Executive functions and impulsivity in suicide attempter adolescents with major depressive disorder

Proinflammatory gene expression is associated with prospective risk for adolescent suicidal thoughts and behaviors over twelve months

OBJECTIVE

Recent theories have implicated inflammatory biology in the development of psychopathology and maladaptive behaviors in adolescence, including suicidal thoughts and behaviors (STB). Examining specific biological markers related to inflammation is thus warranted to better understand risk for STB in adolescents, for whom suicide is a leading cause of death.

METHOD

Participants were 211 adolescent females (ages 9-14 years; Mage = 11.8 years, SD = 1.8 years) at increased risk for STB. This study examined the prospective association between basal levels of inflammatory gene expression (average of 15 proinflammatory mRNA transcripts) and subsequent risk for suicidal ideation and suicidal behavior over a 12-month follow-up period.

RESULTS

Controlling for past levels of STB, greater proinflammatory gene expression was associated with prospective risk for STB in these youth. Similar effects were observed for CD14 mRNA level, a marker of monocyte abundance within the blood sample. Sensitivity analyses controlling for other relevant covariates, including history of trauma, depressive symptoms, and STB prior to data collection, yielded similar patterns of results.

CONCLUSIONS

Upregulated inflammatory signaling in the immune system is prospectively associated with STB among at-risk adolescent females, even after controlling for history of trauma, depressive symptoms, and STB prior to data collection. Additional research is needed to identify the sources of inflammatory up-regulation in adolescents (e.g., stress psychobiology, physiological development, microbial exposures) and strategies for mitigating such effects to reduce STB.

Childhood Maltreatment, Executive Function, and Suicide Attempts in Adolescents

Evidence suggests that child maltreatment is a risk factor for adolescent suicidal behavior. However, the differential influence of distinct forms of child maltreatment on adolescent suicide attempts is understudied and the factors that might exacerbate or ameliorate these associations warrant attention. We examined the associations between two distinct forms of child maltreatment (threat and deprivation) and suicide attempt history, and investigated whether executive function domains moderated these associations. Participants were 119 adolescents (M = 15.24, SD = 1.46, 72.3% female) recruited from an inpatient psychiatric hospital during hospitalization for suicidal thoughts and behaviors. Results indicated that the executive function domains of initiation, shifting, and planning/organization moderated the associations between threat and suicide attempt history. Associations between threat and suicide attempt history were significant only when initiation and shifting T-scores were lower (OR = 1.22, p = .03 and OR = 1.32, p = .01, respectively). The association between threat and suicide attempt history trended toward significance when planning/organization T-scores were lower (OR = 1.15, p = .10). None of the executive function domains moderated the link between deprivation and suicide attempt history. Findings highlight the need for research investigating whether initiation, shifting, and planning/organization might be amendable to intervention in the context of threat-related child maltreatment.

Classification of fNIRS signals from adolescents with MDD in suicide high- and low-risk groups using machine learning

Prefrontal cortex activation is attenuated during cognitive tasks in patients with suicidal ideation or major depressive disorder (MDD). However, the apparent relationship between patients with MDD, especially suicide high-risk (SHR) adolescents, and the characteristics of their hemodynamic responses has not yet been elucidated. To investigate this relationship, we recruited 30 patients with MDD aged 13-19. Functional near-infrared spectroscopy (fNIRS) data were collected for all patients during a Stroop test. Through a ten-time iterative leave-one-out cross-validation via 1000 iterative random search-based feature selections, we achieved a generalized classification accuracy of 70.3±5.0 % (from min. 63.3 % to max. 76.7 %). From the results of random search-based feature selection, Ch08oxy and Ch09deoxy were identified as the two most relevant fNIRS channels. This finding implies that these fNIRS channels can be used as neurological biomarkers to distinguish SHR adolescents with MDD from suicide low-risk (SLR) adolescents. In addition, we determined the oxy-Hb channels of the SHR group, except for Ch01oxy, Ch02oxy, Ch11oxy, and Ch14oxy, were hyperactivated compared to the SLR group.

Cognitive flexibility in inpatient children and adolescents with a history of suicide attempts

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.

Exploring the relationship between suicide vulnerability, impulsivity and executive functioning during COVID-19: A longitudinal analysis

Public health emergencies increase the presence and severity of multiple suicide risk factors and thus may increase suicide vulnerability. Understanding how suicide risk factors interact throughout the course of a global pandemic can inform how to help the most vulnerable groups in society. The aims of the research were to explore the associations between, and changes in, suicide vulnerability, COVID-related stress, worry, rumination, executive functioning and impulsivity across the first 6 weeks of UK lockdown (1st April – May 17, 2020). 418 adults in the UK completed an online survey at three time points during the first lockdown (Time 1 (April 1–5th), Time 2 (April 15–19th April), Time 3 (May 13–17th). Impulsivity and executive functioning remained stable across the first six weeks of UK lockdown. COVID-related stress, worry, and rumination decreased throughout the 6 weeks. Suicide vulnerability was associated with greater impulsivity and poorer executive functioning. Sub-group analysis revealed individuals vulnerable to suicide reported worse COVID-related stress, poorer executive function and greater impulsivity than individuals who reported no suicide vulnerability. Individuals vulnerable to suicide appear to have experienced poorer executive functioning, greater impulsivity and COVID-related stress in the initial phase of the COVID-19 pandemic.

