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Cited by 289Suicide and Self-Harm StudiesNeural and Behavioral Psychology StudiesNeurotransmitter Receptor Influence on Behavior

Reward Signals, Attempted Suicide, and Impulsivity in Late-Life Depression

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Dombrovski, Alexandre Y., Szanto, Katalin, Clark, Luke, Reynolds, Charles F., Siegle, Greg J.·2013·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.75PMC PMC3859132
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Abstract

IMPORTANCE—Suicide can be viewed as an escape from unendurable punishment at the cost of any future rewards. Could faulty estimation of these outcomes predispose to suicidal behavior? In behavioral studies, many of those who have attempted suicide misestimate expected rewards on gambling and probabilistic learning tasks.OBJECTIVES—To describe the neural circuit abnormalities that underlie disadvantageous choices in people at risk for suicide and to relate these abnormalities to impulsivity, which is one of the components of vulnerability to suicide.DESIGN—Case-control functional magnetic resonance imaging study of reward learning using are inforcement learning model.SETTING—University hospital and outpatient clinic.PATIENTS—Fifty-three participants 60 years or older, including 15 depressed patients who had attempted suicide, 18 depressed patients who had never attempted suicide (depressed control subjects), and 20 psychiatrically healthy controls.MAIN OUTCOMES AND MEASURES—Components of the cortical blood oxygenation level–dependent response tracking expected and unpredicted rewards.RESULTS—Depressed elderly participants displayed 2 distinct disruptions of control over reward-guided behavior. First, impulsivity and a history of suicide attempts (particularly poorly planned ones) were associated with a weakened expected reward signal in the paralimbic cortex,which in turn predicted the behavioral insensitivity to contingency change. Second, depression was associated with disrupted corticostriatothalamic encoding of unpredicted rewards, which in turn predicted the behavioral over sensitivity to punishment. These results were robust to the effects of possible brain damage from suicide attempts, depressive severity, co-occurring substance use and anxiety disorders, antidepressant and anticholinergic exposure, lifetime exposure to electroconvulsive therapy, vascular illness, and incipient dementia.CONCLUSIONS AND RELEVANCE—Altered paralimbic reward signals and impulsivity and/or carelessness may facilitate unplanned suicidal acts. This pattern, also seen in gambling and cocaine use, may reflect a primary deficit in the paralimbic cortex or in its mesolimbic input. The over reactivity to punishment in depression may be caused in part by a disruption of appetitive learning in the corticostriatothalamic circuits.

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  • Depressed patients exhibit both hyposensitivity to rewards and oversensitivity to punishments, attributed to alterations in mesolimbic prediction error signaling, and may exhibit a constrained option space ('tunnel vision') during decision-making.

    “For instance, depressed patients exhibit both hyposensitivity to rewards and oversensitivity to punishments 96,97 , attributed to alterations in mesolimbic prediction error signaling 97-99 , and may exhibit a constrained option space ('tunnel vision') during decision-making 100 .”

    From Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model (2020) · cites this paper as [97]

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  • Compared with suicide nonattempters, suicide attempters with the same diagnosis show less activity in the dlPFC, rACC, dACC, thalamus, and insula during decision-making tasks.

    “Compared with suicide nonattempters, suicide attempters having the same diagnosis manifest less activity in the dlPFC, rACC, dACC, thalamus, and insula while performing decision-making tasks (e.g., the Iowa Gambling Task) (95-99).”

    From A brain-centric model of suicidal behavior (2020) · cites this paper as [96]

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Research works printed but not linked: 1

  1. [65]First M Sr Gibbon M Williams JBW Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (SCID-I/P), Version 2 New York Biometrics Research Dept, New York State Psychiatric Institute 1995

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Authors
Dombrovski, A. Y., Szanto, K., Clark, L., Reynolds, C. F., & Siegle, G. J.
Affiliations
University of Pittsburgh (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2013-10-01
Volume
70
Issue
10
Pages
1020
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.75
PMC
PMC3859132
OpenAlex
W2073881246
Cited by
289
References
96
Citations by year
2026: 10 · 2025: 13 · 2024: 12 · 2023: 10 · 2022: 17 · 2021: 48 · 2020: 24 · 2019: 12 · 2018: 38 · 2017: 23 · 2016: 21 · 2015: 28 · 2014: 27 · 2013: 6
FWCI
30.41
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • American Foundation for Suicide Prevention
  • National Institutes of Health (UL1TR000005)
  • National Institute of Mental Health (P30MH090333, K23MH086620, K23MH070471, R01MH085651)
  • National Center for Advancing Translational Sciences
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
suicide attempts, geriatric depression, impulsivity, reward learning, paralimbic cortex, punishment sensitivity, contingency learning, reward-guided behavior, older adults, mesolimbic system
MeSH terms
Aged, Cerebral Cortex, Choice Behavior, Depression, Female, Humans, Impulsive Behavior, Male, Middle Aged, Reward, Risk, Suicide, Attempted, Case-Control Studies, Age of Onset, Substance-Related Disorders

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