Top

European Archives of Psychiatry and Clinical Neuroscience

Published in:

01-12-2007 | ORIGINAL PAPER

White matter hyperintensities and their associations with suicidality in patients with major affective disorders

Authors: Maurizio Pompili, M.D., Stefan Ehrlich, M.D., Eleonora De Pisa, M.D., J. John Mann, M.D., Marco Innamorati, Psy. D., Andrea Cittadini, M.D., Benedetta Montagna, M.D., Paolo Iliceto, Ph.D., Andrea Romano, M.D., Mario Amore, M.D., Roberto Tatarelli, M.D., Paolo Girardi, M.D.

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 8/2007

Abstract

Introduction

A large body of evidence suggests that predisposition to suicide, an important public health problem, is mediated to a certain extent by neurobiological factors. The objective of this cross-sectional study was to compare the prevalence of white matter hyperintensities (WMH) in patients with major affective disorders with and without histories of suicide attempts.

Methods

T2-weighted magnetic resonance images (MRI) of 65 psychiatric inpatients with major depressive disorder or bipolar disorder were rated for the presence of WMH. Diagnoses, presence or absence of suicide risk and substance abuse were determined by the Mini International Neuropsychiatric Interview (MINI). Medical charts were reviewed to ascertain history of suicide attempt and basic clinical variables. Fisher’s Exact Tests and logistic regression modeling were used to test the association between WMH and suicidality. Suicidal patients and controls were not matched for demographic variables and exposure to some risk factors.

Results

Bivariate analysis showed that the prevalence of WMH was significantly higher in subjects with past suicide attempts (Fisher’s Exact Test, p = 0.01) and other clinical indicators of elevated suicide risk. Logistic regression analyses controlling for age, sex, and several clinical risk factors supported this finding (odds ratio = 4.7; 95% confidence interval: 1.4, 16.1).

Conclusions

The increased prevalence of WMH in adults with major affective disorders and a history of suicide attempt, compared to similar patients without such a history, is consistent with previous findings in depressed children, youth and young adults. However, the association between WMH and suicidality holds true for both, depressed and bipolar patients. Our results suggest that WMH in patients with major affective disorders might be useful biological markers of suicidality.

Ahearn EP, Jamison KR, Steffens DC, et al. (2001) MRI correlates of suicide attempt history in unipolar depression. Biol Psychiatry 50:266–270PubMedCrossRef

Amorim P, Lecrubier Y, Weiller E, Hergueta T, Sheehan D (1998) DSM-III-R psychotic disorders: Procedural validity of the Mini International Neuropsychiatric Interview (MINI). Eur Psychiatry 13:26–34CrossRefPubMed

Angst J, Angst F, Stassen HH (1999) Suicide risk in patients with major depressive disorder. J Clin Psychiatry 60(Suppl 2):57–62PubMed

Baldessarini RJ, Pompili M, Tondo L (2006) Suicidal risk in antidepressant drug trials. Arch Gen Psychiatry 63:246–248PubMedCrossRef

Bondy B, Buettner A, Zill P (2006) Genetics of suicide. Mol Psychiatry 11:336–351PubMedCrossRef

Bostwick JM, Pankratz VS (2000) Affective disorders and suicide risk: a reexamination. Am J Psychiatry 157:1925–1932PubMedCrossRef

Brent DA, Mann JJ (2005) Family genetic studies, suicide, and suicidal behavior. Am J Med Genet C Semin Med Genet 133:13–24PubMed

Chen YW, Dilsaver SC (1996) Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol Psychiatry 39:896–899PubMedCrossRef

Derogatis LR (1983) SCL-90-R: adminstration, scoring and procedures manual-II. Clinical Pychometric Research, Towson

10.

Derogatis LR, Cleary PA (1977a) Confirmation of the dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol 33:981–989

11.

Derogatis LR, Cleary PA (1977b) Factorial invariance across gender for the primary symptom dimensions of the SCL-90-R. Brit J Soc Clin Psychol 16:347–356

12.

Dufouil C, de Kersaint-Gilly A, Besancon V (2001) Longitudinal study of blood pressure and white matter hyperintensities: the EVA MRI Cohort. Neurology 56:921–926PubMed

13.

Ehrlich S, Breeze JL, Hesdorffer DC et al. (2005) White matter hyperintensities and their association with suicidality in depressed young adults. J Affect Disord 86:281–287PubMedCrossRef

14.

Ehrlich S, Noam GG, Lyoo IK, Kwon BJ, Clark MA, Renshaw PF (2004) White matter hyperintensities and their associations with suicidality in psychiatrically hospitalized children and adolescents. J Am Acad Child Adolesc Psychiatry 43:770–776PubMedCrossRef

15.

Greenwald BS, Kramer-Ginsberg E, Krishnan RR, Ashtari M, Aupperle PM, Patel M (1996) MRI signal hyperintensities in geriatric depression. Am J Psychiatry 153:1212–1215PubMed

16.

Hawton K, Sutton L, Haw C, Sinclair J, Harriss L (2005) Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry 66:693–704PubMedCrossRef

17.

Joint National Committee on Detection, Evaluation, AND Treatment of high blood pressure (1998) The sixth report of the Joint National Committee on the detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med 24:2413–2446

18.

Judas M, Rados M, Jovanov-Milosevic N, Hrabac P, Stern-Padovan R, Kostovic I (2005) Structural, immunocytochemical, and mr imaging properties of periventricular crossroads of growing cortical pathways in preterm infants. AJNR Am J Neuroradiol 26:2671–2684PubMed

19.

