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Kirshenbaum JS, Pagliaccio D, Bitran A, Xu E, Auerbach RP. Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review. Transl Psychiatry 2024; 14:266. [PMID: 38937430 PMCID: PMC11211511 DOI: 10.1038/s41398-024-02914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.
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Affiliation(s)
- Jaclyn S Kirshenbaum
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alma Bitran
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Elisa Xu
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
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2
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Schantell M, Taylor BK, Mansouri A, Arif Y, Coutant AT, Rice DL, Wang YP, Calhoun VD, Stephen JM, Wilson TW. Theta oscillatory dynamics serving cognitive control index psychosocial distress in youth. Neurobiol Stress 2024; 29:100599. [PMID: 38213830 PMCID: PMC10776433 DOI: 10.1016/j.ynstr.2023.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/09/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background Psychosocial distress among youth is a major public health issue characterized by disruptions in cognitive control processing. Using the National Institute of Mental Health's Research Domain Criteria (RDoC) framework, we quantified multidimensional neural oscillatory markers of psychosocial distress serving cognitive control in youth. Methods The sample consisted of 39 peri-adolescent participants who completed the NIH Toolbox Emotion Battery (NIHTB-EB) and the Eriksen flanker task during magnetoencephalography (MEG). A psychosocial distress index was computed with exploratory factor analysis using assessments from the NIHTB-EB. MEG data were analyzed in the time-frequency domain and peak voxels from oscillatory maps depicting the neural cognitive interference effect were extracted for voxel time series analyses to identify spontaneous and oscillatory aberrations in dynamics serving cognitive control as a function of psychosocial distress. Further, we quantified the relationship between psychosocial distress and dynamic functional connectivity between regions supporting cognitive control. Results The continuous psychosocial distress index was strongly associated with validated measures of pediatric psychopathology. Theta-band neural cognitive interference was identified in the left dorsolateral prefrontal cortex (dlPFC) and middle cingulate cortex (MCC). Time series analyses of these regions indicated that greater psychosocial distress was associated with elevated spontaneous activity in both the dlPFC and MCC and blunted theta oscillations in the MCC. Finally, we found that stronger phase coherence between the dlPFC and MCC was associated with greater psychosocial distress. Conclusions Greater psychosocial distress was marked by alterations in spontaneous and oscillatory theta activity serving cognitive control, along with hyperconnectivity between the dlPFC and MCC.
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Affiliation(s)
- Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Brittany K. Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Amirsalar Mansouri
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Yasra Arif
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Anna T. Coutant
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Danielle L. Rice
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Yu-Ping Wang
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, USA
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging & Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | | | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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Williams LM, Carpenter WT, Carretta C, Papanastasiou E, Vaidyanathan U. Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice. CNS Spectr 2024; 29:26-39. [PMID: 37675453 DOI: 10.1017/s1092852923002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Psychiatric disorders are associated with significant social and economic burdens, many of which are related to issues with current diagnosis and treatments. The coronavirus (COVID-19) pandemic is estimated to have increased the prevalence and burden of major depressive and anxiety disorders, indicating an urgent need to strengthen mental health systems globally. To date, current approaches adopted in drug discovery and development for psychiatric disorders have been relatively unsuccessful. Precision psychiatry aims to tailor healthcare more closely to the needs of individual patients and, when informed by neuroscience, can offer the opportunity to improve the accuracy of disease classification, treatment decisions, and prevention efforts. In this review, we highlight the growing global interest in precision psychiatry and the potential for the National Institute of Health-devised Research Domain Criteria (RDoC) to facilitate the implementation of transdiagnostic and improved treatment approaches. The need for current psychiatric nosology to evolve with recent scientific advancements and increase awareness in emerging investigators/clinicians of the value of this approach is essential. Finally, we examine current challenges and future opportunities of adopting the RDoC-associated translational and transdiagnostic approaches in clinical studies, acknowledging that the strength of RDoC is that they form a dynamic framework of guiding principles that is intended to evolve continuously with scientific developments into the future. A collaborative approach that recruits expertise from multiple disciplines, while also considering the patient perspective, is needed to pave the way for precision psychiatry that can improve the prognosis and quality of life of psychiatric patients.
