Inflammation and suicide risk in adolescents with self-injury: Expanding the role of mental health nursing

Abstract

Recently, inflammatory cytokine profiles have been linked to suicide risk in adolescents with non-suicidal self-injury, highlighting a promising biological dimension of suicide risk assessment. Clinical translation of the cytokine profiles into practice will require frontline engagement of the workforce. Mental health nurses are frequently the most accessible professionals in schools, communities, and low-resource settings and are prime candidates to bridge this gap. By integrating psychosocial evaluation with emerging biomarker data, they can deliver systematic risk assessment, continuous monitoring, and timely intervention. This role would not replace psychiatric expertise; it would extend the reach of psychiatric services, embedding suicide prevention across the continuum of care. For health systems, nurse-led integration may enhance capacity, equity, and resilience in responding to adolescent suicide risk. This editorial demonstrates that empowering nurses to operationalize biomarker-informed strategies is needed for advancing effective and sustainable suicide prevention in this vulnerable population.

Key Words: Suicide; Self-harm; Adolescents; Biomarker; Nursing; Mental health; Psychiatry

Core Tip: Inflammatory biomarkers, such as interleukin-10 and interferon-α, have been associated with suicide risk among adolescents with self-injury, offering a biological complement to psychosocial assessment. However, translating these biological profiles into clinical practice will require specialized healthcare workers. Empowering mental health nurses to integrate biomarker monitoring with structured nursing assessment can transform laboratory findings into practical, equitable, and sustainable strategies for adolescent suicide prevention.

INTRODUCTION

Globally, suicide is a major cause of preventable mortality across age, gender, and ethnic groups[1]. Although adolescent suicide rates have declined globally[2], the World Health Organization still ranks suicide as the third-leading cause of death among youth[3]. Risk factors encompass individual, interpersonal, and environmental domains[4,5], including mental health disorders, suicidal ideation, and self-harm[6,7]. Depression is strongly linked to suicidal behaviors[8], and a bidirectional relationship exists between mental health problems and non-suicidal self-injury (NSSI)[9,10], underscoring adolescents’ vulnerability[11].

TRASLATING BIOMARKER RESEARCH INTO CLINICAL PRACTICE: THE ROLE OF MENTAL HEALTH NURSES

Biological research has added new dimensions to suicide risk assessment. Wen et al[12] found that adolescents with NSSI and a high suicide risk had elevated interleukin-10 and interferon-α levels. In other studies, biomarkers such as tumor necrosis factor-α and C-reactive protein have also been associated with adolescents’ suicidal behaviors[13]. Among these, interleukin-10 is emphasized for its potential role as an independent risk factor[14]. Prior research has also linked immune dysregulation to suicidal behaviors[15,16]. Thus, inflammatory biomarkers could complement psychosocial evaluation in suicide risk assessment[17,18].

Therefore, the challenge now lies not in determining whether biomarkers can predict risk but in translating biological evidence into clinical practice[19]. Clinical application requires validation, cost-effectiveness, and system readiness[20] while overcoming barriers such as limited training and infrastructure[21]. These challenges are compounded by the global shortage of mental healthcare workers[22], with only 13 mental healthcare workers and 1.7 psychiatrists per 100000 globally[23]. Shortages are most severe for child and adolescent services and correlate with higher youth suicide rates[24,25].

Mental health nurses (MHNs) are well placed to bridge the gap between research and clinical application. They represent 44% of the global mental health workforce[23] (approximately 300000 professionals), providing suicide risk assessment and identifying suicidal behaviors in adolescents[26-29]. Their skills in assessing suicide risk are comparable to psychiatrists[30], and several nursing interventions for suicide prevention are evidence-based[31].

Positioning MHNs at the forefront of biomarker translation builds on this foundation[26]. As the first point of contact[32], especially in underserved areas, MHNs can integrate psychosocial assessment with point-of-care biomarker testing to meet community needs[33,34]. In practice, this could follow a structured care model in which validated tools[35], such as the Ask Suicide-Screening Questions[36], are used together with biomarker panels to identify adolescents at heightened risk[13,14]. Those showing elevated results on both assessments should receive regular follow-up - weekly or more frequently if either indicator worsens[37]. Finally, when psychosocial and biological measures remain persistently high, MHNs can initiate targeted interventions, including referral for psychological counseling, psychiatric evaluation, or activation of crisis protocols[38].

This model aligns with global task-sharing strategies and progressive technology use in mental health practice[39,40], shifting selected responsibilities to trained MHNs according to the World Health Organization recommendation[24,41]. Empowering MHNs in this role may offer systemic benefits, expanding monitoring capacity[42], improving access in rural areas and schools[43,44], and strengthening suicide prevention within primary care[38]. This approach supports the global call for screening suicide risk in adolescents[45].

IMPLICATIONS FOR PRACTICE AND FUTURE RESEARCH

However, the education of MHNs in suicide prevention requires reinforcement[46]. The literature has highlighted the need for postgraduate training in managing suicidal behavior[47], including NSSI[48]. Currently, despite their potential[49], few nurses specialize in mental health[50], and this workforce is underused[26]. Postgraduate programs should include modules on adolescent psychological development, evidence-based suicide risk interventions, and inflammatory biomarker interpretation, consistent with recommended curricula and guidelines[51,52]. Competences should be assessed through clinical examinations and supervised clinical practice to ensure both theoretical and clinical proficiency[53].

Future research should evaluate the effectiveness of combining cytokine profiles with nursing assessments to enhance suicide prevention. Integrating biomarker-informed care and adolescent suicide prevention into curricula will ensure MHNs are prepared to apply these strategies. However, implementation may face challenges, such as limited access to biomarker detection equipment, insufficient funding for nurse training, and issues in follow-up care. These barriers can be mitigated through partnerships with primary care laboratories[54], adoption of point-of-care for cytokine detection[55], targeted funding for MHN education, and telehealth-based monitoring systems[56].

CONCLUSION

The promise of inflammatory biomarkers in adolescent suicide prevention cannot be realized without an adequately trained workforce. MHNs may represent the missing link between research and practice, ensuring innovations reach adolescents. By equipping MHNs to act as both providers and connectors, health systems can transform laboratory discoveries into real protection. Adolescents cannot wait for scientific innovations to slowly filter into practice. Empowering MHNs to utilize these insights is essential to building effective, equitable, and sustainable prevention.