institute located within the Baltimore VA hospital. He received his Ph.D. in clinical psychology from Emory University, where he studied the development of psychotic disorders. Dr. Ryan’s goal is to become a career VA research scientist developing biological treatments to prevent suicide in Veterans and other individuals living with mental illness. JKBF’s interest in the exploration of biological factors involved in suicide plays out in Dr. Ryan’s research, which suggests that fatty acid profiles may be associated with suicide. His work is described in our first From the Scientist piece below. We celebrate the cross-institutional collaborations involved in this work, as we believe that a gathering of various perspectives and expertise promotes discovery. JKBF is pleased that our first award recipient exhibits a dedication to researching the biological factors related to suicide, and we wish Dr. Ryan success and productivity in his career ahead. JKBF appreciates the collaboration with IASR and the efforts of the selection committee members, Gil Zalsman, Maria Oquendo, and Cornelis van Heeringen, in making this award possible. Dr. Ryan received an honorarium as well as an award featuring a piece of Jamie's art, and his research is being submitted for publication in a research journal. UPDATE: Dr. Ryan's paper, Serum Fatty Acid Latent Classes Are Associated With Suicide in a Large Military Personnel Sample was published February 2021 in the The Journal of Clinical Psychiatry.

From the Scientist: 

Summary of Presentation “Latent Class Profiles of Serum Fatty Acids are Associated with Risk of Suicide in Military Personnel.”

By Arthur Ryan, Ph.D.
I was interested in how levels of fatty acids in a person’s blood might be associated with risk for suicide, the leading cause of death among active duty members of the U.S. military.Previous research has shown that different types of fatty acids can have various effects on a person’s health.  For example, increased levels of omega-3 fatty acids appear to help reduce the risk of stroke.I wanted to know whether considering levels of several fatty acids at once might help illuminate biological changes that predispose individuals towards suicide. My co-authors and I analyzed data derived from blood samples previously collected from 800 military service members who eventually died of suicide and 800 living military service members. I used a statistical technique that allowed me to identify groups of individuals who have similar “profiles” of fatty acids; by that I mean they had similar patterns of elevations and deficits of multiple individual fatty acids. I then compared these fatty acid groups, known technically as “latent classes,” with one another. [caption id="attachment_764" align="alignleft" width="300"] Photo: Suzy Hazelwood, Pexels.com[/caption] My statistical analysis showed that individuals who later died by suicide were more likely to have certain profiles of fatty acids; for example, they were more likely to have profiles with high levels of certain saturated fatty acids and low levels of certain omega-3 fatty acids. Individuals with the suicide-associated fatty acid profiles were also more likely to have been diagnosed with depression and alcohol use disorder, conditions associated with increased risk for suicide. Fatty acids are essential to many biological systems related to suicide, from the creation and maintenance of neurons to the proper functioning of the immune system.  My co-authors and I speculate that the suicide-associated fatty acid profiles could contribute to changes in the brain, such as increased inflammation, which might further predispose a vulnerable individual towards suicidal behavior. Overall, our research suggests that the levels of fatty acids in a person’s blood might be associated with increased or decreased risk for suicide. It’s important that my co-authors and I note the possibility that the association between fatty acids and suicide is because of some unmeasured third variable related to both fatty acids and suicide; for example, people at risk for suicide might stop eating healthy foods, which would also change their fatty acid levels. However, it is also possible that there is a direct causal connection between fatty acid profiles and suicide.  Measuring fatty acid profiles might never be a way to reliably tell that an individual person is at imminent risk for suicide, but understanding their possible biological connection with suicidal behavior might lead to interventions that help to foster population-level health and resilience, similar to the way that the American Heart Association recommends restricting the amount of saturated fatty acids in your diet as one way to encourage heart health.This research identifying suicide-associated profiles of fatty acids represents one piece in a much larger effort in finding biological factors that might eventually be used to prevent suffering and deaths by suicide.
  1. Armed Forces Health Surveillance Center. Surveillance snapshot: Manner and cause of death, active component, US Armed Forces, 1998-2013. MSMR, 21 (2014).
  2. Yang, B. et al.Circulating long-chain n-3 polyunsaturated fatty acid and incidence of stroke: a meta-analysis of prospective cohort studies. Oncotarget, 83781–83791 (2017).
  3. American Heart Association. Saturated Fat. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats.
Dr. Ryan’s team and their institutional affiliations: Arthur Thomas Ryan, PhD 1,2; Teodor T. Postolache, MD 1,2,3; Daniel Dennis Taub, PhD 4; Holly C. Wilcox, PhD 5,6; Marjan Ghahramanlou-Holloway, PhD 7; John C. Umhau, MD 8,9; Patricia A. Deuster, PhD 10 1- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD 2- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 3- Rocky Mountain MIRECC for Suicide Prevention, Aurora, CO 4- Washington DC VA Medical Center, Washington, DC 5- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 6- Johns Hopkins School of Medicine, Baltimore, MD 7- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 8- Office of New Drugs, Division of Psychiatry Products Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 9- Fort Belvoir Community Hospital, Fort Belvoir, MD 10- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD