Abstract
Objective: This study aims to investigate the significant alterations in brain white matter integrity in individuals with bipolar disorder (BD) who had attempted suicide by applying a tract-based spatial statistics (TBSS) approach with tensor-based spatial normalization.Methods: A TBSS approach with novel tensor-based registration was used to compare the white matter fractional anisotropy (FA) between 51 individuals with BD, of whom 19 had attempted suicide, and 43 healthy controls (HC). The suicide attempt was assessed with the Columbia-Suicide Severity Rating Scale (C-SSRS). In addition, we also investigated the correlations of FA values with clinical measures in BD, including illness duration, and the severity of depression and anxiety measured by the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA), respectively.Results: A significant reduction of FA value in the hippocampal cingulum was observed in BD individuals who had attempted suicide compared with those who had not. For the genu/body of the corpus callosum, inferior fronto-occipital fasciculus, uncinate fasciculus, and anterior thalamic radiation, the reductions in FA values were significantly greater in both BD subgroups who attempted suicide and who did not, compared to HC. The correlation analysis showed that the illness duration of attempters was correlated to the FA value of the genu of the corpus callosum, while the HAMD and HAMA scores of non-attempters were relevant to the FA of the superior longitudinal fasciculus.Conclusion: The observation that white matter integrity was altered in the hippocampal cingulum in BD individuals who attempted suicide suggested that this brain area may be the neurobiological basis of suicide attempts. Our findings also support the involvement of white matter (WM) microstructure of frontal–subcortical circuits in the neurobiological mechanism of BD. In addition, the illness duration of patients with attempted suicide may have an effect on the altered integrity of the corpus callosum.
Highlights
Suicide attempt is defined as a non-fatal, self-inflicted, potentially life-threatening behavior with an intent to die [1], which is reported to be associated with a poor quality of life [2]
By using a tract-based spatial statistics (TBSS) approach with tensor-based registration, we demonstrated that fractional anisotropy (FA) was significantly reduced in the hippocampal cingulum of individuals with bipolar disorder (BD) who had attempted to commit suicide compared with those who had not
We found that both attempters and non-attempters with BD had significantly reduced FA in the genu/body of the corpus callosum, inferior fronto-occipital fasciculus, uncinate fasciculus (UF), and anterior thalamic radiation when compared with healthy controls (HC)
Summary
Suicide attempt is defined as a non-fatal, self-inflicted, potentially life-threatening behavior with an intent to die [1], which is reported to be associated with a poor quality of life [2]. It has been reported that bipolar disorder (BD) has a high lifetime risk for suicide attempts and suicide completion. 25–56% of individuals with BD present at least one suicide attempt during their lifetime, and ∼15–19% of individuals with BD die from suicide [3]. In view of the subjectivity and non-specificity of the sociodemographic and clinical information of suicide attempts, it is of great significance to try to elucidate the neural basis underpinning suicide attempts in BD. Non-invasive neuroimaging studies are qualified to explore the neurophysiological basis of suicide attempts at a neuroanatomical level. Decreased FA signifies less anisotropic diffusion and reduced microstructural integrity [8]
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