A Neural Basis for the Acquired Capability for Suicide

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

Alterations of insular dynamic functional connectivity and psychological characteristics in unmedicated bipolar depression patients with a recent suicide attempt

BACKGROUND

Mounting evidence showed that insula contributed to the neurobiological mechanism of suicidal behaviors in bipolar disorder (BD). However, no studies have analyzed the dynamic functional connectivity (dFC) of insular Mubregions and its association with personality traits in BD with suicidal behaviors. Therefore, we investigated the alterations of dFC variability in insular subregions and personality characteristics in BD patients with a recent suicide attempt (SA).

METHODS

Thirty unmedicated BD patients with SA, 38 patients without SA (NSA) and 35 demographically matched healthy controls (HCs) were included. The sliding-window analysis was used to evaluate whole-brain dFC for each insular subregion seed. We assessed between-group differences of psychological characteristics on the Minnesota Multiphasic Personality Inventory-2. Finally, a multivariate regression model was adopted to predict the severity of suicidality.

RESULTS

Compared to NSA and HCs, the SA group exhibited decreased dFC variability values between the left dorsal anterior insula and the left anterior cerebellum. These dFC variability values could also be utilized to predict the severity of suicidality (r = 0.456, p = 0.031), while static functional connectivity values were not appropriate for this prediction. Besides, the SA group scored significantly higher on the schizophrenia clinical scales (p < 0.001) compared with the NSA group.

CONCLUSIONS

Our findings indicated that the dysfunction of insula-cerebellum connectivity may underlie the neural basis of SA in BD patients, and highlighted the dFC variability values could be considered a neuromarker for predictive models of the severity of suicidality. Moreover, the psychiatric features may increase the vulnerability of suicidal behavior.

The amygdala connectivity with depression and suicide ideation with suicide behavior: A meta-analysis of structural MRI, resting-state fMRI and task fMRI

In recent decades, the primary intention of neuroscientists and psychiatrics is to evaluate the connectivity between brain regions and psychiatric disorders. The amygdala has central immersion in memory alliance, stress response, emotional perception, and automatic responses to emotional stimuli. This paper uses a meta-analysis approach to establish the relationship between structural resting state and functional amygdala connectivity with depression and suicide ideation with suicide behavior. In addition, this study explores the moderating effect of patients' demographic characteristics (gender and age) based on 30 studies. The results show that structural amygdala connectivity is positively related to the instability of depression, while for resting and task functional connectivity amygdala shows a significant negative connection with depression. Furthermore, the amygdala showed a partial activation for non-suicide self-injuries and suicide ideation. From structural and functional magnetic imaging, the current findings also support the moderating effect of the age of the participants on the amygdala connectivity with psychiatric conditions. Generally, amygdala connectivity with psychiatric disorders was not significantly moderate with the role of gender, however, this study enhances the existing hypothetical review articles and confirms the connectivity of the psychological condition with the amygdala region. It concludes that the amygdala plays a vital role in regulating and responding to emotions.

Resting-state neural mechanisms of capability for suicide and their interaction with pain - A CAN-BIND-05 Study

BACKGROUND

Suicidal ideation is highly prevalent in Major Depressive Disorder (MDD). However, the factors determining who will transition from ideation to attempt are not established. Emerging research points to suicide capability (SC), which reflects fearlessness of death and increased pain tolerance, as a construct mediating this transition. This Canadian Biomarker Integration Network in Depression study (CANBIND-5) aimed to identify the neural basis of SC and its interaction with pain as a marker of suicide attempt.

METHODS

MDD patients (n = 20) with suicide risk and healthy controls (n = 21) completed a self-report SC scale and a cold pressor task measuring pain threshold, tolerance, endurance, and intensity at threshold and tolerance. All participants underwent a resting-state brain scan and functional connectivity was examined for 4 regions: anterior insula (aIC), posterior insula (pIC), anterior mid-cingulate cortex (aMCC) and subgenual anterior cingulate cortex (sgACC).

RESULTS

In MDD, SC correlated positively with pain endurance and negatively with threshold intensity. Furthermore, SC correlated with the connectivity of aIC to the supramarginal gyrus, pIC to the paracingulate gyrus, aMCC to the paracingulate gyrus, and sgACC to the dorsolateral prefrontal cortex. These correlations were stronger in MDD compared to controls. Only threshold intensity mediated the correlation between SC and connectivity strength.

