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Abstract
In biological suicide research, low cerebrospinal fluid-5-hydroxyindolacetic acid
(CSF-5HIAA) concentrations have been associated with suicidality, aggression and impulsivity.
However, it frequently appears that the interpretation of existing study results is
flawed. The analysis of various published findings suggests that contaminating factors
like impulsivity or depressive symptoms in suicide attempters are often not taken
into consideration at the time of suicide. The seemingly 'robust' association of low
CSF-5HIAA concentration with 'suicidality' and 'aggression' is in fact rather weak.
Reported associations of subgroups of suicidal behavior (e.g. violent suicide attempts)
with low CSF-5HIAA concentrations are likely to represent somewhat premature translations
of findings from studies that have flaws in methodology. Furthermore, the perception
of 'suicidal behavior' as autoaggressive behavior or inwardly directed aggression
in the view of the authors may not be useful in biological suicide research. The construct
of aggressivity is insufficiently defined, resulting in difficulties to interpret
empirical data. Some evidence exists, however, that reduced CSF-5HIAA concentrations
might be related to certain depressive symptoms and changes in impulsivity. More carefully
designed studies are required to overcome the existing methodological shortcomings.