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Lee Y, Gilbert JR, Waldman LR, Zarate CA, Ballard ED. Potential association between suicide risk, aggression, impulsivity, and the somatosensory system. Soc Cogn Affect Neurosci 2024; 19:nsae041. [PMID: 38874947 PMCID: PMC11219302 DOI: 10.1093/scan/nsae041] [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] [Received: 10/02/2023] [Revised: 04/05/2024] [Accepted: 06/13/2024] [Indexed: 06/15/2024] Open
Abstract
Aggression and impulsivity are linked to suicidal behaviors, but their relationship to the suicidal crisis remains unclear. This magnetoencephalography (MEG) study investigated the link between aggression, impulsivity, and resting-state MEG power and connectivity. Four risk groups were enrolled: high-risk (HR; n = 14), who had a recent suicidal crisis; lower-risk (LR; n = 41), who had a history of suicide attempts but no suicide attempt or ideation in the past year; clinical control (CC; n = 38), who had anxiety/mood disorders but no suicidal history; and minimal risk (MR; n = 28), who had no psychiatric/suicidal history. No difference in resting-state MEG power was observed between the groups. Individuals in the HR group with high self-reported aggression and impulsivity scores had reduced MEG power in regions responsible for sensory/emotion regulation vs. those in the HR group with low scores. The HR group also showed downregulated bidirectional glutamatergic feedback between the precuneus (PRE) and insula (INS) compared to the LR, CC, and MR groups. High self-reported impulsivity was linked to reduced PRE to INS feedback, whereas high risk-taking impulsivity was linked to upregulated INS to postcentral gyrus (PCG) and PCG to INS feedback. These preliminary findings suggest that glutamatergic-mediated sensory and emotion-regulation processes may function as potential suicide risk markers.
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Affiliation(s)
- Yoojin Lee
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Laura R Waldman
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
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Coon H, Shabalin A, DiBlasi E, Monson ET, Han S, Kaufman EA, Chen D, Kious B, Molina N, Yu Z, Staley M, Crockett DK, Colbert SM, Mullins N, Bakian AV, Docherty AR, Keeshin B. Absence of nonfatal suicidal behavior preceding suicide death reveals differences in clinical risks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.05.24308493. [PMID: 38883733 PMCID: PMC11177925 DOI: 10.1101/2024.06.05.24308493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Nonfatal suicidality is the most robust predictor of suicide death. However, only ~10% of those who survive an attempt go on to die by suicide. Moreover, ~50% of suicide deaths occur in the absence of prior known attempts, suggesting risks other than nonfatal suicide attempt need to be identified. We studied data from 4,000 population-ascertained suicide deaths and 26,191 population controls to improve understanding of risks leading to suicide death. This study included 2,253 suicide deaths and 3,375 controls with evidence of nonfatal suicidality (SUI_SI/SB and CTL_SI/SB) from diagnostic codes and natural language processing of electronic health records notes. Characteristics of these groups were compared to 1,669 suicides with no prior nonfatal SI/SB (SUI_None) and 22,816 controls with no lifetime suicidality (CTL_None). The SUI_None and CTL_None groups had fewer diagnoses and were older than SUI_SI/SB and CTL_SI/SB. Mental health diagnoses were far less common in both the SUI_None and CTL_None groups; mental health problems were less associated with suicide death than with presence of SI/SB. Physical health diagnoses were conversely more often associated with risk of suicide death than with presence of SI/SB. Pending replication, results indicate highly significant clinical differences among suicide deaths with versus without prior nonfatal SI/SB.
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Affiliation(s)
- Hilary Coon
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrey Shabalin
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Emily DiBlasi
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Eric T. Monson
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Seonggyun Han
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin A. Kaufman
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Danli Chen
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brent Kious
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Zhe Yu
- Pedigree & Population Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Michael Staley
- Utah State Office of the Medical Examiner, Utah Department of Health and Human Services, Salt Lake City, UT
| | | | - Sarah M. Colbert
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Niamh Mullins
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Amanda V. Bakian
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anna R. Docherty
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brooks Keeshin
- Department of Psychiatry & Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT
- Primary Children’s Hospital Center for Safe and Healthy Families, Salt Lake City, UT
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Yavuz BE, Turan S, Mutlu C, Çamlı ŞE. A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls. Suicide Life Threat Behav 2024. [PMID: 38738815 DOI: 10.1111/sltb.13090] [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: 01/15/2024] [Revised: 03/31/2024] [Accepted: 04/18/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Deficits in neurocognition and social-cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social-cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide. METHOD Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age- and sex-matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social-cognition and neurocognitive characteristics. RESULTS Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246). CONCLUSION While the neurocognitive and social-cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.
