Blood Test for Suicide

As an emergency room nurse puts the finishing touches on your bandage the physician who sutured the laceration on your wrist comes back into the room with a serious expression on her face: "Sorry, but you'll need to stay. You just tested positive for suicide, and no, it doesn't matter that you told us it was accidental."

This recent article suggests we may someday acquire a biomarker that enables prediction of a suicide attempt. I like to imagine the consequences of such a tool.

The notion that such a tool could save lives by preventing suicide clearly motivates its development, but questions quickly arise: How far in advance will it work? Will we detain or restrain solely on the basis of a positive test? Will we free the person only after the test returns to normal? Will the test predict suicide bombers or just those with a mental illness, or will this positive test define a new mental disorder in the next edition of the DSM? What about patients seeking assisted suicide?

Life insurance companies will want to use the test to screen applicants. Some will want to screen those who want to purchase a firearm.

Will the test predict response to treatment? Lithium may prevent suicide. Will treatment with the drug lead to a normal test? What happens when the patient stops the lithium?

Once a patient has tested positive will we want to repeat the test at intervals in the future? For how long? Will we allow such patients to refuse further testing? Will the clinical picture always match the test result? Upon which will we rely? If someone attempts suicide or admits to intent to take their own life will a negative test result lead us to reassure them that they really do not pose a risk and do not need help? How will we handle potential false negatives?

We need to address these and many other related questions before we incorporate this test into clinical practice.

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