Study explores relationship between hormones and aggression

In years to come, predicting a person’s risk of becoming violent could be as simple as spitting into a test tube.

Drew Barzman, MD, a child and adolescent forensic psychiatrist at Cincinnati Children’s, is leading a team from Cincinnati Children’s, the University of Cincinnati (UC) and the Veterans Administration (VA) Medical Center to determine whether a saliva test can accurately identify children most likely to become violent.

Barzman’s work has examined testosterone and cortisol levels in pre-teen boys admitted to Cincinnati Children’s for psychiatric care. The project also has measured the steroid dehydroepiandrosterone (DHEA), which also has been associated with aggression.

“Other investigators have found a correlation between hormone levels and violence, but most of those have been long-term outpatient measures,” Barzman says. “Our study focuses on inpatients with the goal of providing rapid, real-time assessment.”

Data from saliva testing was measured against data from the Brief Rating of Aggression by Children and Adolescents (BRACHA) questionnaire, an assessment tool also developed by Barzman’s team, to predict a patient’s likelihood of becoming violent. Early data demonstrating the validity of the BRACHA tool were published in 2011 in the Journal of the American Academy of Psychiatry and the Law.

A fast and accurate saliva test could help predict violence in a wider range of settings, Barzman says.

Hospitals and clinics could benefit immediately from better ways to anticipate and reduce violence. Every year, countless mental health professionals are assaulted by patients. In fact, they are seven times more likely to suffer assault-related injuries than the average US worker, according to the Bureau of Labor Statistics.

If the results of a large study are positive, a valid saliva test also could help improve safety in schools, juvenile detention facilities and other institutions. Another potential area for study would be evaluating salivary hormone testing as a biomarker to measure treatment outcomes.

“For pediatricians, accurate tests could help them decide whether to start or stop medications and whether to refer a patient to the hospital,” Barzman says. “However, we have much more validation work to do before we can reach definitive conclusions.”

The research team includes Douglas Mossman, MD, a psychiatrist at UC and a nationally recognized authority on violence prediction; Michael Sorter, MD, Director, Division of Psychiatry at Cincinnati Children’s; David Klein, PhD, MD, an endocrinologist at Cincinnati Children’s; and Thomas Geracioti , MD, an expert in the endocrinology of mental disorders based at the VA.