Attention deficit in depressed suicide attempters

Abstract

Attention is typically impaired in depression and may play a role in risk for suicidal behavior. In this study, 66 non-patients, 83 depressed subjects with no past history of suicide attempt, 53 depressed subjects with one or more low lethality suicide attempts, and 42 depressed subjects with at least one high lethality attempt were compared on two computerized measures of attention, a Continuous Performance Test (CPT) and a Stroop task. All subjects were medication free at the time of assessment. Attention was impaired in all depressed subjects but worse in those with a past history of suicidal behavior. CPT performance did not differ among the groups, but Stroop interference was significantly poorer in all depressed subjects relative to non-patients, and poorer still in high lethality suicide attempters relative to all other groups. Interference score correlated modestly with subjective depression, functional level, suicide ideation, number of past suicide attempts, and lethality of past attempts. Depression-related impairments of attention, especially susceptibility to interference, are accentuated in those with a past history of suicidal behavior. Fundamental deficits in attention control may play a role in risk for suicidal behavior, and may contribute to a variety of cognitive deficits in suicidal patients. Brain mechanisms subserving attention control, which overlap considerably with regions implicated in affective disorders, may be a useful target for studies seeking to characterize neuropsychological factors associated with suicidal behavior.

Suicidal Behaviours in Affective Disorders: A Defcit of Cognitive Inhibition?

“…Lower performance in suppression and restraint function of cognitive inhibition. Analyzing the studies according to the type of affective disorders, executive dysfunction with cognitive inhibition were observed in patients with major depression with a history of severe suicide attempts, 39,40 depressed patients who attempted suicide, 32,42 and depressed patients with suicidal ideations. 47 For patients with BD, more executive dysfunction and cognitive inhibition deficit was found among BD-II, compared with BD-I, patients who attempted suicide, 35 and BD-I patients with suicide attempts, compared with patients with nonsuicide attempts BD-I.…”

Impaired Executive Function in Contemplated and Attempted Suicide in Late Life

“…In the first comprehensive study of cognitive performance in attempted suicide, Keilp and colleagues (10) found evidence of executive deficits in high-lethality suicide attempters, specifically on tasks requiring organization and focused effort: the Stroop interference task, the A not B task, verbal fluency task, and the Wisconsin Card Sorting Task (WCST), where suicide attempters failed to maintain cognitive set (10). Subsequent studies have found impairment in specific aspects of executive function, including attentional control (11, 15), response inhibition (14), and verbal fluency (9). However, the findings of these studies are inconclusive; their implications for the cognitive diathesis of suicide are complicated by small sample sizes, the inclusion of individuals with a distant history of suicidal behavior and depression, and especially the lack of suicide ideator control groups.…”

“…The present case-control study aimed to examine whether executive function impairments are associated with contemplation of suicide (16), suicidal behavior (10, 11, 17), or both, in late life, above and beyond the effect of depression. Thus, we report performance on the EXIT in both suicide attempters and suicide ideators separately, compared with groups of non-suicidal depressed older adults, and older adults with no lifetime psychiatric history.…”

Le suicide de la personne âgée : existe-t-il des spécificités liées à l’âge ?

“…Plusieurs études ont mis en évidence de moins bonnes performances exécutives (inflexibilité mentale réactive et conceptuelle, diminution de la fluence verbale et des capacités de catégorisation) des suicidants en comparaison de témoins affectifs chez la personne d'âge moyen (Keilp et al, 2001 ;Keilp et al, 2008 ;Marzuk et al, 2005 ;Raust et al, 2007 ;Malloy-Diniz et al, 2009) et âgée (Dombrovski et al, 2008a ;King et al, 2000 ;McGirr et al, 2011). Les résultats sont contradictoires dans des populations de suicidants hétérogènes au plan diagnostic (Bartfai et al, 1990 ;Burton et al, 2011 ;Ellis et al, 1992).…”

“…Son déficit est associé chez la personne déprimée à une recrudescence de ruminations, facteur d'idées suicidaires (Morrison et O'Connor, 2008 ;Joormann et Gotlib, 2010). Un déficit de l'inhibition cognitive est suggéré chez des déprimés suicidants ou suicidaires plus jeunes (Keilp et al, 2008 ;Westheide et al, 2008 ;Harkavy-Friedman et al, 2006).…”