Psychological Medicine

Original Articles

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

A. Y. Dombrovskia1 c1, G. J. Sieglea1, K. Szantoa1, L. Clarka2, C. F. Reynolds 3rda1 and H. Aizensteina1

a1 Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

a2 Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, UK

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.

(Received June 06 2011)

(Revised September 04 2011)

(Accepted September 07 2011)

(Online publication October 17 2011)

Correspondence

c1 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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