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Study explores brain connectivity, suicide risk in bipolar disorder

Multimodal neuroimaging results indicated significantly decreased brain connectivity among adolescents and young adults with bipolar disorder who attempted suicide.

“As many as 56% of individuals with bipolar disorder attempt suicide, and 15% to 19% die by suicide,” Jennifer A.Y. Johnston, MA, of Yale School of Medicine, and colleagues wrote. “Suicidal behavior is a leading cause of death and often commences during adolescence or young adulthood, when frontolimbic systems implicated in suicidal behavior are maturing. Thus, elucidating the neural underpinnings of suicidal behavior during adolescence and young adulthood may improve early identification and prevention.”

To assess neural systems of suicidal behavior in adolescents and young adults with bipolar disorder, researchers compared regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli between 26 individuals with bipolar disorder and prior suicide attempt and 42 individuals with bipolar disorder without a suicide attempt.

Participants who attempted suicide exhibited significant decreases in gray matter volume in the orbitofrontal cortex, hippocampus and cerebellum.

White matter integrity in the uncinate fasciculus, ventral frontal and right cerebellum regions was significantly lower in participants who attempted suicide.

Further, participants who attempted suicide exhibited significant decreases in amygdala functional connectivity to the left ventral and right rostral prefrontal cortex.

Exploratory analyses indicated a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality among participants who attempted suicide.

“This study provides preliminary evidence for gray matter and white matter relationships and associations of system features with suicidal ideation and attempt lethality,” the researchers wrote. “Integrated study of brain structure and function, and their associations with symptoms and behavior, in suicide research is important in elucidating risk mechanisms that may involve complex, parallel, and interacting relationships between developing circuitry and symptoms and behaviors. Longitudinal studies are needed to more fully investigate development of system features, their role in the transition from suicidal ideation to behavior and risk for completed suicide, and the role of emotion regulation in suicidal behavior in bipolar disorder and whether it generalizes to other disorders.” – by Amanda Oldt

Disclosure: Johnston reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.