• Brian L Mishara and David N Weisstub.
• Centre for Research and Intervention on Suicide, Ethical Issues and End of Life Practices, Université du Québec à Montréal, Montreal, Quebec, Canada; Psychology Department, Université du Québec à Montréal, Montreal, Quebec, Canada. Electronic address: mishara.brian@uqam.ca.
• Prev Med. 2021 Nov 1; 152 (Pt 1): 106685.

AbstractWe explore ethical premises and practical implications of using genetic testing to predict suicide risk. Twin studies indicate heritable components of suicide risk, intertwined with the heritability of mental disorders, and possibly other traits. Current genetics research has abandoned searching for single gene Mendelian determinants, in favour of complex probabilistic epigenetic models. Genome-Wide Association Studies (GWAS) might identify thousands of single nucleotide polymorphisms (SNPs), each contributing very little to the variance associated with behavioral phenotypes. However, suicide is a behavioral outcome rather than a phenotype, with so many different causal aetiologies, that it is impossible to predict the behaviors of individuals. We analyse practical and ethical issues that would arise if future research were to identify genetic information that will accurately predict suicide. Applying ACCE guidelines that specify when genetic tests should and should not be used, we examine the Analytic Validity, Clinical Validity, Clinical Utility and Ethical, Legal, and Social Implications. Low sensitivity and specificity for predicting suicide diminish potential advantages and exacerbate risks. Key considerations include the likelihood that testing will result in effective preventive interventions, which are not currently available, and unreliable positive results increasing hopelessness, stigma, and psychosocial risks. If the unregulated direct-to-consumer genetic testing services include suicide risk assessments, their use risks negative impacts. In the future, if genetic testing could accurately identify suicide risk in individuals, its use would be contraindicated if we cannot provide effective preventive interventions and mitigate the negative impacts of informing people about their risk level.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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