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Affiliation(s)
- B Ece Yavuz
- Department of Child and Adolescent Psychiatry, TC Sağlık Bakanlığı Cizre Dr. Selahattin Cizrelioğlu Devlet Hastanesi, Şırnak, Turkey
| | - Serkan Turan
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Caner Mutlu
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Şafak Eray Çamlı
- Department ofChild and Adolescent Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Myers CE, Del Pozzo J, Perskaudas R, Dave CV, Chesin MS, Keilp JG, Kline A, Interian A. Impairment in recognition memory may be associated with near-term risk for suicide attempt in a high-risk sample. J Affect Disord 2024; 350:7-15. [PMID: 38220108 PMCID: PMC10922624 DOI: 10.1016/j.jad.2024.01.018] [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: 06/07/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Prior work has implicated several neurocognitive domains, including memory, in patients with a history of prior suicide attempt. The current study evaluated whether a delayed recognition test could enhance prospective prediction of near-term suicide outcomes in a sample of patients at high-risk for suicide. METHODS 132 Veterans at high-risk for suicide completed a computer-based recognition memory test including semantically-related and -unrelated words. Outcomes were coded as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as aborted/interrupted attempt or preparatory behavior, or neither (noSE), within 90 days after testing. RESULTS Reduced performance was a significant predictor of upcoming ASA, but not OtherSE, after controlling for standard clinical variables such as current suicidal ideation and history of prior suicide attempt. However, compared to the noSE reference group, the OtherSE group showed a reduction in the expected benefit of semantic relatedness in recognizing familiar words. A computational model, the drift diffusion model (DDM), to explore latent cognitive processes, revealed the OtherSE group had decreased decisional efficiency for semantically-related compared to semantically-unrelated familiar words. LIMITATIONS This study was a secondary analysis of an existing dataset, involving participants in a treatment trial, and requires replication; ~10 % of the sample was excluded from analysis due to failure to master the practice tasks and/or apparent noncompliance. CONCLUSION Impairments in recognition memory may be associated with near-term risk for suicide attempt, and may provide a tool to improve prediction of when at-risk individuals may be transitioning into a period of heightened risk for suicide attempt.
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Affiliation(s)
- Catherine E Myers
- Research Service, VA New Jersey Health Care Service, East Orange, NJ, United States of America; Department of Pharmacology, Physiology & Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, United States of America
| | - Jill Del Pozzo
- Mental Health and Behavioral Services, VA New Jersey Health Care Service, Lyons, NJ, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rokas Perskaudas
- Mental Health and Behavioral Services, VA New Jersey Health Care Service, Lyons, NJ, United States of America
| | - Chintan V Dave
- Research Service, VA New Jersey Health Care Service, East Orange, NJ, United States of America; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States of America
| | - Megan S Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America
| | - John G Keilp
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States of America
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, United States of America
| | - Alejandro Interian
- Mental Health and Behavioral Services, VA New Jersey Health Care Service, Lyons, NJ, United States of America; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, United States of America.
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Escobar LE, Liew M, Yirdong F, Mandelos KP, Ferraro-Diglio SR, Abraham BM, Polanco-Roman L, Benau EM. Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis. J Affect Disord 2024; 349:8-20. [PMID: 38169241 DOI: 10.1016/j.jad.2023.12.082] [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] [Received: 08/01/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control. METHODS We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA. RESULTS We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A. LIMITATIONS There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included. CONCLUSIONS Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.
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Affiliation(s)
- Lesly E Escobar
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | - Megan Liew
- Department of Psychology, SUNY Stony Brook, Stony Brook, NY, USA; Department of Psychology, University of Missouri, Columbia, MO, USA
| | - Felix Yirdong
- Department of Psychology, CUNY Graduate Center, New York, NY, USA
| | | | | | - Blessy M Abraham
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Erik M Benau
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA.