LIMITATIONS

Resting-state scans provided an indirect assessment of SC and the pain network.

CONCLUSIONS

These findings highlight point to a neural network underlying SC that is associated with pain processing. This supports the potential clinical utility of pain response measurement as a method to investigate markers of suicide risk.

Risk-Taking Behavior among Suicide Attempters

Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.

The Interaction Effects of Suicidal Ideation and Childhood Abuse on Brain Structure and Function in Major Depressive Disorder Patients

Suicidal ideation (SI) is a direct risk factor for suicide in patients with depression. Regarding the emergence of SI, previous studies have discovered many risk factors, including childhood abuse as the major public problem. Previous imaging studies have demonstrated that SI or childhood abuse has effects on brain structure and function, respectively, but the interaction effects between them have not been fully studied. To explore the interaction effect between SI and childhood abuse, 215 patients with major depressive disorder completed the Childhood Trauma Questionnaire to evaluate childhood abuse and Beck's Scale for Suicidal Ideation to evaluate SI. Then, they completed magnetic resonance imaging (MRI) within one week after completing questionnaires. Respectively, we preprocessed the structural and functional images and analyzed gray matter volumes (GMV) and mean fractional amplitude of low-frequency fluctuation (mfALFF) values. Results showed that the changes of GMV in the cuneus, precuneus, paracentric lobule, inferior frontal gyrus, and caudate nucleus and local activity in cuneal and middle temporal gyrus are in relation with SI and childhood abuse. And in left caudate, SI and childhood abuse interact with each other on the influence of GMV. That is, the influence of SI in GMV was related to childhood abuse, and the influence of childhood abuse in GMV was also related to SI. Therefore, the combination of SI and childhood abuse based on imaging should help us better understand the suicide ideation developing mechanism and propose more effective targeted prevention strategies for suicide prevention.

Identification of Risk Factors to Predict the Occurrences of Relapses in Individuals with Schizophrenia Spectrum Disorder in Iran

Schizophrenia Spectrum Disorder (SSD) is a chronic psychiatric disorder with a modest treatment outcome. In addition, relapses are commonplace. Here, we sought to identify factors that predict relapse latency and frequency. To this end, we retrospectively analyzed data for individuals with SSD. Medical records of 401 individuals with SSD were analyzed (mean age: 25.51 years; 63.6% males) covering a five-year period. Univariate and multivariate Penalized Likelihood Models with Shared Log-Normal Frailty were used to determine the correlation between discharge time and relapse and to identify risk factors. A total of 683 relapses were observed in males, and 422 relapses in females. The Relapse Hazard Ratio (RHR) decreased with age (RHR = 0.99, CI: (0.98–0.998)) and with participants’ adherence to pharmacological treatment (HR = 0.71, CI: 0.58–0.86). In contrast, RHR increased with a history of suicide attempts (HR = 1.32, CI: 1.09–1.60), and a gradual compared to a sudden onset of disease (HR = 1.45, CI: 1.02–2.05). Gender was not predictive. Data indicate that preventive and therapeutic interventions may be particularly important for individuals who are younger at disease onset, have a history of suicide attempts, have experienced a gradual onset of disease, and have difficulties adhering to medication.

Gray matter volume alterations associated with suicidal ideation and suicide attempts in patients with mood disorders

BACKGROUND

Mood disorders are severe mental disorders related to increased suicidal behavior. Finding neural features for suicidal behavior, including suicide attempts (SAs) and suicidal ideation (SI), in mood disorders may be helpful in preventing suicidal behavior.

METHODS

Subjects consisted of 70 patients with mood disorders and suicidal behavior, 128 patients with mood disorders without suicidal behavior (mood disorders control, MC), and 145 health control (HC) individuals. All participants underwent structural magnetic resonance imaging (MRI). We used voxel-based morphometry (VBM) techniques to examine gray matter volumes (GMVs).

RESULTS

Significant differences were found in GMVs of the left and right middle frontal gyrus among the patients with mood disorders and suicidal behavior, MC, and HC. Post hoc comparisons showed significant differences in the GMVs of the above regions across all three groups (P < 0.01): HC > MC > mood disorders with suicidal behavior. However, there were no significant differences in the GMVs of the left and right middle frontal gyrus between the mood disorders with SI and mood disorders with SAs groups.

