Executive performance of depressed suicide attempters: the role of suicidal ideation

Abstract

Suicidal ideation is clearly associated with impaired cognitive performance. Our results suggest that executive deficits seen in depressive suicide attempters have a state-dependent component.

Impaired Executive Function in Contemplated and Attempted Suicide in Late Life

“…Because all suicidal participants in our study had current suicidal ideation at the time of cognitive assessment, this study cannot adequately assess the extent to which executive functioning deficits precede or follow the onset of suicidal ideation. Our findings, taken together with those of Marzuk et al (16) and Westheide et al (14), are consistent with the notion that executive function deficits may contribute to the emergence of suicidal thoughts, but not specifically the final act of ending one’s life. However, because group differences in performance on the EXIT were notable but small in our sample, our findings are more suggestive rather than definitive, and require replication in larger samples.…”

“…There is evidence that social stressors, known to trigger suicidal thoughts, lead to a deterioration of executive control and self-regulation (31). Other studies have found that current suicidal ideation may be a stronger predictor of executive functioning deficits compared to history of suicidal behavior (14, 16). Because all suicidal participants in our study had current suicidal ideation at the time of cognitive assessment, this study cannot adequately assess the extent to which executive functioning deficits precede or follow the onset of suicidal ideation.…”

“…Marzuk and colleagues (16) similarly found that current suicidal was related to executive deficits regardless of history of suicidal behavior. Later, Westheide et al (14) also found that only suicide attempters with current suicidal ideation, compared to attempters with no current suicidal ideation displayed cognitive impairments in decision-making and motor inhibition (31). …”

“…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 authors concluded that current suicidal ideation, regardless of history of suicide attempt, may be associated with impaired executive function. Westheide et al (14) found that only suicide attempters with current suicidal ideation, compared to attempters with no current suicidal ideation displayed executive deficits, most notably on impulsive decision-making. The conclusions of these studies were limited by either the lack of a suicide ideator group without past attempts, or the inclusion of mixed ideator and attempter participants.…”