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Wang Q, Wen M, Fan S, Liu J, Wang X, Guo W, Hu J, Zhang J, Li B, Zhang L, Zhang Y, Li K. Attention-Dominated Cognitive Dysfunction May Be a Biological Marker for Distinguishing SA from SI in Adolescents: A Network Analysis Study Based on Adolescent Depression. Psychol Res Behav Manag 2024; 17:945-956. [PMID: 38464812 PMCID: PMC10924855 DOI: 10.2147/prbm.s448904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/27/2024] [Indexed: 03/12/2024] Open
Abstract
Objective Suicidal behavior is strongly correlated with depressive symptoms and the degree of suicidal ideation. Cognitive impairment may have varying degrees of influence on suicidal ideation (SI) and suicidal attempts (SA). The aim of this study was to identify the cognitive biomarkers that distinguish suicidal ideation from suicidal attempts in adolescents. Methods The cross-sectional sample comprised 54 adolescents with major depressive disorder (MDD) and 32 healthy controls (HC). The THINC-it was utilized to assess cognitive function of all the samples. Suicidal ideation was examined by the Positive and Negative Suicide Ideation Scale (PANSI). Based on the type of data, one-way ANOVA or Kruskal-Wallis was performed to investigate group differences. Bonferroni post-hoc analysis was employed for regulating type I error for pairwise comparisons. Network analysis was used to compare the networks associated with suicidal ideation, depression symptoms, and cognitive function between SA and SI. Results The depression symptoms (HAMD-17) (F=72.515, P<0.001) and suicidal ideation (PANSI) (F=267.952, P<0.001) in the SA were higher than those in the SI. Analysis of between-group differences showed SA performed worse in THINC-it, especially in "Spotter (SP)" (P=0.033), "Objective cognition score (OS)" (P=0.027) and "Composite score (CS)" (P=0.017). Compared with SI, network analysis revealed that SA had a unique network of cognitive function, depressive symptoms, and suicidal ideation. Nevertheless, both networks exhibit comparable performance concerning the node strength of cognitive function. Within their separate networks, the aspects of CS, OS, and SP have emerged as the three most crucial elements. Conclusion Adolescents with SI or SA exhibit a broad spectrum of cognitive impairments. Attention impairment can be beneficial in discerning between SI and SA. Future interventions for adolescent suicide can center on attention and the comprehensive cognitive ability that it represents.
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Affiliation(s)
- Qi Wang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Min Wen
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shaohang Fan
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jinning Liu
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Xiaowen Wang
- Psychosomatic Medicine Department, Jiangxi Provincial People's Hospital, Nanchang, People's Republic of China
| | - Wentao Guo
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Jinyun Hu
- Psychiatric Department, The Second People's Hospital of Yuxi, Yunnan, People's Republic of China
| | - Jialan Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
| | - Bing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Lili Zhang
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Yunshu Zhang
- Clinical Medicine College, Hebei University, Hebei, People's Republic of China
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Hebei, People's Republic of China
- Hebei Provincial Key Laboratory of Major Mental and Behavioral Disorders, Hebei, People's Republic of China
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Yun JY, Choi SH, Park S, Jang JH. Association of executive function with suicidality based on resting-state functional connectivity in young adults with subthreshold depression. Sci Rep 2023; 13:20690. [PMID: 38001278 PMCID: PMC10673918 DOI: 10.1038/s41598-023-48160-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] [Received: 09/23/2023] [Accepted: 11/22/2023] [Indexed: 11/26/2023] Open
Abstract
Subthreshold depression (StD) is associated an increased risk of developing major depressive disorder (MDD) and suicidality. Suicidality could be linked to distress intolerance and use of context-dependent strategies. We identified neural correlates of executive functioning among the hubs in the resting-state functional connectome (rs-FCN) and examined associations with recent suicidality in StD and MDD. In total, 79 young adults [27 StD, 30 MDD, and 23 healthy controls (HC)] were scanned using magnetic resonance imaging. Neurocognitive measures of the mean latency to correct five moves in the One Touch Stockings of Cambridge (OTSMLC5), spatial working memory between errors (SWMBE), rapid visual information processing A' (RVPA'), and the stop signal reaction time in the stop signal test (SSTSSRT) were obtained. Global graph metrics were calculated to measure the network integration, segregation, and their balance in the rs-FCN. Regional graph metrics reflecting the number of neighbors (degree centrality; DC), participation in the shortcuts (betweenness centrality; BC), and accessibility to intersections (eigenvector centrality; EC) in the rs-FCN defined group-level hubs for StD, HC, and MDD, separately. Global network metrics were comparable among the groups (all P > 0.05). Among the group-level hubs, regional graph metrics of left dorsal anterior insula (dAI), right dorsomedial prefrontal cortex (dmPFC), right rostral temporal thalamus, right precuneus, and left postcentral/middle temporal/anterior subgenual cingulate cortices were different among the groups. Further, significant associations with neurocognitive measures were found in the right dmPFC with SWMBE, and left dAI with SSTSSRT and RVPA'. Shorter OTSMLC5 was related to the lower centralities of right thalamus and suffer of recent 1-year suicidal ideation (all Ps < 0.05 in ≥ 2 centralities out of DC, BC, and EC). Collectively, salience and thalamic networks underlie spatial strategy and planning, response inhibition, and suicidality in StD and MDD. Anti-suicidal therapies targeting executive function and modulation of salience-thalamic network in StD and MDD are required.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Susan Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Psychiatry, Seoul National University Health Service Center, 1 Gwanak-Ro, Gwanak-Gu, 08826, Seoul, Republic of Korea.
