GENETIC STUDIES OF SUICIDAL BEHAVIOR

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Margaux Hemingway recently committed suicide. This attracted media attention not only because she was the world's highest-paid model but also because she was the granddaughter of Ernest Hemingway—himself a suicide victim. Some of the news stories accurately reported that suicide was no stranger to the Hemingway family as Ernest's brother, sister, and father had all committed suicide. Thus, there have been five suicides in the Hemingway family, spaning four generations. Such family histories often lead to the question about whether or not suicide may have a genetic component. Interestingly, Margaux Hemingway was quoted as saying: “Alcoholism and suicide seem to be something we Hemingways have inherited.” This article examines this possibility by reviewing relevant clinical, twin, and adoption studies as well as recent molecular genetic studies.

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CLINICAL STUDIES

A family history of suicide has been noted to be associated with suicidal behavior at all stages of the life cycle.

TWIN STUDIES

Identical twins share the same genes, whereas fraternal twins share only 50% of their genes. Thus, if the propensity to commit suicide was transmitted genetically, concordance for suicide should be found more frequently among identical than fraternal twins. Kallman 13 stated “If hereditary factors play a decisive role we should find a concordant tendency to suicide more frequently in one-egg than in two-egg pairs regardless of ordinary differences in environment.”

In 1967, Haberlandt 10, 11

ADOPTION STUDIES

The strongest evidence for the presence of genetic factors in suicide comes from the adoption studies carried out in Denmark by Schulsinger et al 38 and Wender et al.46 The strength of the adoption strategy is that it is the best way to tease apart “nature” from “nuture” issues. This is because individuals separated at birth, or shortly afterward, share their genes—but not subsequent environmental experiences—with their biologic relatives. In contrast, adoptees share their environmental

BIOLOGICAL SUBSTRATE

Kety 15 also noted that there has been much recent work on the biology of impulsivity and that disturbance in central serotonin has been described in relation to suicidal behavior. In this regard, it is noteworthy that Buchsbaum et al 5 found that significantly more college students with low blood platelet levels of the enzyme monoamine oxidase (MAO) had a family history of suicidal behavior compared with students with high platelet MAO levels. This enzyme is involved in the metabolism of

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    Address reprint requests to Alec Roy, MD Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue/Psychiatry 116A East Orange, NJ 07018

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