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Affiliation(s)
- Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Evangelos Papanastasiou
- Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Rhineland-Palatinate, Germany
- HMNC Holding GmbH, Wilhelm-Wagenfeld-Strasse 20, 80807Munich, Bavaria, Germany
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Terpstra AR, Vila-Rodriguez F, LeMoult J, Chakrabarty T, Nair M, Humaira A, Gregory EC, Todd RM. Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression. J Affect Disord 2023; 321:182-190. [PMID: 36341803 DOI: 10.1016/j.jad.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment. METHODS Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five. RESULTS Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline. LIMITATIONS The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results. CONCLUSIONS Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.
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Affiliation(s)
- Alex R Terpstra
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
| | - Joelle LeMoult
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Medha Nair
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Afifa Humaira
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth C Gregory
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Rebecca M Todd
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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MacPherson HA, Kim KL, Seymour KE, Wolff J, Esposito-Smythers C, Spirito A, Dickstein DP. Cognitive Flexibility and Impulsivity Deficits in Suicidal Adolescents. Res Child Adolesc Psychopathol 2022; 50:1643-1656. [PMID: 35751716 PMCID: PMC10269680 DOI: 10.1007/s10802-022-00952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
Although neurocognitive deficits have been documented in adolescents with suicidal ideation (SI) and suicide attempts (SA), it is unclear whether certain impairments differentiate these groups, potentially suggesting heightened risk for SA. Focus on specific facets of impulsivity and cognitive control may indicate distinctions between adolescents with SA vs. SI. The current study examined dimensions of impulsivity and cognitive control in 141 adolescents with SA (n = 41) vs. SI without SA (n = 49) vs. typically-developing controls (TDCs; n = 51). Adolescents completed cross-sectional neurocognitive tasks via the Cambridge Neuropsychological Testing Automated Battery, in addition to demographic and clinical measures. Analyses involved ANOVAs and ANCOVAs. Results indicated that adolescents with SA demonstrated less set shifting/cognitive flexibility (reduced ability to adapt to/disengage from stimuli) and greater impulsive decision making (reduced ability to collect/evaluate information before making decisions) compared to TDCs. In addition, both TDCs and adolescents with SA had greater response inhibition (increased ability to stop motor responses that have begun/become prepotent) than those with SI. Similar results were found when analyzing female adolescents separately. There were no significant differences for male adolescents, potentially due to the small subsample (n = 40). There were no significant findings for spatial planning/problem solving or visuospatial working memory. Findings suggest: 1) less set shifting/cognitive flexibility and greater impulsive decision making for adolescents with SA vs. TDCs; and 2) greater response inhibition for TDCs and adolescents with SA vs. SI. Such information may be useful for improving risk assessments (adding neurocognitive tasks) and targeted treatments (incorporating cognitive remediation) for this impaired population.
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Affiliation(s)
| | - Kerri L Kim
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Karen E Seymour
- National Institutes of Health, Center for Scientific Review, Rockville, MD, USA
| | - Jennifer Wolff
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel P Dickstein
- PediMIND Program, Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
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McRae E, Stoppelbein L, O’Kelley S, Smith S, Fite P. Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:715-725. [PMID: 35958716 PMCID: PMC9360295 DOI: 10.1007/s40653-022-00439-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 05/12/2023]
Abstract
Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.
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Affiliation(s)
- Elizabeth McRae
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | | | - Sarah O’Kelley
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | - Shana Smith
- Jacksonville State University, Jacksonville, Alabama US
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7
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Aguinaldo LD, Coronado C, Gomes DA, Courtney KE, Jacobus J. Application of the RDoC Framework to Predict Alcohol Use and Suicidal Thoughts and Behaviors among Early Adolescents in the Adolescent Brain and Cognitive Development (ABCD) Study. Brain Sci 2022; 12:brainsci12070935. [PMID: 35884741 PMCID: PMC9315509 DOI: 10.3390/brainsci12070935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Alcohol use confers risk for suicidal thoughts and behaviors (ideation, attempt) in early adolescents. The Research Domain Criteria provides a framework for examination of multidimensional and modifiable risk factors. We examined distinct latent profiles based on patterns of positive valence (reward responsivity) and cognitive systems (neurocognition) from the ABCD Study (age 9−10, N = 10,414) at baseline enrollment. Longitudinal associations were determined between baseline positive valence and cognitive profiles and group classification (alcohol use, suicidal thoughts and behaviors, or their co-occurrence) two-years after initial assessment (ages 11−12). Three unique profiles of positive valence, cognition, alcohol use, and suicidal thoughts and behaviors were identified. Two baseline profiles predicted alcohol use and suicidal thoughts and behaviors, two-years after initial assessment. Low positive valence with high cognition (but low impulsivity) predicted alcohol use (OR = 1.414, p< 0.001), while high positive valence with low cognition (but high impulsivity) predicted suicidal thoughts and behaviors (OR = 1.25, p = 0.038), compared to average positive valence and cognition. Unique profiles of positive valence and cognitive systems among 9−12-year-olds may be predictive of alcohol use and suicidal thoughts and behaviors over a two-year period. Findings underscore the potential for trajectory research on positive valence and cognitive profiles to enhance prevention for early-adolescents.