CONCLUSIONS

These findings provide evidence that abnormal regional GMV in the middle frontal gyrus is associated with suicidal behavior in mood disorders. Further investigation is warranted to determine whether the GMV alterations in mood disorders with SI are different from these in mood disorders with SAs.

Gradually evaluating of suicidal risk in depression by semi-supervised cluster analysis on resting-state fMRI

A timely and effective evaluation of the suicidal ideation bears practical meaning, particularly for the depressive who tend to disguise the real suicide intent and without obvious symptoms. Measuring individual ideation of the depression with uncertain or transient suicide crisis is the purpose. Resting-state fMRI data were collected from 78 depressed patients with variable clinical suicidal crisis. Thirty subjects were well labeled as extremely serious individuals with suicide attempters or as without suicidal ideation. A feature mask was constructed via the two sample t-test on their regional conncectivities. Then, a semi-supervised machine learning frame using the feature mask was designed to assist in clarifying gradation of suicidal susceptibility for the residual forty-eight vaguely defined subjects, by a way of Iterative Self-Organizing Data analysis techniques (ISODATA). Such semi-supervised model was designed purposely to block out the effect of disease itself on the suicide intendancy evaluation. The vague-labeled patients were divided into another two different stages relating to their suicidal susceptibility. The distance ratio of each subject to the two well-defined extreme groups in the feature space can be utilized as the suicide risk index. The re-evaluation of the Nurses' Global Assessment of Suicide Risk (NGASR) via experts blind to original HAM-D rates was significantly correlated with the model estimation. The constructed model suggested its potential to examine the risk of suicidal in an objective way. The functional connectivity, locating mostly within the frontal-temporal circuit and involving the default mode network (DMN), were well integrated to discriminative the gradual susceptibility of suicidal.

ADAPTED TO FEAR: FEARLESSNESS ABOUT DEATH IS ASSOCIATED WITH HEART RATE VARIABILITY

Objective: Capability for suicide, which refers to an individual's ability to enact potentially lethal harm to oneself and overcome the fear of dying, is an empirically supported component of the Interpersonal-Psychological Theory of Suicide. Although an abundance of research has examined capability for suicide through the use of self-report data, little research has assessed specific psychophysiological mechanisms that may contribute to capability for suicide. We assessed relationships between capability for suicide (fearlessness about death and pain tolerance), high frequency heart rate variability (HF HRV), and subjectively reported fear during a death related event. Given that greater HRV is associated with calmness and lack of distress, we predicted that HRV during a fearful event would be positively associated with the capability for suicide.

Method: Data were collected from 101 undergraduates. Participants self-reported fearlessness about death and had their pain tolerance assessed with an algometer. HF HRV was assessed prior to, during, and following a film-viewing task designed to elicit fear of death.

Results: Correlations revealed that fearlessness about death was negatively associated with self-reported fear during the film viewing and positively associated with self-reported and objective pain tolerance. Linear regressions found that fearlessness about death, but not self-reported or objective pain tolerance, was positively associated with HF HRV during the film-viewing and recovery.

Discussion: During a fearful, death related event, greater HF HRV was associated with greater fearlessness about death, suggesting that HF HRV may represent one possible mechanism through which fearlessness about death is maintained.

Understanding the Transition from Suicidal Desire to Planning and Preparation: Correlates of Suicide Risk within a Psychiatric Inpatient Sample of Ideators and Attempters

BACKGROUND

There is a clear need to better understand the trajectory from suicidal ideation to enactment of lethal suicidal behavior. Identification of factors that promote desire and the transition to intent and behavior is critical for the advancement of theory, risk formulation, and prevention.

METHOD

In this cross sectional study, correlates of suicide risk were examined at theoretically distinct points along the trajectory from suicidal thinking to behavior (i.e., desire, plans and preparations, suicide attempt) in a manner consistent with the Three-Step Theory and an ideation-to-action framework. The sample included 197 adult inpatients (60% male, 40% white) hospitalized due to ideation or a recent suicide attempt.

RESULTS

Psychological pain and fearlessness about death were associated with desire and plans and preparations for suicide. There were no significant differences in suicide risk correlates between ideators and attempters.

LIMITATIONS

The primary limitations of the current study relate to the cross-sectional design and the nature of the sample, which do not allow for inference of causal relations, or generalizability to outpatient and community samples or to individuals who die by suicide.