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Chen Q, Armstrong SE, Vakil F, Bridge JA, Keilp JG, Sheftall AH. Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors. J Affect Disord 2023; 339:318-324. [PMID: 37442443 PMCID: PMC10530242 DOI: 10.1016/j.jad.2023.07.038] [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: 02/22/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. METHODS The current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. RESULTS Of the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. LIMITATIONS Prospective data is needed to confirm cross-sectional findings. CONCLUSIONS Poorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.
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Affiliation(s)
- Qi Chen
- Columbia University, NY, New York, United States of America
| | | | - Fatima Vakil
- Abdul Latif Jameel Poverty Action Lab (J-PAL) North America, Massachusetts Institute of Technology (MIT), Cambridge, MA, United States of America
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America; Departments of Pediatrics and Psychiatry & Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - John G Keilp
- Department of Psychiatry, Columbia University, NY, New York, United States of America
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America.
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Albermann M, Emery S, Baumgartner N, Strumberger M, Erb S, Wöckel L, Müller-Knapp U, Rhiner B, Contin-Waldvogel B, Bachmann S, Schmeck K, Berger G, Häberling I. Executive functions and borderline personality features in adolescents with major depressive disorder. Front Hum Neurosci 2023; 17:957753. [PMID: 37425294 PMCID: PMC10325791 DOI: 10.3389/fnhum.2023.957753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF). Methods We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity. Results Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries. Conclusion On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF. Clinical trial registration www.ClinicalTrials.gov, identifier NCT03167307.
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Affiliation(s)
- Mona Albermann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | - Sophie Emery
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | | | - Michael Strumberger
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
| | - Suzanne Erb
- Child and Adolescent Psychiatric Services St. Gallen, St. Gallen, Switzerland
| | - Lars Wöckel
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
- Clienia Littenheid AG, Littenheid, Switzerland
| | | | - Bruno Rhiner
- Child and Adolescent Psychiatry Thurgau, Weinfelden, Switzerland
| | | | - Silke Bachmann
- University Clinic of the Martin-Luther University Halle – Wittenberg’s Medical Faculty, Halle, Germany
- Département de Psychiatrie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Klaus Schmeck
- Research Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel, University of Basel, Basel, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland
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10
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Riera-Serra P, Gili M, Navarra-Ventura G, Riera-López Del Amo A, Montaño JJ, Coronado-Simsic V, Castro A, Roca M. Longitudinal associations between executive function impairments and suicide risk in patients with major depressive disorder: A 1-year follow-up study. Psychiatry Res 2023; 325:115235. [PMID: 37178501 DOI: 10.1016/j.psychres.2023.115235] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/16/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Impaired executive function (EF) is a key feature of patients with major depressive disorder (MDD) that several studies have linked to suicidal ideation and suicide attempts. This is the first longitudinal study to examine the association between impaired EF and suicide risk in adult patients with MDD. Longitudinal prospective study with 3 assessment points: baseline, 6 and 12 months. The Columbia-Suicide Severity Rating Scale (C-SSRS) was used to assess suicidality. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess EF. The association between EF impairments and suicidality was analyzed using mixed-effects models. Out of 167 eligible outpatients, 104 were included in the study. Of these, 72 were re-evaluated at 6 months and 60 at 12 months, obtaining 225 complete observations of the EF. Impaired decision-making and risk-taking behavior were associated with suicidal ideation. Difficulty in impulse control was related to suicidal ideation and to greater severity of suicidal ideation. Impaired spatial planning and working memory was linked to suicide attempts. Our results add to previous literature that the association between EF impairments and suicidality is maintained over the long term, supporting it as a longitudinal risk factor and a possible neurocognitive marker of suicide in patients with MDD.