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8
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Huang MH, Chen MH, Chan YLE, Li CT, Tsai SJ, Bai YM, Su TP. Pro-inflammatory cytokines and suicidal behavior among patients with bipolar I disorder. J Psychiatr Res 2022; 150:346-352. [PMID: 34844744 DOI: 10.1016/j.jpsychires.2021.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Suicidal behavior and different mood states of bipolar I disorder (BD) have been shown to be associated with dysregulated proinflammatory cytokines. Only a few studies have examined the association between inflammation and SB in BD, and the association between proinflammatory cytokines, SB, and cognitive deficits in patients with BD remains unclear. METHODS 77 patients with BD and 61 age-/sex-matched healthy controls were recruited. Patients were divided into two groups: with suicidal ideation (SI; n = 21) and no SI (n = 56). SI was defined by a score of ≥1 in item 10 of Montgomery Åsberg Depression Rating Scale. Levels of proinflammatory cytokines, including soluble interleukin-6 receptor (sIL-6R), soluble tumor necrosis factor-α receptor type 1 (sTNF-αR1), and C-reactive protein (CRP), were measured, and cognitive function was assessed using 2-back task and Go/No-Go task. RESULTS Patients with SI had higher levels of sTNF-αR1 than those without SI and the controls (p = .004). BD patients with or without a history of suicide attempt had higher levels of CRP than the controls. SI was associated with serum levels of sTNF-αR1 and IL-6sR, even after additionally controlling for working memory and inhibitory control (p < .05). CONCLUSION This study indicates that serum levels of sTNF-αR1 have distinct differences between BD patients with or without SI, and our findings strengthen the hypothesis of a link between suicidal behavior and neuro-inflammation pathophysiology in BD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Yuanshan and Suao Branch, Ilan, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yee-Lam E Chan
- Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Mei Bai
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Tung-Ping Su
- Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan.
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Abstract
Suicide is a leading cause of death, and presently, there is no definitive clinical indicator of future suicide behaviors. Anhedonia, a transdiagnostic symptom reflecting diminished ability to experience pleasure, has recently emerged as a risk factor for suicidal thoughts and behaviors (STBs). This overview, therefore, has the following aims. First, prior research relating anhedonia to STBs will be reviewed, with a particular focus on clarifying whether anhedonia is more closely associated with suicidal thoughts versus behaviors. Second, the National Institute of Mental Health's Research Domain Criteria Positive Valence Systems provide a useful heuristic to probe anhedonia across different units of analysis, including clinical symptoms, behaviors, neural mechanisms, and molecular targets. Accordingly, anhedonia-related constructs linked to STBs will be detailed as well as promising next steps for future research. Third, although anhedonia is not directly addressed in leading suicide theories, this review will provide potential inroads to explore anhedonia within diathesis-stress and interpersonal suicide frameworks. Last, novel approaches to treat anhedonia as a means of reducing STBs will be examined.
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Affiliation(s)
- Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
- Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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Hirjak D, Schwarz E, Meyer-Lindenberg A. [Twelve years of research domain criteria in psychiatric research and practice: claim and reality]. DER NERVENARZT 2021; 92:857-867. [PMID: 34342676 DOI: 10.1007/s00115-021-01174-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
The research domain criteria (RDoC) initiative of the National Institute of Mental Health (NIMH) was presented 12 years ago. The RDoC provides a matrix for the systematic, dimensional and domain-based study of mental disorders that is not based on established disease entities as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). The primary aim of RDoC is to understand the nature of mental health and illness in terms of different extents of dysfunction in psychological/biological systems with interconnected diagnoses. This selective review article aims to provide a comprehensive overview of RDoC-based studies that have contributed to a better conceptual organization of mental disorders. Numerous promising and methodologically sophisticated studies on RDoC were identified. The number of scientific studies increased over time, indicating that dimensional research is increasingly being pursued in psychiatry. In summary, the RDoC initiative has a considerable potential to more precisely define the complexity of pathomechanisms underlying mental disorders; however, major challenges (e.g. small and heterogeneous study samples, unclear biomarker definitions and lack of replication studies) remain to be overcome in the future. Furthermore, it is plausible that a diagnostic system of the future will integrate categorical and dimensional approaches to arrive at a stratification that can underpin a precision medical approach in psychiatry.
