Microbial Dysbiosis as an Emerging Pathology of Suicidal Behaviour? A Critical Review, Passing Through Depression to Chronic Pain.

Background: Suicidal behaviour (SB) is one of the most complex neuropsychiatric conditions, with an etiopathogenesis that remains elusive despite a myriad of studies revealing its multifaceted nature, influenced by various biological, psychological, socioeconomic and cultural factors, usually with complex reciprocal and synergistic interactions. Emerging evidence has recently suggested a potential involvement of pathogens and host-tissue derived microbial species in contributing to SB. This review aims to provide a concise synthesis of clinical evidence focusing on the presence of microbial alterations in subjects with SB and in those exhibiting risk factors for SB, thereby exploring a possible new perspective in suicidology.

Summary: We conducted a surveillance of the literature in the PUBMED database, from its inception to 10 May 2025, to identify associations between infection/microbial alterations with SB and some of its risk factors (by focusing on two pathologic examples of psychiatric and somatic origins, respectively: depression and chronic pain, two often closely related conditions). Major clinical findings were selected and synthesised into a hypothetical framework to support the presence of a microbe-related origin of SB. We found that SB was associated with selected infections, such as Toxoplasma gondii and Cytomegalovirus. Dysbiosis, including changes in diversity and/or abundance of selected microbial species, in the oral cavity, gastrointestinal tract, and other mucosal tissues, was observed in subjects with SB and individuals with psychiatric (depression) and somatic (chronic pain) risk factors of SB.

Key message: Microbial dysbiosis might contribute to SB etiopathogenesis. Further studies in this emerging field of research are expected to provide additional mechanistic insights for an improved understanding, prevention, and therapeutic management of this neuropsychiatric condition.