Methylation Risk Scores in Psychiatric Disorders: Advancing Epigenetic Research in Mental Health

DNA methylation is an epigenetic modification implicated in psychiatric disorders influenced by both genetic and environmental factors. Methylation risk scores (MRSs) have emerged as a tool for quantifying accumulated epigenetic modifications and assessing the predisposed risk for certain common disorders. This narrative review introduces the MRS application in psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), social anxiety disorder (SAD), and panic disorder (PD), while also discussing the current limitations and ethical considerations in psychiatric research. MRSs are calculated from epigenome-wide association studies (EWASs) for psychiatric disorders in various tissues from blood and brain and reflect methylation patterns associated with the psychiatric disorder risk. MRSs provide a perspective of how the cumulative methylation patterns at specific CpG sites may contribute to the onset of psychiatric disorders. In SCZ and BD, MRSs derived from both blood and brain tissues have shown distinct methylation profiles that differentiate these disorders, particularly in patients with a high genetic SCZ risk. MRSs are also used to assess the impact of environmental factors, such as early-life adversity and chronic stress, on psychiatric outcomes. In SAD and PD, where epigenetic studies are relatively limited, MRSs revealed both shared and distinct epigenetic features between anxiety disorders, with specific methylation changes associated with social avoidance in SAD patients. MRSs can serve as biomarkers, providing a valuable understanding of both genetic predispositions and environmental influences on gene regulation. However, the lack of large-scale EWAS datasets and standardized summary statistics remains as a limitation. To address this issue, this review provides a list of publicly available raw intensity data (IDAT) files from psychiatric epigenetic studies that can help facilitate future research by providing the raw data necessary for conducting independent EWASs and MRS calculations. As the field advances, careful consideration must be given to the ethical implications of MRS applications, particularly in clinical intervention and prevention. While MRSs hold promise for future personalized medicine applications, informing treatment decisions based on an individual's methylation profile, caution is warranted regarding their predictive utility and effect size limitations. This review emphasizes the importance of MRSs in advancing psychiatric research, bridging the gap between genetic risk and environmental factors.