Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
United States Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
J Affect Disord. 2025 Jan 15;369:588-598. doi: 10.1016/j.jad.2024.09.149. Epub 2024 Sep 26.
The suicide rate for United States military veterans is 1.5× higher than that of non-veterans. To meaningfully advance suicide prevention efforts, research is needed to delineate factors that differentiate veterans with suicide attempt/s, particularly in high-risk groups, e.g., major depressive disorder (MDD), from those with suicidal ideation (no history of attempt/s). The current study aimed to identify clinical, neurocognitive, and neuroimaging variables that differentiate suicide-severity groups in veterans with MDD.
Sixty-eight veterans with a DSM-5 diagnosis of MDD, including those with no ideation or suicide attempt (N = 21; MDD-SI/SA), ideation-only (N = 17; MDD + SI), and one-or-more suicide attempts (N = 30; MDD + SA; aborted, interrupted, actual attempts), participated in this study. Participants underwent a structured diagnostic interview, neurocognitive assessment, and 3 T-structural/diffusion tensor magnetic-resonance-imaging (MRI). Multinomial logistic regression models were conducted to identify variables that differentiated groups with respect to the severity of suicidal behavior.
Relative to veterans with MDD-SI/SA, those with MDD + SA had significantly higher left cingulum fractional anisotropy, decreased attentional control on emotional-Stroop, and faster response time with intact accuracy on Go/No-Go. Relative to MDD + SI, MDD + SA had higher left cingulum fractional anisotropy and faster response time with intact accuracy on Go/No-Go.
Findings are based on retrospective, cross-sectional data and cannot identify causal relationships. Also, a healthy control group was not included given the study's focus on differentiating suicide profiles in MDD.
This study suggests that MRI and neurocognition differentiate veterans with MDD along the suicide-risk spectrum and could inform suicide-risk stratification and prevention efforts in veterans and other vulnerable populations.
美国退伍军人的自杀率比非退伍军人高 1.5 倍。为了有意义地推进预防自杀工作，需要进行研究以确定区分有自杀企图的退伍军人的因素，特别是在高风险群体中，例如，有或无自杀意念的重度抑郁症（MDD）患者。本研究旨在确定可区分 MDD 退伍军人自杀严重程度组别的临床、神经认知和神经影像学变量。
68 名退伍军人符合 DSM-5 重度抑郁症诊断标准，包括无自杀意念或自杀企图（N=21；MDD-SI/SA）、仅有自杀意念（N=17；MDD+SI）和一次或多次自杀企图（N=30；MDD+SA；未遂、中断、实际企图）。参与者接受了结构化诊断访谈、神经认知评估和 3T 结构/弥散张量磁共振成像（MRI）。多分类逻辑回归模型用于确定可区分各组自杀行为严重程度的变量。
与 MDD-SI/SA 退伍军人相比，MDD+SA 退伍军人的左侧扣带束分数各向异性明显较高，情绪 Stroop 注意力控制降低，Go/No-Go 任务的反应时间更快且准确率保持不变。与 MDD+SI 相比，MDD+SA 退伍军人的左侧扣带束分数各向异性较高，Go/No-Go 任务的反应时间更快且准确率保持不变。
研究结果基于回顾性、横断面数据，无法确定因果关系。此外，由于研究重点是区分 MDD 中的自杀特征，因此未纳入健康对照组。
本研究表明，MRI 和神经认知可区分 MDD 退伍军人的自杀风险谱，可为 MDD 退伍军人和其他弱势群体的自杀风险分层和预防工作提供信息。
