IntroductionHyperactivity of the Hypothalamic-Pituitary-Adrenal (HPA) axis is a common finding in Major DepressiveDisorder. Similar studies on suicide attempters are less abundant, and the results are divergent. The main aim of the present study was to investigate HPA-axis parameters by the time of a suicide attempt and at follow-up in search for associations between HPA axis function and suicidal behavior. MethodsThirty-five suicide attempters and 16 non-suicidal controls were admitted to a psychiatric ward between the years of 1986 an 1992. Corticotrophin-releasing hormone (CRH) in cerebrospinal fluid and urinary cortisol were obtained for the suicide attempters. The patients were followed up approximately 12 years after the index admission. Cortisol was measured in saliva, and additional suicide attempts and current psychiatric symptoms were registered. ResultsAt follow up, evening salivary cortisol was lower in suicide attempters compared to controls. Low cortisol levels at follow up were associated with severe psychiatric symptoms. Among women, repeated suicide attempts were associated with low morning and lunch salivary cortisol, and in this subgroup we also found significant correlations between salivary cortisol at follow up, and CRH as well as urinary cortisol at index. ConclusionWe found evidence for an association between low HPA axis activity and suicidal behavior. This could be due to long lasting and severe psychiatric morbidity, which in turn has exhausted the HPA axis of these patients. The potential role of hypocortisolism should be given more attention in studies on suicidal patients.