Differences between suicide attempters and nonattempters in depressed older patients: depression severity, white-matter lesions, and cognitive functioning.
OBJECTIVE
The population of older adults with major depressive disorder (MDD) has the highest rate of suicide. White-matter brain lesions (WML) are a potential biologic marker for suicidality in young and middle-aged adults and are correlated with cognitive impairment in older adults. In this study of older patients with MDD, we examined 1) if a history of suicide attempts was associated with a more severe course of MDD; 2) if WML are a biologic marker for suicide; and 3) if suicide attempt history is associated with cognitive impairment mediated by WML.


METHODS
Data from the Neurocognitive Outcomes of Depression in the Elderly study.


METHODS
Depressed patients (60+) who had ever attempted suicide (n = 23) were compared with depressed patients (60+) who had not attempted suicide (n = 223).


METHODS
Baseline and follow-up assessments were obtained for depressive symptoms (every 3 months) and cognitive functioning (every 6 months) over 2 years. Three magnetic resonance imaging scans were conducted.


RESULTS
At baseline, suicide attempters reported more severe past and present symptoms (e.g., depressive symptoms, current suicidal thoughts, psychotic symptoms, earlier age of onset, and more lifetime episodes) than nonattempters. Suicide attempters had more left WML at baseline, and suicide attempt history predicted a greater growth in both left and right WML. WML predicted cognitive decline; nonetheless, a history of suicide attempt was unrelated to cognitive functioning.


CONCLUSIONS
Severity of depressive symptoms and WML are associated with suicide attempts in geriatric depressed patients. Suicide attempts predicted neurologic changes, which may contribute to poorer long-term outcomes in elder attempters.
Department of Psychology, Florida State University, Tallahassee, FL. Electronic address: sachs@psy.fsu.edu.
Natalie
N
Sachs-Ericsson
Jennifer L
JL
Hames
Thomas E
TE
Joiner
Elizabeth
E
Corsentino
Nicole C
NC
Rushing
Emily
E
Palmer
Ian H
IH
Gotlib
Edward A
EA
Selby
Steven
S
Zarit
David C
DC
Steffens
D000368:Aged; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology*; D063189:Symptom Assessment; D066127:White Matter / Q000473:pathology*
Geriatric; major depression; white-matter lesions