White Matter Hyperintensities and Their Association With Suicidally in Major Affective Disorders: A Meta-Analysis of Magnetic Resonance Imaging Studies

Abstract

Introduction Individuals who have deep and periventricular white matter hyperintensities may have a higher risk for suicidal behavior. There are mixed results in the literature regarding whether unipolar or bipolar patients who have attempted suicide have more MRI findings of deep white matter hyperintensities (DWMH) or periventricular hyperintensities (PVH) relative to those who have no history of suicide attempts. Methods We performed a meta-analysis of studies examining white matter hyperintensities (WMH) in mood disorder patients with and without a history of suicide attempts. Results Four studies and a total of 173 patients who attempted suicide and 183 who did not attempt were included. A significantly higher number of attempters were found to have hyperintensities than non-attempters. Unipolar depressed patients who were attempters had 1.9 times more DWMH and 2.1 times more PVH than those who were non-attempters. Bipolar patients who were attempters had 5.4 times more PVH than those who were non-attempters. Taken together, unipolar and bipolar patients who were attempters had 2.8 times more DWMH and 4.5 times more PVH than those who were not attempters. Conclusions These findings raise the possibility that WMH are biological substrates of symptoms that lead to suicidal behavior.

Astrocytic Hypertrophy in Anterior Cingulate White Matter of Depressed Suicides

“…The differences between cortical gray and white matter astrocytes highlighted in the present study need to be explored further, but may have to do with an increased facility of cytokines to diffuse within the brain along white matter tracts (Konsman et al, 2000). Interestingly, white matter hyper-intensities (WMHs) (Debette and Markus, 2010), which are thought to represent regions of acute astrocyte activation (Simpson et al, 2007) or astrogliosis (Fazekas et al, 1993), increase the risk of developing MDD (Bae et al, 2006;de Groot et al, 2000;Iosifescu et al, 2007;Li et al, 2007; reviewed by Tham et al, 2010) and are strongly associated with suicide (Grangeon et al, 2010). WMHs, have been proposed to arise from inflammation and oxidative stress (Wright et al, 2009;Xu et al, 2010; reviewed by Rosenberg, 2009) both of which are well documented to be increased in depression (Maes, 2008;Miller et al, 2009).…”

Reduced posterior corpus callosum area in suicidal and non-suicidal patients with bipolar disorder

“…A recent review of neuroimaging studies of suicidal patients showed involvement of the ventrolateral orbital, dorsomedial and dorsolateral prefrontal cortices, the anterior cingulate gyrus, and, to a lesser extent, the amygdala (Jollant et al, 2011). In addition, alterations in white matter connections have been suggested (Grangeon et al, 2010). These studies support the concept of specific neuroanatomical alterations in suicidal behavior in patients with mental disorders.…”

“…Regarding suicide attempts in bipolar patients, the data remain rare. Periventricular white matter hyperintensities have been reported in patients with major affective disorders who attempt suicide (Pompili et al, 2008;Grangeon et al, 2010). Moreover, abnormalities in the structure and function of the prefrontal cortex in bipolar patients who attempt suicide have also been found, but these abnormalities have been found in suicidal patients with other psychiatric diagnoses as well (Sublette et al, 2006).…”

Decreased Kidney Function Is a Significant Factor Associated with Silent Cerebral Infarction and Periventricular Hyperintensities

“…White matter lesions (WMLs) of the brain, as detected on T 2 -weighted MRI, are considered to be related to vascular risk factors [15,25] , and are associated with age, hypertension, diabetes mellitus, a history of stroke, and a history of heart disease [26] . In the general population, WMLs can be a predictor of dementia [27] , depression [28] , mood disorder [29] , future symptomatic stroke [30][31][32] and gait disturbances [28,33] , and also occur more frequently in neurologically normal people with multiple risk factors for stroke than in those without [34] . WMLs show evidence of ischemia, representing loss of cells and axons from the lesion with the associated influx of these glia and macrophages [35] .…”