title: Prefrontal cortex markers of suicidal vulnerability in mood disorders: a model-based structural neuroimaging study with a translational perspective.
abstract: The vulnerability to suicidal behavior has been modeled in deficits in both valuation and cognitive control processes, mediated by ventral and dorsal prefrontal cortices. To uncover potential markers of suicidality based on this model, we measured several brain morphometric parameters using 1.5T magnetic resonance imaging in a large sample and in a specifically designed study. We then tested their classificatory properties. Three groups were compared: euthymic suicide attempters with a past history of mood disorders and suicidal behavior (N=67); patient controls with a past history of mood disorders but not suicidal behavior (N=82); healthy controls without any history of mental disorder (N=82). A hypothesis-driven region-of-interest approach was applied targeting the orbitofrontal cortex (OFC), ventrolateral (VLPFC), dorsal (DPFC) and medial (including anterior cingulate cortex; MPFC) prefrontal cortices. Both voxel-based (SPM8) and surface-based morphometry (Freesurfer) analyses were used to comprehensively evaluate cortical gray matter measure, volume, surface area and thickness. Reduced left VLPFC volume in attempters vs both patient groups was found (P=0.001, surviving multiple comparison correction, Cohen's d=0.65 95% (0.33-0.99) between attempters and healthy controls). In addition, reduced measures in OFC and DPFC, but not MPFC, were found with moderate effect sizes in suicide attempters vs healthy controls (Cohen's d between 0.34 and 0.52). Several of these measures were correlated with suicidal variables. When added to mood disorder history, left VLPFC volume increased within-sample specificity in identifying attempters in a significant but limited way. Our study, therefore, confirms structural prefrontal alterations in individuals with histories of suicide attempts. A future clinical application of these markers will, however, necessitate further research.
authors.affiliation: McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Mood Disorders Centre, School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
authors.forename: N
authors.initials: N
authors.lastname: Lawrence
authors.affiliation: Department of Psychiatry and Inserm, Université Montpellier I and CHU Montpellier, Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Olié
authors.affiliation: Department of Psychiatry and Inserm, Université Montpellier I and CHU Montpellier, Montpellier, France.
authors.forename: F
authors.initials: F
authors.lastname: Cyprien
authors.affiliation: Department of Radiology, Université Montpellier I and CHU Montpellier, Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: le Bars
authors.affiliation: Department of Radiology, Université Montpellier I and CHU Montpellier, Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Bonafé
authors.affiliation: Clinical and Translational Affective Neuroscience Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Phillips
authors.affiliation: Department of Psychiatry and Inserm, Université Montpellier I and CHU Montpellier, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Courtet
authors.affiliation: 1] McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada [2] CHU Nîmes, Nimes, France.
authors.forename: F
authors.initials: F
authors.lastname: Jollant
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008131:London; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D019964:Mood Disorders / Q000473:pathology* / Q000523:psychology*; D059906:Neuroimaging / Q000379:methods*; D017397:Prefrontal Cortex / Q000473:pathology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted