Default mode dysfunction underpins suicidal activity in mood disorders

Gin Singh Malhi · Pritha Das · Tim Outhred · Richard Allan Bryant · Vince D. Calhoun · J. John Mann

73 citations0/0 files storedPsychological Medicine

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Suicide and Self-Harm Studies Functional Brain Connectivity Studies Mental Health via Writing

Abstract

BACKGROUND: Suicide is a serious and not uncommon consequence of mood disorders that occurs primarily when individuals are depressed. Understanding the neurobiology of suicidal activity (thoughts or behaviors) is likely to facilitate prevention. METHOD: Seventy-nine adult depressed mood disorder patients (MDP), of which 25 had attempted suicide at least once, and 66 healthy controls (HC) participated in this study. Resting-state functional MRI was used to identify neural activity differences between suicide attempters (SA) and non-attempters (NA). Specifically, differences were examined in functional connectivity both within and between four large cognitive networks [Executive Control (ECN), Default Mode (DMN), Salience (SN), and Basal Ganglia (BGN)] and their respective associations with suicidal activity. RESULTS: Compared to HCs, patients had greater posterior DMN activity, but less activity in the BGN, and less low-frequency spectral power in the dorso-medial DMN. Furthermore, increased posterior DMN activity in SA was associated with recent suicidal activity, whereas NA had reduced BGN activity and less dorso-medial DMN spectral power, the latter being associated with lifelong suicidal thinking. SA also had greater activity in midline circuitry compared to both HC and NA, and the pattern of BGN and DMN co-activity differed between SA and NA. CONCLUSIONS: DMN engagement raises the possibility that suicidal activity in mood disorder patients may be a consequence of impaired self-referential thought processing. Furthermore, differential BGN and DMN co-activation according to suicide attempt status suggests that attempting suicide perhaps alters cognitive flexibility. These insights are potentially useful for understanding the neural basis of suicide activity.

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References

2011The Columbia–Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults 2006Self-referential processing in our brain—A meta-analysis of imaging studies on the self 2004Cortical midline structures and the self 2005Suicide in 406 Mood-Disorder Patients With and Without Long-Term Medication: A 40 to 44 Years' Follow-Up 2014Suicidal Behaviour in Mood Disorders—Who, When, and Why?2005Executive functioning in depressed patients with suicidal ideation 2015Suicide in women 2017Rumination, Suicidal Ideation, and Suicide Attempts: A Meta-Analytic Review

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