CONCLUSIONS

Psychological pain and fearlessness about death may function as transitional factors that are associated with the transition from desire to suicidal intent in psychiatric inpatients. Findings have important implications for clinical practice. Treatment interventions should reduce psychological pain, increase safety, and reduce access to means.

Serum oxytocin concentrations in current and recent suicide survivors are lower than in healthy controls

BACKGROUND

Suicide and suicide attempts are dramatic events both for the individuals concerned and for their social circles. From a psychopathological perspective, suicidal behavior could be understood as a severe breakdown in relations with their social worlds. Oxytocin is a neuropeptide highly involved in the perception of facets of social relationship such as their quality feelings of belongingness, and mutual trust. Given this, we expected that serum oxytocin concentrations would be lower in current and recent suicide survivors than in healthy controls.

METHODS

A total of 48 participants (mean age: 27 years; 62.5% females) took part in the study. Of these, 16 (62.5% females) survived a suicide attempt 12-24 h ago; 16 (62.5% females) had made a suicide attempt about 12 weeks ago, and 16 (62.5% females) were healthy age- and gender-matched controls. Blood samples were taken in the morning to assess serum oxytocin concentrations. Participants also completed questionnaires covering sociodemographic information and a scale assessing suicidal ideation.

RESULTS

Compared to healthy controls, suicide survivors had significantly lower serum oxytocin concentrations, but these levels did not differ between current and recent suicide survivors. Compared to healthy controls and recent suicide attempters, current suicide attempters recorded significantly higher scores on the Beck scale for suicidal ideation. Across the sample as a whole, higher scores for suicidal ideation were associated with lower serum oxytocin concentrations. Serum oxytocin concentrations and scores on the Beck scale for suicidal ideation did not differ between females and males.

CONCLUSIONS

Given that oxytocin is a neurobiological correlate of subjectively perceived quality of social interaction and social relationships, the results support the notion that suicide attempts are closely linked to suicide survivors' perceptions of the quality of their social lives. Speculatively, and based on the serum oxytocin concentrations, it also appears that 12 weeks after a suicide attempt, the survivor's perceived quality of social life has not significantly improved.

Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation

BACKGROUND

Suicidality is a leading cause of death among adolescents. In addition to other psychiatric conditions, youths with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) are at heightened risk for suicide. Decision-making deficits are a hallmark symptom of ADHD and DBDs and are also implicated in suicidal behavior. We examined behavioral and neural differences in decision making among youths with ADHD and DBDs with (SI+) and without (SI-) histories of suicidal ideation.

METHODS

The Balloon Analog Risk Task, a risky decision-making task, was completed by 57 youths with ADHD and DBDs (38% SI+) during functional magnetic resonance imaging. Mean stop wager (mean wager at which youths bank money) was the primary measure of risk taking. We conducted whole-brain and region-of-interest analyses in the anterior cingulate cortex and orbitofrontal cortex (OFC) during choice (win vs. inflate) and outcome (inflate vs. explode) contrasts using parametric modulators accounting for probability of balloon explosion.

RESULTS

There were no differences between SI+ and SI- youths in Balloon Analog Risk Task performance. SI+ youths showed decreasing activation in the right medial frontal gyrus when choosing inflate as explosion probability increased compared with SI- youths. During explosions, SI- youths showed increasing activation in the left OFC as explosions became more likely. SI+ showed increasing left medial OFC activity in response to inflations as explosion probability increased.

CONCLUSIONS

SI+ youths may show heightened sensitivity to immediate reward and decreased sensitivity to potential loss as evidenced by medial frontal gyrus activity. OFC findings suggest that SI+ youths may be drawn to reward even when there is high probability of loss.

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

Biological bases of suicidal behaviours: A narrative review

Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.

[Social pain at the core of suicidal behavior]

BACKGROUND

Intolerable pain is often reported in suicide notes. Moreover, the frequency of life events preceding a suicidal act is high, especially interpersonal difficulties. Such adversity is the source of psychological or social pain.

METHODS

We propose a narrative review to discuss the role of pain in the suicidal process while having a focus on social ties.

