Neuropsychological Dysfunction in Depressed Suicide Attempters

• Published in: The American journal of psychiatry Vol. 158; no. 5; pp. 735 - 741
• Main Authors: Keilp, John G., Sackeim, Harold A., Brodsky, Beth S., Oquendo, Maria A., Malone, Kevin M., Mann, J. John
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01-05-2001; American Psychiatric Association
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Biological and medical sciences; Depression; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Female; Humans; Male; Medical sciences; Mental depression; Mental disorders; Middle Aged; Mood disorders; Motor Skills - physiology; Multivariate Analysis; Neurology; Neuropsychological impairment; Neuropsychological Tests - statistics & numerical data; Parasuicide; Personality Inventory - statistics & numerical data; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Suicide; Suicide, Attempted - psychology; Suicide, Attempted - statistics & numerical data; Suicides & suicide attempts; Wechsler Scales - statistics & numerical data; Mood disorder; Human; Executive function; Education level; Memory; Attention; Prediction; Depression; Cognition; Professional status; Lethal character; Suicide attempt; Concomitant disease; Premorbid intelligence; Sociodemographic factor; Risk factor; Intellectual ability; Severity score; Motricity; Age; Comparative study
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.158.5.735

OBJECTIVE: Neuropsychological deficits in the context of psychiatric disease may be associated with suicide risk. In this study, neuropsychological performance was compared among depressed patients with at least one prior suicide attempt of high lethality, depressed patients with low-lethality prior attempts, depressed patients with no prior suicide attempts, and nonpatients. METHOD: Fifty unmedicated patients in a major depressive episode (21 with no history of suicide attempts and 14 and 15 patients with previous attempts of low and high lethality, respectively) and 22 nonpatients were assessed. Groups were comparable in age, education, occupational level, and estimated premorbid intelligence. The neuropsychological battery produced scores within five composite domains: general intellectual functioning (current), motor functioning, attention, memory, and executive functioning. RESULTS: Patients whose prior suicide attempts were of high lethality performed significantly worse than all groups on tests of executive functioning and were the only group to perform significantly worse than nonpatients on tests of general intellectual functioning, attention, and memory. A discriminant function analysis revealed two prominent dimensions in the data: one that discriminated high-lethality suicide attempters from all other groups (primarily associated with performance on tests of executive functioning) and another that discriminated all depressed patient groups from nonpatients (associated with performance on measures of attention and memory). For the patients with high-lethality prior suicide attempts, deficits did not appear to reflect diffuse brain damage from past attempts, since the results of tests commonly affected by diffuse injury were not selectively impaired. CONCLUSIONS: Neuropsychological deficits in depressed patients with high-lethality prior suicide attempts suggest impairment of executive functioning beyond that typically found in major depression. This more extensive neuropsychological impairment in the context of depression may be a risk factor for severe suicide attempts.