Abstract
BackgroundSuicide is a serious public health concern. Depression is the main gateway to suicidal behavior. The already established relationship between depression and suicidal risk should now focus on the investigation of more specific factors: recent studies have suggested an association between vulnerability to suicidal behavior and neurocognitive alterations, a nuclear symptom of depression. This project aims to identify alterations in the Executive Functions (EF) of patients suffering a first depressive episode that might constitute a risk factor for suicidal ideation, suicidal attempts and suicide, to allow for more adequate suicide prevention.MethodsProspective longitudinal design involving two groups (first depressive episodes with and without alterations in their EF) and four repeated measures (0, 6, 12 and 24 months). The estimated minimum sample size is 216 subjects. The variables and measurement instruments will include socio-demographic variables, clinical variables (age of illness onset, family and personal antecedents, psychopathological and medical comorbidity, suicidal ideation, suicide attempts and completed suicides, severity of depression, including melancholic or atypical, remission of the depressive episode), and neuropsychological variables (EF and decision-making processes evaluated through the Cambridge Neuropsychological Test Automated Battery (CANTAB)).DiscussionFirst and foremost, the identification of clinical and neuropsychological risk factors associated with suicidal behavior will open the possibility to prevent such behavior in patients with a first depressive episode in the context of clinical practice. Secondly, interventions aimed at cognitive impairment (in particular: EF) derived from the study may be incorporated into strategies for the prevention of suicidal behavior. Finally, impaired neurocognitive function (even in early stages) could become an identifiable endophenotype or “marker” in clinical and neurobiological studies about suicidal behavior in depressive patients.
Highlights
Suicide is a serious public health concern
Different research lines are aiming to elucidate whether cognitive alterations disappear or not during the phases of remission, imply stable or permanent deficits and, whether they depend on the severity, number of episodes or depressive subtype, among other variables
More evidence is needed to determine whether cognitive alterations are a “state”, a “trait” or a “scar”
Summary
Suicide is a serious public health concern. Depression is the main gateway to suicidal behavior. The already established relationship between depression and suicidal risk should focus on the investigation of more specific factors: recent studies have suggested an association between vulnerability to suicidal behavior and neurocognitive alterations, a nuclear symptom of depression. This project aims to identify alterations in the Executive Functions (EF) of patients suffering a first depressive episode that might constitute a risk factor for suicidal ideation, suicidal attempts and suicide, to allow for more adequate suicide prevention. In recent years an increasing number of papers, from the fields of neuroscience and neuropsychology, have established that between 20 and 60% of depressed patients show different alterations in executive functions (EF) [11]. Trivedi and Greer [12] analyzed 12 papers, systematic reviews and meta-analyzes, that included comparisons between cognitive performance of depressed patients and healthy subjects and concluded that there is enough evidence supporting the fact that cognitive alterations
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