Relationship of HPA axis and HPT axis impairment with suicide attempts in non-suicidal self-injury adolescents

Abstract

Objective  To explore the correlation between suicide attempt (SA) in adolescents with non-suicidal self-injury (NSSI)and  the function change of the hypothalamic-pituitary-thyroid (HPT) axis and the hypothalamic-pituitary-adrenal (HPA) axis function change. Methods  A cross-sectional survey was conducted among adolescents aged 13-19 years with a history of NSSI who were hospitalized in Beijing Anding Hospital,Capital Medical University from December 2020 to May 2022. The clinical features,thyroid function ［free triiodothyronine (FT3),free thyroxine (FT4),total T3 (TT3),total T4 (TT4),thyroid stimulating hormone (TSH)］, adrenocorticotropin (ACTH) and cortisol (CORT) levels were collected. The patients were divided into non-SA group and SA group according to the  absence or presence of SA in the last one year. According to the time period of SA occurrence (1 month),patients in the SA group were divided into recent SA and past SA. The multivariate logistic regression model was used to analyze the influencing factors of SA behavior.  Results  A total of 79 adolescent patients of mood disorder with NSSI were enrolled.Among them, 49 (62.03%) patients had SA and 29(59.18%) patients had attempted suicide within the past month. The univariate analysis showed that there were statistical differences in age of disease onset,gender,and education level between the SA and non-SA groups (P<0.05). There were statistical differences in age,TSH, and ACTH level between the recent SA group and past SA group (P<0.05). The logistic regression analysis showed that female (P=0.027,OR=2.941,95%CI: 1.131-7.649) was risk factor for SA behavior. Low ACTH level（P=0.043，OR=1.019，95%CI：1.001-1.037）was related factor for recent SA. Conclusion  Female adolescents of mood disorders with NSSI were more likely to attempt suicidality and ACTH was related with recent SA.

Keywords

adolescent / non-suicidal self-injury / suicide attempt / hypothalamic-pituitary-adrenal axis / hypothalamic-pituitary-thyroid axis