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Cortisol level and suicidal risk

Dear Editor,

The publication on “cortisol level and suicidal risk” by Ahmed et al. is very interesting (Ahmed et al. 2016). Ahmed et al. concluded that “There are relatively increased levels of morning and evening cortisol in major depressive disorder patients in comparison with controls; thoughts of death are positively associated with elevated morning and evening cortisol level (Ahmed et al. 2016)”. In fact, there are many factors that might results in aberration of cortisol level. In the present study, the control of confounding factor is questionable. The control of venipuncture pain and hemolysis which is an important primary inference on blood cortisol level should be considered (Lima-Oliveira et al. 2013; Snyder et al. 2004) and there is a remained question on the present study by Ahmed et al. (Ahmed et al. 2016) on the mentioned confounding factor. In clinical chemistry laboratory diagnostic test, the aberration of cortisol level can be seen in case with venipuncture pain and hemolytic samples (Lima-Oliveira et al. 2013; Snyder et al. 2004).


  • Ahmed S, Moussa F, Moustafa A, Ayoub DR. Cortisol level in depressed patients and its relation with suicidal risk and anhedonia. Egypt J Neurol Psychiatry Neurosurg. 2016;53:193–9.

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  • Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Quality impact on diagnostic blood specimen collection using a new device to relieve venipuncture pain. Indian J Clin Biochem. 2013;28(3):235–41.

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JB participated in its design and coordination, helped to draft the manuscript, and read and approved the final manuscript. WV participated in its design and coordination, helped to draft the manuscript, and read and approved the final manuscript.

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Correspondence to Beuy Joob.

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Joob, B., Wiwanitkit, V. Cortisol level and suicidal risk. Egypt J Neurol Psychiatry Neurosurg 54, 22 (2018).

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