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Affiliation(s)
- Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Guillem Navarra-Ventura
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain.
| | - Antonio Riera-López Del Amo
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Juan José Montaño
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
| | - Victoria Coronado-Simsic
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Adoración Castro
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Edificio S, Palma (Mallorca), Spain; Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain
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11
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Itzhaky L, Chubarov E, Keilp JG, Shbiro L, Levy T, Zalsman G. Cognitive flexibility in inpatient children and adolescents with a history of suicide attempts. Psychiatry Res 2023; 321:115067. [PMID: 36738593 DOI: 10.1016/j.psychres.2023.115067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Abstract
An increase in suicide rates during adolescence has made it the second leading cause of death for this age group. While potential deficits in cognitive flexibility have been thought to contribute to suicidality, this factor has been evaluated in only a few studies among this age group. The current study sought to evaluate cognitive flexibility in 100 psychiatric inpatient children and adolescents (age X=14.39, SD=2.53), with (n=26) and without (n=74) a history of suicide attempts, using the Wisconsin Card Sorting Test (WCST). Results showed no differences between the groups in WCST scores. However, in a small sub-sample with mood disorders only, those with a history of a suicide attempt performed better than those without such history. These findings are contrary to our hypothesis that those who attempted suicide have worse cognitive flexibility, though consistent with earlier data in adults. Further research is needed to shed light on these findings.
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Affiliation(s)
- Liat Itzhaky
- Geha Mental Health Center, Petah Tikva, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, NY, USA.
| | | | - John G Keilp
- Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, NY, USA
| | - Liat Shbiro
- Geha Mental Health Center, Petah Tikva, Israel
| | - Tomer Levy
- Geha Mental Health Center, Petah Tikva, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tikva, Israel; Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, NY, NY, USA; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Israel
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12
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Chen L, Wang Q, Xu T. Working memory function in patients with major depression disorder: A narrative review. Clin Psychol Psychother 2022; 30:281-293. [PMID: 36510396 DOI: 10.1002/cpp.2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
Working memory (WM) deficits are recognized as serious cognitive impairment in patients with major depressive disorder (MDD). This review aims to clarify the effects of impaired WM function in patients with MDD and explore non-invasive and effective treatments that can be adopted in clinical practice. This review (1) synthesizes extant literature examining brain function and brain areas in terms of WM in individuals with depression, (2) utilizes the outcomes of the studies presented in this review to discuss the effects of impaired WM function on cognitive processing in individuals with depression, (3) integrates the treatments explored in current studies and (4) provides some suggestions for future research. We found that (1) central executive (CE) components affect the processing of WM, and this might be one of the factors influencing cognitive biases, as it is implicated in repetitive negative thinking and rumination; (2) the left dorsal anterior cingulate cortex (dACC), the left dorsolateral prefrontal cortex (DLPFC) and the regions of the default mode network (DMN) play a vital role in CE functioning; and (3) psychotherapy, cognitive training, exercise and physical therapy can be used as complementary treatments for MDD.
