Zusammenfassung
HINTERGRUND: Übereinstimmende Befunde aus einer Vielzahl von Forschungsdesigns (Adoptions-, Familien-, Migranten- und Zwillingsstudien sowie Genom-Scans, familiennamenbasierte, geografische und molekulargenetische Studien) weisen auf eine Beteiligung genetischer Risikofaktoren für Suizid hin. Dieser Beitrag bietet einen ausführlichen und aktuellen Überblick über die zu diesem Thema vorhandenen Zwillingsstudien. METHODEN: Über extensive Literatursuche wurden insgesamt 32 Studien (19 Fallberichte, 5 zwillingsregisterbasierte Studien, 4 populationsbasierte epidemiologische Studien, 4 Studien überlebender Ko-Zwillinge) eruiert, die hier zusammengefasst und diskutiert werden. Dieses Literaturkorpus wurde zwischen 1812 und 2006 in 6 verschiedenen Sprachen publiziert und enthält Daten aus 13 Ländern. ERGEBNISSE: Eine Meta-Analyse aller zwillingsregisterbasierten Studien und aller Fallberichte aggregiert zeigt, dass eineiige Zwillinge signifikant häufiger für Suizid konkordant sind als zweieiige Zwillinge. Ausschließlich psychosoziale Erklärungen für diesen Befund werden durch die Ergebnisse von Ko-Zwillingsstudien ausgeschlossen. Populationsbasierte epidemiologische Studien zeigen einen signifikanten Beitrag genetischer Faktoren (geschätzte Heritabilität: 30–55%) für den weitergefassten Phänotyp suizidalen Verhaltens (Suizidgedanken, Suizidpläne, Suizidversuche), der für die verschiedenen Typen suizidalen Verhaltens weitgehend überlappt und von der Vererbung psychiatrischer Erkrankungen weitgehend unabhängig ist. Effekte nicht-geteilter Umwelt (persönliche Lebenserfahrungen) tragen ebenfalls substantiell zum Risiko für suizidales Verhalten bei, nicht jedoch Effekte geteilter Umwelt (Familie). SCHLUSSFOLGERUNG: Die Gesamtheit der Befunde aus Zwillingsstudien zu Suizid legt sehr deutlich eine Beteiligung genetischer Faktoren an der Anfälligkeit zu suizidalem Verhalten nahe. Beschränkungen der Zwillings-Methode, Mängel der Literatur und weitere Punkte werden zur Förderung des Forschungsfortschritts in diesem Bereich ausführlich diskutiert (u.a.: Bias-Quellen und Leerstellen in der Literatur, Fehler in früheren Überblicksarbeiten, Alters- und Geschlechtseffekte sowie Zwillingsbesonderheiten bezüglich Suizidrisiko, wissenschaftsgeschichtlicher Kommentar).
Summary
OBJECTIVES: Convergent evidence from a multitude of research designs (adoption, family, genomescan, geographical, immigrant, molecular genetic, surname, and twin studies of suicide) suggests genetic contributions to suicide risk. The present account provides a comprehensive and up-to-date review of the twin studies on this topic. METHODS: A total of 32 studies (19 case reports, 5 twin register-based studies, 4 population-based epidemiological studies, 4 studies of surviving co-twins) located through extensive literature search strategies are summarized and discussed here. This literature corpus was published between 1812 and 2006 in six languages and reports data from 13 countries. RESULTS: A meta-analysis of all register-based studies and all case reports aggregated shows that concordance for completed suicide is significantly more frequent among monozygotic than dizygotic twin pairs. The results of co-twin studies rule out exclusively psychosocially based explanations of this pattern. Population-based epidemiological studies demonstrate a significant contribution of additive genetic factors (heritability estimates: 30–55%) to the broader phenotype of suicidal behavior (suicide thoughts, plans and attempts) that largely overlaps for different types of suicidal behavior and is largely independent of the inheritance of psychiatric disorders. Nonshared environmental effects (i.e. personal experiences) also contribute substantially to the risk of suicidal behavior, whereas effects of shared (family) environment do not. CONCLUSIONS: The totality of evidence from twin studies of suicide strongly suggests genetic contributions to liability for suicidal behavior. To further research progress in this area, an extensive discussion of design limitations, shortcomings of the literature and further points is provided, including sources of bias, gaps in the literature, errors in previous reviews, age and sex effects and twin-singleton differences in suicide risk, and notes from a history-of-science view.
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Voracek, M., Loibl, L. Genetics of suicide: a systematic review of twin studies. Wien Klin Wochenschr 119, 463–475 (2007). https://doi.org/10.1007/s00508-007-0823-2
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DOI: https://doi.org/10.1007/s00508-007-0823-2