Leaper SA, Murray AD, Lemmon HA, Staff RT, Deary IJ, Crawford JR, Whalley LJ (2001) Neuropsychologic correlates of brain white matter lesions depicted on MR images: 1921 Aberdeen Birth Cohort. Radiology 221:51–55PubMedCrossRef

20.

Lecrubier Y, Sheehan D, Weiller E, et al. (1997) A short diagnostic structured interview. Eur Psychiatry 12:224–231CrossRef

21.

Lesser IM, Boone KB, Mehringer CM, Wohl MA, Miller BL, Berman NG (1996) Cognition and white matter hyperintensities in older depressed patients. Am J Psychiatry 153:1280–1287PubMed

22.

Mann JJ (2003) Neurobiology of suicidal behaviour. Nat Rev Neurosci 4:819–828PubMedCrossRef

23.

Mann JJ, Currier D, Oquendo MA, Amsel LV, Ellis SP (2006) Can biological tests assist prediction of suicide in mood disorders? Int J Neuropsychopharmacol 9:465–474PubMedCrossRef

24.

McGuffin P, Marusic A, Farmer A (2001) What can psychiatric genetics offer suicidology? Crisis 22:61–65PubMed

25.

Moller HJ (2006) Is there evidence for negative effects of antidepressants on suicidality in depressive patients? A systematic review. Eur Arch Psychiatry Clin Neurosci 256:476–496PubMedCrossRef

26.

Möller-Leimkühler AM, Bottlender R, Strauss A, Rutz W (2004) Is there evidence for a male depressive syndrome in inpatients with major depression? J Affect Disord 80:87–93PubMedCrossRef

27.

Möller-Leimkühler AM, Heller J, Paulus NC (2007) Subjective well-being and ‘male depression’ in male adolescents. J Affect Disord 98:65–72PubMedCrossRef

28.

O’Brien J, Ames D, Chiu E, Schweitzer I, Desmond P, Tress B (1998) Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study. BMJ 317:982–984PubMed

29.

Ovbiagele B, Saver JL (2006) Cerebral white matter hyperintensities on MRI: current concepts and therapeutic implications. Cerebrovasc Dis 22:83–90PubMedCrossRef

30.

Peterson BS (2003) Brain imaging studies of the anatomical and functional consequences of preterm birth for human brain development. Ann N Y Acad Sci 1008:219–237PubMedCrossRef

31.

Sheehan DV, Lecrubier Y, Sheehan KH et al. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33PubMed

32.

Silverstone T, McPherson H, Li Q, Doyle T (2003) Deep white matter hyperintensities in patients with bipolar depression, unipolar depression and age-matched control subjects. Bipolar Disord 5:53–57PubMedCrossRef

33.

Sinclair JM, Harriss L, Baldwin DS, King EA (2005) Suicide in depressive disorders: a retrospective case-control study of 127 suicides. J Affect Disord 87:107–113PubMedCrossRef

34.

Soares JC, Mann JJ (1997) The anatomy of mood disorders—review of structural neuroimaging studies. Biol Psychiatry 41:86–106PubMedCrossRef

35.

Steffens DC, Krishnan KR (1998) Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions. Biol Psychiatry 43:705–712PubMedCrossRef

36.

Thomas AJ, O’Brien JT, Davis S, Ballard C, Barber R, Kalaria RN, Perry RH (2002) Ischemic basis for deep white matter hyperintensities in major depression: a neuropathological study. Arch Gen Psychiatry 59:785–792PubMedCrossRef

37.

Thomas AJ, Perry R, Barber R, Kalaria RN, O’Brien JT (2002) Pathologies and pathological mechanisms for white matter hyperintensities in depression. Ann N Y Acad Sci 977:333–339PubMedCrossRef

38.

Videbech P (1997) MRI findings in patients with affective disorder: a meta-analysis. Acta Psychiatr Scand 96:157–168PubMedCrossRef

39.

Whitaker AH, Van Rossem R, Feldman JF, Schonfeld IS, Pinto-Martin JA, Tore C, Shaffer D, Paneth N (1997) Psychiatric outcomes in low-birth-weight children at age 6 years: relation to neonatal cranial ultrasound abnormalities. Arch Gen Psychiatry 54:847–856PubMed

40.

Wozniak J, Biederman J, Kwon A, Mick E, Faraone S, Orlovsky K, Schnare L, Cargol C, van Grondelle A (2005) How cardinal are cardinal symptoms in pediatric bipolar disorder? An examination of clinical correlates. Biol Psychiatry 58:583–588PubMedCrossRef

41.

Yanai I, Fujikawa T, Horiguchi J, Yamawaki S, Touhouda Y (1998) The 3-year course and outcome of patients with major depression and silent cerebral infarction. J Affect Disord 47:25–30PubMedCrossRef

Title: White matter hyperintensities and their associations with suicidality in patients with major affective disorders
Authors: Maurizio Pompili, M.D.
Stefan Ehrlich, M.D.
Eleonora De Pisa, M.D.
J. John Mann, M.D.
Marco Innamorati, Psy. D.
Andrea Cittadini, M.D.
Benedetta Montagna, M.D.
Paolo Iliceto, Ph.D.
Andrea Romano, M.D.
Mario Amore, M.D.
Roberto Tatarelli, M.D.
Paolo Girardi, M.D.
Publication date: 01-12-2007
Publisher: D. Steinkopff-Verlag
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 8/2007
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-007-0755-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

White matter hyperintensities and their associations with suicidality in patients with major affective disorders

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2007

Complicated grief after traumatic loss

Ruminative coping as avoidance

Suicide victims’ contacts with physicians during the year before death

Insular volume reduction in schizophrenia

The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults

An attachment-based model of complicated grief including the role of avoidance