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Multiple serum biomarkers for predicting suicidal behaviours in depressive patients receiving pharmacotherapy

Published online by Cambridge University Press:  17 May 2022

Jae-Min Kim*
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Hee-Ju Kang
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Ju-Wan Kim
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Wonsuk Choi
Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
Ju-Yeon Lee
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Sung-Wan Kim
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Il-Seon Shin
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
Min-Gon Kim
Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology, Gwangju, South Korea
Byung Jo Chun
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
Robert Stewart*
King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK South London and Maudsley NHS Foundation Trust, London, UK
Author for correspondence: Jae-Min Kim, E-mail:; Robert Stewart, E-mail:
Author for correspondence: Jae-Min Kim, E-mail:; Robert Stewart, E-mail:



Predictive values of multiple serum biomarkers for suicidal behaviours (SBs) have rarely been tested. This study sought to evaluate and develop a panel of multiple serum biomarkers for predicting SBs in outpatients receiving a 12-month pharmacotherapy programme for depressive disorders.


At baseline, 14 serum biomarkers and socio-demographic/clinical characteristics including previous suicidal attempt and present suicidal severity were evaluated in 1094 patients with depressive disorders without a bipolar diagnosis. Of these, 884 were followed for increased suicidal severity and fatal/non-fatal suicide attempt outcomes over a 12-month treatment period. Individual and combined effects of serum biomarkers on these two prospective SBs were estimated using logistic regression analysis after adjustment for relevant covariates.


Increased suicidal severity and fatal/non-fatal suicide attempt during the 12-month pharmacotherapy were present in 155 (17.5%) and 38 (4.3%) participants, respectively. Combined cortisol, total cholesterol, and folate serum biomarkers predicted fatal/non-fatal suicide attempt, and these with interleukin-1 beta and homocysteine additionally predicted increased suicidal severity, with clear gradients robust to adjustment (p values < 0.001).


Application of multiple serum biomarkers could considerably improve the predictability of SBs during the outpatient treatment of depressive disorders, potentially highlighting the need for more frequent monitoring and risk appraisal.

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Copyright © The Author(s), 2022. Published by Cambridge University Press

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Jae-Min Kim and Hee-Ju Kang contributed equally as first authors, Jae-Min Kim and Robert Stewart contributed equally as corresponding authors


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