Neuroimaging Correlates of Suicidality in Decision-Making Circuits in Posttraumatic Stress Disorder.

Jennifer Barredo,Benjamin D Greenberg,Linda L Carpenter,Emily Aiken,Mascha Van 'T Wout-Frank,Noah S Philip

doi:10.3389/fpsyt.2019.00044

Jennifer Barredo, Benjamin D Greenberg + Show 4 more

Open Access

https://doi.org/10.3389/fpsyt.2019.00044

Copy DOI

Abstract

In depression, brain and behavioral correlates of decision-making differ between individuals with and without suicidal thoughts and behaviors. Though promising, it remains unknown if these potential biomarkers of suicidality will generalize to other high-risk clinical populations. To preliminarily assess whether brain structure or function tracked suicidality in individuals with posttraumatic stress disorder (PTSD), we measured resting-state functional connectivity and cortical thickness in two functional networks involved in decision-making, a ventral fronto-striatal reward network and a lateral frontal cognitive control network. Neuroimaging data and self-reported suicidality ratings, and suicide-related hospitalization data were obtained from 50 outpatients with PTSD and also from 15 healthy controls, and all were subjected to seed-based resting-state functional connectivity and cortical thickness analyses using a priori seeds from reward and cognitive control networks. First, general linear models (GLM) were used to evaluate whether ROI-to-ROI functional connectivity was predictive of self-reported suicidality after false discovery rate (FDR)-correction for multiple comparisons and covariance of age and depression symptoms. Next, regional cortical thickness statistics were included as predictors of ROI-to-ROI functional connectivity in follow-up GLMs evaluating structure-function relationships. Functional connectivity between reward regions was positively correlated with suicidality (p-FDR ≤ 0.05). Functional connectivity of the lateral pars orbitalis to anterior cingulate/paracingulate control regions also tracked suicidality (p-FDR ≤ 0.05). Furthermore, cortical thickness in anterior cingulate/paracingulate was associated with functional correlates of suicidality in the control network (p-FDR < 0.05). These results provide a preliminary demonstration that biomarkers of suicidality in decision-making networks observed in depression may generalize to PTSD and highlight the promise of these circuits as transdiagnostic biomarkers of suicidality.

Highlights

We are in the midst of a public health crisis
We examined restingstate functional connectivity in decision-making networks in a naturalistic sample of adult outpatients selected for a current diagnosis of posttraumatic stress disorder (PTSD)
Previewing our results, we found that functional connectivity in the reward and cognitive control networks was positively correlated with self-reported suicidality after covariance for age and depression symptoms

Summary

Introduction

We are in the midst of a public health crisis. Suicide rates have risen precipitously over the last decade in most demographic groups [1]. The ability to predict patients’ suicide risk remains poor [2, 3]. Problems with risk assessment are due, in part, to dependence upon patients’ insight and willingness to disclose suicidal thoughts and behaviors. Several studies in patients with depression have found that those with a history of prior suicide attempts and depression make more high-risk choices on value-based decision-tasks [e.g., simulated gambling [7, 8], delay discounting [9, 10], probabilistic learning [11]] when compared to depressed, non-suicidal counterparts [but see [12]]

Methods

Results

Conclusion