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The temptation of suicide: striatal gray matter, discounting of delayed rewards, and suicide attempts in late-life depression

Published online by Cambridge University Press:  17 October 2011

A. Y. Dombrovski ,
G. J. Siegle ,
K. Szanto ,
L. Clark ,
C. F. Reynolds 3rd  and
H. Aizenstein
A. Y. Dombrovski*
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
G. J. Siegle
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
K. Szanto
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
L. Clark
Affiliation:
Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, UK
C. F. Reynolds 3rd
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
H. Aizenstein
Affiliation:
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
*Address for correspondence: A. Y. Dombrovski, M. D., Western Psychiatric Institute and Clinic, 100 N Bellefield Ave, Pittsburgh, PA 15213, USA. (Email: dombrovskia@upmc.edu)
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Abstract

Background

Converging evidence implicates basal ganglia alterations in impulsivity and suicidal behavior. For example, D2/D3 agonists and subthalamic nucleus stimulation in Parkinson's disease (PD) trigger impulse control disorders and possibly suicidal behavior. Furthermore, suicidal behavior has been associated with structural basal ganglia abnormalities. Finally, low-lethality, unplanned suicide attempts are associated with increased discounting of delayed rewards, a behavior dependent upon the striatum. Thus, we tested whether, in late-life depression, changes in the basal ganglia were associated with suicide attempts and with increased delay discounting.

Method

Fifty-two persons aged ⩾60 years underwent extensive clinical and cognitive characterization: 33 with major depression [13 suicide attempters (SA), 20 non-suicidal depressed elderly] and 19 non-depressed controls. Participants had high-resolution T1-weighted magnetization prepared rapid acquisition gradient–echo (MPRAGE) magnetic resonance imaging (MRI) scans. Basal ganglia gray matter voxel counts were estimated using atlas-based segmentation, with a highly deformable automated algorithm. Discounting of delayed rewards was assessed using the Monetary Choice Questionnaire (MCQ) and delay aversion with the Cambridge Gamble Task (CGT).

Results

SA had lower putamen but not caudate or pallidum gray matter voxel counts, compared to the control groups. This difference persisted after accounting for substance use disorders and possible brain injury from suicide attempts. SA with lower putamen gray matter voxel counts displayed higher delay discounting but not delay aversion. Secondary analyses revealed that SA had lower voxel counts in associative and ventral but not sensorimotor striatum.

Conclusions

Our findings, although limited by small sample size and the case–control design, suggest that striatal lesions could contribute to suicidal behavior by increasing impulsivity.

Keywords

Basal gangliacorpus striatumdecision makingglobus pallidusputamenrewardsuicide
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 6 , June 2012 , pp. 1203 - 1215
Copyright
Copyright © Cambridge University Press 2011

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