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. 2019 Feb 15:245:1139-1148.
doi: 10.1016/j.jad.2018.11.097. Epub 2018 Nov 28.

Preliminary examination of gray and white matter structure and longitudinal structural changes in frontal systems associated with future suicide attempts in adolescents and young adults with mood disorders

Elizabeth T Cox Lippard  1 , Jennifer A Y Johnston  2 , Linda Spencer  2 , Susan Quatrano  2 , Siyan Fan  2 , Anjali Sankar  2 , Judah Weathers  3 , Brian Pittman  2 , Maria A Oquendo  4 , Hilary P Blumberg  3
Affiliations

Preliminary examination of gray and white matter structure and longitudinal structural changes in frontal systems associated with future suicide attempts in adolescents and young adults with mood disorders

Elizabeth T Cox Lippard et al. J Affect Disord. .

Abstract

Background: Mood disorders are major risk factors for suicidal behavior. While cross-sectional studies implicate frontal systems, data to aid prediction of suicide-related behavior in mood disorders are limited. Longitudinal research on neuroanatomical mechanisms underlying suicide risk may assist in developing targeted interventions. Therefore, we conducted a preliminary study investigating baseline gray and white matter structure and longitudinal structural changes associated with future suicide attempts.

Methods: High-resolution structural magnetic resonance imaging, diffusion tensor imaging, and suicide-related behavioral assessment data for 46 adolescents and young adults with mood disorders [baseline agemean = 18 years; 61% female] were collected at baseline and at follow-up (intervalmean = 3 years). Differences in baseline and longitudinal changes in gray matter volume and white matter fractional anisotropy in frontal systems that distinguished the participants who made future attempts from those who did not were investigated.

Results: Seventeen (37%) of participants attempted suicide within the follow-up period. Future attempters (those attempting suicide between their baseline and follow-up assessment), compared to those who did not, showed lower baseline ventral and rostral prefrontal gray matter volume and dorsomedial frontal, anterior limb of the internal capsule, and dorsal cingulum fractional anisotropy, as well as greater decreases over time in ventral and dorsal frontal fractional anisotropy (p < 0.005, uncorrected).

Limitations: Sample size was modest.

Conclusions: Results suggest abnormalities of gray and white matter in frontal systems and differences in developmental changes of frontal white matter may increase risk of suicide-related behavior in youths with mood disorders. Findings provide potential new leads for early intervention and prevention strategies.

Keywords: Bipolar Disorder; Depression; Diffusion Tensor Imaging; Magnetic Resonance Imaging; Suicide.

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Conflict of interest statement

DISCLOSURES:

Maria Oquendo receives royalties for the commercial use of the Columbia Suicide Severity Rating Scale and her family owns stock in Bristol Myers Squibb. Hilary Blumberg received an honorarium for a talk from Aetna. Other authors have no financial conflicts of interest to report.

Figures

Figure 1.
Figure 1.. Areas of lower gray matter volume in adolescents/young adults with mood disorders that made future suicide attempts compared to those who did not.
The axial-oblique images show the regions of lower gray matter volume in the future suicide group (Future-SA, N=17) compared with the group that did not make a future suicide attempt (NonFuture-SA, N=29). No regions of larger gray matter volume were observed in the Future-SA group compared with the NonFuture-SA group. Significance threshold is p<0.005; cluster>20 voxels. Left of figure denotes left side of brain. The color bar represents the range of T values.
Figure 2.
Figure 2.. Areas of lower fractional anisotropy (FA) in adolescents/young adults with mood disorders that made future suicide attempts compared to those who did not.
(A) The axial-oblique images show the regions of lower FA in the future suicide group (Future-SA, N=16)compared with the group that did not make a future suicide attempt (NonFuture-SA, N=26). No regions of larger FA were observed in the Future-SA group compared with the NonFuture-SA group. (B) The axial-oblique images show regions of lower FA in ventral prefrontal white matter in the future suicide group (Future-SA, N=13) compared with the group that did not make a future suicide attempt (NonFuture-SA, N=25) after removing four individuals who had current A/SUDs. (C) The bar graph shows FA at baseline between the NonFuture-SA group (N=25) and Future-SA subgroups [Future-SA subdivided into individuals who made a future attempt and did not have a prior attempt (Future-SAno-pastSA, N=6) and those that did have a prior attempt (Future-SA+pastSA, N=7)]. ***=p<0.005; For (A) and (B) significance threshold is p<0.005; cluster>20 voxels. Left of figure denotes left side of brain. The color bar represents the range of T values.
Figure 3.
Figure 3.. Areas showing differences in FA changes between baseline and follow-up in adolescents/young adults with mood disorders that made future suicide attempts compared to those who did not.
(A) The axial-oblique images show regions where differences in FA changes were observed between the future suicide group (Future-SA, N=13) compared with the group who did not make a future suicide attempt (NonFuture-SA, N=23). The Future-SA group showed progressive decreases in FA of clusters but the NonFuture-SA group did not. Significance threshold is p<0.005; cluster>20 voxels. Left of figure denotes left side of brain. The color bar represents the range of T values. (B) The bar graph shows differences in calculated change in FA (follow-up minus baseline) between the NonFuture-SA group (N=23) and Future-SA subgroups [Future-SA subdivided into individuals who made a future attempt and did not have a prior attempt (Future-SAno-pastSA, N=6) and those that did have a prior attempt (Future-SA+pastSA, N=7]. ***=p<0.005, **=p<0.01; T=p≤0.07.
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