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Affiliation(s)
- Dusan Hirjak
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Emanuel Schwarz
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Andreas Meyer-Lindenberg
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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Prediction of suicidal ideation and attempt in 9 and 10 year-old children using transdiagnostic risk features. PLoS One 2021; 16:e0252114. [PMID: 34033672 PMCID: PMC8148349 DOI: 10.1371/journal.pone.0252114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
The objective of the current study was to build predictive models for suicidal ideation in a sample of children aged 9–10 using features previously implicated in risk among older adolescent and adult populations. This case-control analysis utilized baseline data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from 21 research sites across the United States (N = 11,369). Several regression and ensemble learning models were compared on their ability to classify individuals with suicidal ideation and/or attempt from healthy controls, as assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version. When comparing control participants (mean age: 9.92±0.62 years; 4944 girls [49%]) to participants with suicidal ideation (mean age: 9.89±0.63 years; 451 girls [40%]), both logistic regression with feature selection and elastic net without feature selection predicted suicidal ideation with an AUC of 0.70 (CI 95%: 0.70–0.71). The random forest with feature selection trained to predict suicidal ideation predicted a holdout set of children with a history of suicidal ideation and attempt (mean age: 9.96±0.62 years; 79 girls [41%]) from controls with an AUC of 0.77 (CI 95%: 0.76–0.77). Important features from these models included feelings of loneliness and worthlessness, impulsivity, prodromal psychosis symptoms, and behavioral problems. This investigation provided an unprecedented opportunity to identify suicide risk in youth. The use of machine learning to examine a large number of predictors spanning a variety of domains provides novel insight into transdiagnostic factors important for risk classification.
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Auerbach RP, Pagliaccio D, Allison GO, Alqueza KL, Alonso MF. Neural Correlates Associated With Suicide and Nonsuicidal Self-injury in Youth. Biol Psychiatry 2021; 89:119-133. [PMID: 32782140 PMCID: PMC7726029 DOI: 10.1016/j.biopsych.2020.06.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022]
Abstract
There is no definitive neural marker of suicidal thoughts and behaviors (STBs) or nonsuicidal self-injury (NSSI), and relative to adults, research in youth is more limited. This comprehensive review focuses on magnetic resonance imaging studies reporting structural and functional neural correlates of STBs and NSSI in youth to 1) elucidate shared and independent neural alternations, 2) clarify how developmental processes may interact with neural alterations to confer risk, and 3) provide recommendations based on convergence across studies. Forty-seven articles were reviewed (STBs = 27; NSSI = 20), and notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years. Structural magnetic resonance imaging research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STBs, and there is reduced anterior cingulate cortex volume related to STBs and NSSI. With regard to functional alterations, blunted striatal activation may characterize STB and NSSI youth, and there is reduced frontolimbic task-based connectivity in suicide ideators and attempters. Resting-state functional connectivity findings highlight reduced positive connectivity between the default mode network and salience network in attempters and show that self-injurers exhibit frontolimbic alterations. Together, suicidal and nonsuicidal behaviors are related to top-down and bottom-up neural alterations, which may compromise approach, avoidance, and regulatory systems. Future longitudinal research with larger and well-characterized samples, especially those integrating ambulatory stress assessments, will be well positioned to identify novel targets that may improve early identification and treatment for youth with STBs and NSSI.
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Affiliation(s)
- Randy P. Auerbach
- Department of Psychiatry, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, New York, USA, Corresponding author: 1051 Riverside Drive, Pardes 2407, New York, NY 10032;
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Grace O. Allison
- Department of Psychiatry, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Kira L. Alqueza
- Department of Psychiatry, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Maria Fernanda Alonso
- Department of Psychiatry, Columbia University, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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