Progression from health to disease is driven by FLTs in the PINE network, which is likely to undergo changes characteristic of system instability. Biomarkers of system instability may effectively predict the critical transition to MDD.

Applying CBP theories to the dysfunctional complex biological systems in MDD led to development of integrals and differentials of biomarkers that can be used in screening for MDD and planning future biomarker research, targeting intracellular and extracellular inflammation, HPA axis dysfunction, and tryptophan metabolism.

Objective: A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders. Methods: We undertook a systematic search of multiple databases for studies that ascertained an association between serum lipids and suicidality in adult patients with schizophrenia spectrum disorders (18-65 years) from database inception to 2 September 2020. Qualitative analysis was done using National Institute of Health (NIH) scales. The standard mean difference (SMD) and 95% confidence intervals (CI) were calculated for each study and standardized relative to the study. Adjusted p-value, Z-test, and heterogeneity were calculated, as well as testing for publication bias. Results: Of 1262 records identified, 17 studies (n = 3113) were included in our systematic review, while 11 studies were included in the meta-analysis. The majority of studies (11) rated fair on qualitative analysis. Data from seven studies (n = 1597) revealed a medium effect size for an association between low total cholesterol and suicide attempts (SMD −0.560; 95% CI: 0.949-0.170; p = 0.005). People with history of suicide attempt had a mean cholesterol value 0.56 SD lower than the mean in those without suicide attempts. There were differences in how a suicide attempt was defined and there was high heterogeneity (I 2 = 83.3%). No significant association was found between any of the serum lipid parameters and suicide ideation. Funnel-plot analysis suggested small study effects with publication bias. Conclusions: Suicide attempts in people with schizophrenia spectrum disorders are associated with low mean total cholesterol levels.