RESULTS

Using Ecological Momentary Assessment in suicide attempters it has been shown that being alone increased suicidal ideation while being with close others significantly reduced this risk. At a neuroanatomical level, suicidal vulnerability is associated with dysfunctional insula activation during social exclusion, a region involved in social and physical pain processing. Social pain elicited by social exclusion or devaluation shares common neurobiological patterns with physical pain. It is also an exemplar of psychological pain. Despite the complexity of its definition, higher psychological pain levels are associated with suicidal ideation and acts. Finally, intense physical pain or chronic pain are strong risk factors of suicidal ideation and act. Interestingly, suicide notes often report the existence of an intolerable pain. Presence of psychological pain and difficulties in communication predict the lethality and seriousness of suicide attempts. Moreover, presence of psychological pain is associated with more impulsive choices in suicidal patients, suggesting that a suicidal act is a means to escape intolerable suffering despite negative long-term consequences (i.e. death). Analgesics are usually used to get relief from pain but are also frequently involved in suicidal overdoses. It has been shown that opioid analgesics are associated with an increased risk of suicide. Higher consumption of opioid analgesics has been shown in suicidal patients in comparison to patients with history of depression but no suicidal act and healthy controls whereas non-suicidal patients were those reporting higher presence of pain in comparison to healthy controls. It may suggest that opioids are being used by suicidal patients to get relief from psychological/social pain rather than from physical pain. Involvement of opioidergic system in suicidal process opens new therapeutic strategies. Recently, the time-limited, short-term use of very low dosages of sublingual buprenorphine (vs. placebo) was associated with decreased suicidal ideation and mental pain in severely suicidal patients without substance abuse. In a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder, ACT has shown its effectiveness in reducing suicidal ideation and psychological pain. Evidence indicates that maintaining contact either via letter, postcard or telephone with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Based on these results, a preventive program of recontact for suicide attempters, VIGILANS, has been developed in France in usual care.

CONCLUSION

The approach of the suicidal issue by the angle of pain and social disconnection offers new advances to improve clinical assessment, to identify new biological pathways involved in suicidal risk, and to propose innovative therapeutic and preventive actions.

Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts

BACKGROUND

Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs).

METHOD

Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background.

RESULTS

A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI.

CONCLUSIONS

The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.

Interest of neuroimaging of social exclusion in suicide

With one million deaths worldwide, suicide is a major health issue. The frequency of life events preceding suicidal act is high and raises the question of their role in suicidal process. At biological level, dysfunctional neural processing of social exclusion may participate in suicidal risk through an increased perception of social adversity in vulnerable subjects. The purpose of this narrative review is to discuss neuroimaging findings related to social exclusion and loneliness, and to open new perspectives to investigate sensitivity to social stress in suicide.

Critical Issues in Men's Mental Health

This narrative review highlights key issues in men's mental health and identifies approaches to research, policy and practice that respond to men's styles of coping. Issues discussed are: 1) the high incidence of male suicide (80% of suicide deaths in Canada, with a peak in the mid-50 s age group) accompanied by low public awareness; 2) the perplexing nature of male depression, manifesting in forms that are poorly recognised by current diagnostic approaches and thus poorly treated; 3) the risky use of alcohol among men, again common and taking a huge toll on mental and physical health; 4) the characteristic ways in which men manage psychological suffering, the coping strengths to be recognised, and the gaps to be addressed; 5) the underutilization of mental health services by men, and the implication for clinical outcomes; and 6) male-specific approaches to service provision designed to improve men's accessing of care, with an emphasis on Canadian programs. The main conclusion is that a high proportion of men in Western society have acquired psychological coping strategies that are often dysfunctional. There is a need for men to learn more adaptive coping approaches long before they reach a crisis point. Recommendations are made to address men's mental health through: healthcare policy that facilitates access; research on tailoring interventions to men; population-level initiatives to improve the capacity of men to cope with psychological distress; and clinical practice that is sensitive to the expression of mental health problems in men and that responds in a relevant manner.

Cholecystokinin (CCK) level is higher among first time suicide attempters than healthy controls, but is not associated with higher depression scores

Suicide and suicide attempts are dramatic events for both the individuals concerned and for their social environments. Efforts have been made to identify reliable biological predictors of suicide and suicide attempts. In the present study, we focused on one potential marker, cholecystokinin (CCK), among first time suicide attempters. A total of 25 suicide attempters (mean age: 30 years; 80% females) and 23 healthy controls were enrolled in the present cross-sectional study. Experts rated participants' symptoms of depression (Hamilton Depression Rating Scale; HDRS). Blood levels of CCK levels were assessed. Suicide attempters had CCK levels 22.67 times higher and HDRS scores 14.33 higher than healthy controls. CCK levels were only weakly associated with HDRS scores. CCK appears to be a fairly reliable biomarker for suicide attempts. However, CCK levels were not associated with depression scores, making it difficult to match biological markers to depressive behaviour.

Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions

PURPOSE OF REVIEW

The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide.

RECENT FINDINGS

Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior. A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs.

Network basis of suicidal ideation in depressed adolescents

BACKGROUND

Suicidal ideation rates rise precipitously in adolescence, contributing to risk for attempts. Although researchers are beginning to explore the brain basis of attempts in depressed adolescents, none have focused on the basis of ideation, which has implications for prevention. This study examined the association between intrinsic neural network coherence and the severity of suicidal ideation in depressed adolescents.

METHODS

Forty adolescents diagnosed with Major Depressive Disorder were administered the Columbia-Suicide Severity Rating Scale and underwent resting-state fMRI. We quantified within-network coherence in the executive control (ECN), default mode (DMN), and salience (SN) networks, and in a non-relevant network consisting of noise signal. We associated coherence in each of these networks with the greatest lifetime severity of suicidal ideation experienced, covarying for motion, age of depression onset, and severity of current depressive and anxious symptoms.

RESULTS

Lower coherence in the left ECN, anterior DMN, and SN were independently associated with greater lifetime severity of suicidal ideation. When including all three significant networks and covariates in a single model, only the left ECN significantly predicted suicidal ideation.

LIMITATION

Studies with a larger sample size are needed to verify our findings.

CONCLUSIONS

Our finding of hypoconnectivity in multiple networks extends emerging evidence for hypoconnectivity in adolescent suicidality and is consistent with theoretical conceptualizations of suicidal ideation as a complex set of cognitions associated with cognitive control, self-referential thinking, and processing salient information. While multiple networks could be targets for effective early interventions, those targeting ECN functionality (cognitive control) may be particularly beneficial.

The experience of social exclusion in women with a history of suicidal acts: a neuroimaging study

Suicidal behaviors result from a complex interaction between social stressors and individual vulnerability. However, little is known of the specific neural network supporting the sensitivity to social stressors in patients at risk of suicidal acts. Using functional Magnetic Resonance Imaging, we investigated brain processing of social rejection in suicide attempters. Thirty-six euthymic women with a history of depression and suicidal behavior were compared to 41 euthymic women with a history of depression but no suicidal attempt, and 28 healthy controls. The Cyberball Game was used as a validated social exclusion paradigm. Relative to healthy controls, both patient groups reported higher levels of social distress related to the task, without significant differences according to suicidal status. Compared to patients without any history of suicide attempt and healthy controls, suicide attempters showed decreased contrast in the left insula and supramarginal gyrus during the exclusion vs. inclusion condition, after controlling for number of depressive episodes, medication, mood disorder type or social phobia. Our study highlights impaired brain response to social exclusion in euthymic female suicide attempters in regions previously implicated in pain tolerance and social cognition. These findings suggest sustained brain dysfunctions related to social perception in suicide attempters.

Psychological and physical pain as predictors of suicide risk: evidence from clinical and neuroimaging findings

PURPOSE OF REVIEW

Suicide is a multidimensional clinical phenomenon with complex biological, social and psychological risk factors. Therefore, it is imperative for studies to focus on developing a unified understanding of suicide risk that integrates current clinical and neurobiological findings. A recent line of research has implicated different classifications of pain in understanding suicide risk, including the concepts of psychache and pain tolerance. Although psychache is defined as the experience of unbearable psychological pain, pain tolerance refers to the greatest duration or intensity of painful stimuli that one is able to bear. This review will focus on integrating current clinical and neurobiological findings by which psychache and pain tolerance confer suicide risk.

RECENT FINDINGS

Results indicate that psychache has been identified as a significant risk factor for suicide and that psychache may be associated with the neurocircuitry involved in the modulation of physical pain. Converging evidence has also been found linking pain tolerance to self-injurious behaviours and suicide risk. The experience of psychache and physical pain in relation to other predictors of suicide, including reward processing, hopelessness and depression, are further discussed.

SUMMARY

Future research examining the pain-suicide connection is required to understand the mechanism behind clinically relevant risk factors for suicide, which can ultimately inform the construction of empirically supported suicide risk assessment and intervention techniques.