A Systematic Review of Behavior-Outcome Psychological Assessments as Correlates of Suicidality

AIM

Identifying correlates of suicidality is an important goal for suicide researchers because these correlates may predict suicidal behaviors. Psychological tasks that assess sensitivity to the outcomes of actions (i.e., consequence-based learning) have been commonly used by researchers seeking to identify correlates of suicidality. This is likely due to the straightforward integration of the tasks within most theoretical frameworks for understanding suicidality. Contextual factors have been shown to have a substantial effect on responding in behavior-outcome tasks. However, the direct relevance of these factors as determinants of behavior in suicide research is not clear. Thus, the purpose of this review was to assess the role of context in tasks involving behavior-outcome relations in suicide research.

METHODS

Four databases were searched using terms from general learning theory. Articles that featured evaluation of tasks with hypothetical or real outcomes to differentiate suicidality were included.

RESULTS

Eighty-two studies met inclusion criteria. Across studies there were 27 different tasks. Most instances of tasks across studies involved rewards (76.9%), while others emphasized punishment (15.7%), social (5.6%), or virtual suicide (1.8%) outcomes. Differentiation of suicidality was detected by 43.4%, 64.7%, 83.3%, and 50% of tasks featuring reward, punishment, social contexts, and virtual suicide respectively. All but five studies were retrospective.

CONCLUSION

Tasks that more closely mimic contexts and outcomes related to suicide appear to produce more pronounced differentiation of people with suicidality from people without suicidality. The lack of prospective designs is an important limitation of the literature.HIGHLIGHTSTasks that involve punishment or social outcomes better discriminate suicidality.Reward-based tasks are overused in suicide research.The conditioning hypothesis of suicidality is closely aligned with the literature.Only 5 of 82 studies incorporated prospective measures.

The association between alcohol use and suicide attempt in employees

Purpose: This study aimed to analyze the alcohol use patterns that may influence suicide attempt in employees who have suicidal ideation.Methods: The 15,199 participants were classified into three groups according to suicide risk severity. Participant scores on the Alcohol Use Disorders Identification Test-Korea (AUDIT-K), subscale for drinking amount/frequency (AUDIT-C, items 1–3), subscale for dependence/related problems (AUDIT-D/P, items 4–10), and other sociodemographic and psychiatric scales were analyzed between the groups using one-way analysis of variance (ANOVA) and the chi-square test, followed by post hoc analysis using the Bonferroni correction.Results: A statistically significant difference between all three groups was observed for AUDIT-D/P scores after post hoc analysis (P < 0.001), indicating an increasing trend for greater suicide risk. This trend was present in both sexes and across all age groups above 30 years old.Conclusion: Alcohol dependence/related problems are significantly associated with suicide attempt among employees. Assessing and preventing suicide risk according to these issues may minimize socioeconomic losses due to suicide.

Neurocognitive Functioning in Adolescents at Risk for Suicidal Behaviors

Today, little is still known about the neurocognitive functioning of the individual at risk for suicide in a relevant developmental stage like adolescence. Thus, the main goal of the present work was to analyze the neurocognitive performance of adolescents at high risk for suicide. A total of 1509 adolescents from a stratified random cluster sampling were selected. Adolescents at risk for suicidal behaviors included 83 participants. A comparison group of 83 participants matched by age and gender was also randomly selected from the sample. The Paykel Suicide Scale (PSS) and the University of Pennsylvania Computerized Neurocognitive Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Adolescents at risk for suicide revealed statistically significant impairments across different neurocognitive domains including complex cognition, episodic memory and social cognition. No significant differences were found for Sensorimotor and Executive Function domains. Results found in the present study contribute relevant information about the nature of the neurocognitive impairments associated with suicide and add information in order to deeper comprehend the tentative etiology of suicide thoughts and attempts in adolescents with the aim to establish preventive treatments.

Neurocognitive markers of suicidal ideation in patients with anxiety and mood disorders

Objective: This study aims at identifying associations between cognitive function and suicidal ideation in the sample of patients with anxiety and mood disorders (AMD).Methods: In sum, 186 (age = 39 ± 12.3 years; 142 [76.3%] females) patients with AMD were enrolled in the study. Assessment included evaluation of socio-demographic information, medication use, anxiety and depression symptoms. Cognitive tests included measures of psychomotor performance and incidental learning using the Digit Symbol Test. Trail Making Tests respectively measured perceptual speed, task-switching and executive control. Additionally, 21 patients completed tests from the Cambridge Automated Neuropsychological Test Battery measuring set shifting (Interdimensional/extradimensional set-shift), executive planning (Stockings of Cambridge), and decision making (Cambridge Gamble Task [CGT]).Results: Almost half (45.0%, n = 86) of the study sample patients had experienced suicidal ideations. In multivariable regression analysis, suicidal ideation was associated with a greater overall proportion of bet and risk taking on the CGT task (β = 0.726, p = .010 and β = 0.634, p = .019), when controlling for socio-demographic characteristics, medication use, anxiety and depression symptoms.Conclusions: Outpatients with AMD and suicidal ideation could be distinguished by the presence of cognitive deficits in the executive function domain, particularly in impulse-control and risk taking.