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Affiliation(s)
- Lijie Chen
- School of Medical Humanities, China Medical University, Shenyang, China.,Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Qi Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Tianchao Xu
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
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13
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Wu H, Lu L, Qian Y, Jin XH, Yu HR, Du L, Fu XL, Zhu B, Chen HL. The significance of cognitive-behavioral therapy on suicide: An umbrella review. J Affect Disord 2022; 317:142-148. [PMID: 36041581 DOI: 10.1016/j.jad.2022.08.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/27/2022] [Accepted: 08/21/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Suicide becomes a widespread public health concern. Cognitive-behavioral therapy (CBT) is used to correct negative thoughts and behaviors of patients at risk of suicide. The aim of this research is to summarize and evaluate the existing evidence to explore the impact of CBT on suicide. METHOD We conducted a systematic searched in PubMed, Web of Science, Cochrane database from the first available year to March 2021. The methodological quality was evaluated by AMSTAR-2 tool, and the evidence quality was evaluated by GRADE classification. We summarized all the comparative effects of CBT on suicide, and used forest plots to describe the impact of CBT on suicide related outcomes included suicidal ideation, suicide attempts. The random effects model was used to summarize data. RESULTS Nine systematic reviews and meta-analysis were included. Most of the systematic reviews and meta-analysis were of medium methodological and evidence quality. The impact of CBT on suicide outcomes could be divided into the following two categories: CBT reduced levels of suicidal ideation (SMD -0.28, 95 % CI -0.36 to -0.21), CBT relieved suicide attempts (RR 0.77, 95 % CI 0.69 to 0.87). CONCLUSION Based on the current evidence, CBT could relieve suicide, including suicide ideation, suicide attempts. CBT is scalable and cost-effective. It is helpful for health professionals to formulate personalized CBT programs, promote clinical and community applications and integrate them into comprehensive suicide interventions and prevention strategies.
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Affiliation(s)
- Hua Wu
- Medical School of Nantong University, Nantong, Jiangsu 226001, China
| | - Liu Lu
- Medical School of Nantong University, Nantong, Jiangsu 226001, China
| | - Yan Qian
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Xiao-Hong Jin
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Hai-Rong Yu
- Department of Thoracic Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
| | - Lin Du
- Medical School of Nantong University, Nantong, Jiangsu 226001, China
| | - Xue-Lei Fu
- Medical School of Nantong University, Nantong, Jiangsu 226001, China
| | - Bin Zhu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nantong, University and Nantong First people's Hospital, Haier Lane Road, No.6, Nantong, Jiangsu 226001, China.
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu 226019, China.
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14
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Karvelis P, Diaconescu AO. A Computational Model of Hopelessness and Active-Escape Bias in Suicidality. COMPUTATIONAL PSYCHIATRY (CAMBRIDGE, MASS.) 2022; 6:34-59. [PMID: 38774778 PMCID: PMC11104346 DOI: 10.5334/cpsy.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/15/2022] [Indexed: 12/27/2022]
Abstract
Currently, psychiatric practice lacks reliable predictive tools and a sufficiently detailed mechanistic understanding of suicidal thoughts and behaviors (STB) to provide timely and personalized interventions. Developing computational models of STB that integrate across behavioral, cognitive and neural levels of analysis could help better understand STB vulnerabilities and guide personalized interventions. To that end, we present a computational model based on the active inference framework. With this model, we show that several STB risk markers - hopelessness, Pavlovian bias and active-escape bias - are interrelated via the drive to maximize one's model evidence. We propose four ways in which these effects can arise: (1) increased learning from aversive outcomes, (2) reduced belief decay in response to unexpected outcomes, (3) increased stress sensitivity and (4) reduced sense of stressor controllability. These proposals stem from considering the neurocircuits implicated in STB: how the locus coeruleus - norepinephrine (LC-NE) system together with the amygdala (Amy), the dorsal prefrontal cortex (dPFC) and the anterior cingulate cortex (ACC) mediate learning in response to acute stress and volatility as well as how the dorsal raphe nucleus - serotonin (DRN-5-HT) system together with the ventromedial prefrontal cortex (vmPFC) mediate stress reactivity based on perceived stressor controllability. We validate the model by simulating performance in an Avoid/Escape Go/No-Go task replicating recent behavioral findings. This serves as a proof of concept and provides a computational hypothesis space that can be tested empirically and be used to distinguish planful versus impulsive STB subtypes. We discuss the relevance of the proposed model for treatment response prediction, including pharmacotherapy and psychotherapy, as well as sex differences as it relates to stress reactivity and suicide risk.
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Affiliation(s)
- Povilas Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Andreea O. Diaconescu
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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