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Linking Genetics and Mental Health Conditions

Hilary Coon speaking in HMHI auditorium

HMHI Expert Spotlight: Hilary Coon, PhD

Meet Hilary Coon, PhD, Professor of Psychiatry as well as the H.A. and Edna Benning Presidential Endowed Chair at Huntsman Mental Health Institute (HMHI). We asked Hilary a few questions about her work at HMHI and what she enjoys doing when she's not working.

What is your area/areas of specialty?

My research work is dedicated to the discovery of risk factors for complex psychiatric conditions, focusing on underlying genetic risks and how these may increase vulnerability to exposures and stressors. Over the past several years, this work has increasingly focused on a large collaborative effort to understand risk factors leading to suicide death.

Suicide is an urgent public health crisis; Utah currently has the 6th highest suicide rate in the country, and rates have increased by 46% here since 1999. While the prediction of suicide attempts is improving, the prediction of suicide mortality remains near zero. We're using some unique Utah resources to achieve this goal, including ~9,000 DNA samples from Utah suicide deaths through a long-term collaboration with our Utah Medical Examiner. These deaths have been linked to the Utah Population Database (UPDB), a statewide data resource that includes demographics, environmental data, two decades of electronic medical records, and unique deep genealogical records that allow us to pursue innovative studies of familial risks.

Our ongoing work has involved multiple methods to pursue genetic risk discovery in this unique research resource, including genome-wide association and polygenic risk, familial genetic variants in extended high-risk families, studies to elucidate genes and gene pathways using whole genome sequence data, studies to identify and characterize subgroups of individuals at high risk for suicide death, and studies to explore the ethical, legal, and social implications of impending discoveries. We have additionally expanded this work to include Natural Language Processing (NLP) in physician notes to more accurately characterize suicidal thoughts and behaviors, and other aspects of risk that are poorly captured in the administrative diagnostic electronic health records.

"We hope that even through the basic act of studying underlying biological risks we will begin to reframe suicide as a medical condition, reducing stigma and offering hope for the future."

Hilary Coon, PhD

What do you love most about the work that you do?

Although there is an undeniable thrill with every new discovery, I actually find more reward in the creativity and excitement in planning of new studies and in developing and carrying out new methods to work with challenging and complex data. I'm also working with probably the nicest, smartest, most talented group of researchers on the planet, and count myself incredibly blessed to be a part of this amazing crew.

What is the latest update(s) on your research?

In the last year, we have pursued investigations of suicide risk in bipolar disorder, in substance use disorders, and in psychosis. We have published work showing that extended familial risk of suicide death is associated with younger age at death and also highly elevated polygenic risk of suicide. We also have finished some initial work on ethical issues surrounding use of genetic risk information for predicting suicide risk. Finally, our group continues to offer our unique data to make contributions to large international consortia groups studying genetic risk leading to suicidal behaviors.

How does the research you do help patients?

We realize that right now our work sits a fair distance upstream from direct patient benefit; we believe much work will be needed before results may be clinically translatable. Though we hope for results that will eventually be able to help direct resources to those in most need, we are also careful, recognizing that this is a highly sensitive area of research; we strive for rigorous replication, and we do not wish to over-interpret findings. As we make progress, we hope that even through the basic act of studying underlying biological risks we will begin to reframe suicide as a medical condition, reducing stigma and offering hope for the future.

What research are you hoping to work on next?

Recently, I have finalized permissions and funding support to obtain stored blood spots from ~30,000 non-suicide deaths, which have been stored at the Utah Medical Examiner since 2005. Preliminary linking suggests that between 6,000-7,000 of these samples will be from accidental overdoses, another urgent health crisis that overlaps with suicide death. Funding is in place for DNA extraction and genotyping of ~2,500 of these non-suicide deaths, and sequencing of ~100 where we can highly select them using medical records data for chronic opioid misuse, and for additional extended familial risk of drug use.

Current data from our suicide cohort shows us that suicides with opioid and other drug misuse have increased polygenic risks associated with pain phenotypes, opioid use disorder, and smoking phenotypes, but also other psychiatric conditions, including ADHD, PTSD, and schizophrenia. The study of non-suicide accidental overdose deaths may help reveal similarities and differences in genetic, clinical, demographic, and familial risks associated with these outcomes.


What are you passionate about outside

I love the fact that Salt Lake is in the middle of an unparalleled outdoor playground. I'm an avid skier, hiker, and biker, and the landscapes of Utah have the capacity to transport me. I like to explore the world outside of Utah and to experience different places and cultures around the world. I'm also a trained classical musician; I got an undergraduate degree in music as well as math. I play principal oboe in the Salt Lake Symphony, which is a terrific local community orchestra.