Alterations in performance and discriminating power of the death/suicide implicit association test across the lifespan.

The Death/Suicide Implicit Association Test (d/s-IAT) has differentiated individuals with prior and prospective suicide attempts in previous studies, however, age effects on test results remains to be explored. A three-site study compared performance on the d/s-IAT among participants aged 16-80 years with depression and prior suicide attempt (n = 82), with depression and no attempts (n = 80), and healthy controls (n = 86). Outcome measures included the standard difference (D) score, median reaction times, and error rates. Higher D scores represent a stronger association between death/suicide and self, while lower scores represent a stronger association between life and self. The D scores differed significantly among groups overall. Participants with depression exhibited higher scores compared to healthy controls, but there was no difference between participants with and without prior suicide attempts(F[2,242]=8.76, p<.001). Response times for participants with prior attempts differed significantly from other groups, with no significant differences in error rates. The D score was significantly affected by age (ß =-0.007, t = 3.65, p<.001), with slowing of response times in older ages. Results suggest reaction time d/s-IAT D scores may not distinguish implicit thinking about suicide as response times slow with age, but slowed response times may be sensitive to suicide risk potentially indicating basic information processing deficits.

Is Late-Onset Suicidal Behavior a Distinct Subtype?

This clinical viewpoint article aims to draw attention to a yet unexplored factor influencing suicidal behavior: age of onset of suicidal behavior. To tackle the substantial heterogeneity among depressed older attempters, we suggest consideration of at least two distinct pathways to suicidal behavior in late life based on when the first suicidal crisis occurred. Specifically, we discuss the current state of research and the rationale behind the suggested early-late-onset categorization of late-life suicidal behavior. We summarize available evidence so far on early-onset and late-onset attempters, and the potential heterogeneity in the interplay of risk/precipitating factors. Certain risk factors for suicide, such as impulsivity and borderline traits, decrease with age, while memory and broader cognitive impairments increase with age. Research indicates that familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems are found predominantly in attempters experiencing their first suicidal crisis between youth and early midlife. In contrast, dementia prodrome is one of the most promising but understudied candidates for late-onset suicide risk, especially in the context of other risk factors. Moreover, personality traits conferring increased vulnerability to late-onset suicidal behavior (such as high conscientiousness) are not the same as ones classically identified in younger attempters and in older suicide attempters who have early-onset suicidal behavior (such as neuroticism and Cluster B traits). We discuss methodological points about studying age of onset of suicidal behavior, outline clinical implications, share ideas for future directions, and call for research on this understudied topic.

Childhood trauma is associated with early-onset but not late-onset suicidal behavior in late-life depression.

OBJECTIVES: To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults. DESIGN: Cross-sectional study. SETTING: Inpatient and outpatient psychiatric services in Pennsylvania. PARTICIPANTS: Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38). MEASUREMENTS: The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse. RESULTS: Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups. CONCLUSIONS: Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

Long-Term Suicidal Ideation Profiles in Late-Life Depression and Their Association With Suicide Attempt or Death by Suicide.

Objective: In young and middle-aged adults, suicidal ideation is an important predictor of prospective suicide attempts, but its predictive power in late life remains unclear. In this study, we used Latent Profile Analysis (LPA) in a cohort of depressed older adults to identify distinct ideation profiles and their clinical correlates and test their association with risk of suicidal behavior longitudinally.Methods: A total of 337 depressed older adults (aged 50-93 years) were assessed for suicidal ideation and behavior for up to 14 years (median = 3 years), at least once per year (study period: 2002-2020). LPA was used, which derived 4 profiles of ideation scores based on subject-level aggregates. Groups were compared using analysis of variance (ANOVA) and χ2 tests at baseline and competing risk survival analysis during follow-up.Results: Ideation showed significant decline over time, on average (P < .001). LPA identified 4 suicidal ideation profiles. Risk of suicide attempt/death was higher for chronic severe ideators (age-adjusted hazard ratio [HR] = 5.75; 95% CI, 2.25-14.7; P < .001) and highly variable ideators (HR = 3.21; 95% CI, 1.03-10.1; P = .045) compared to fast-remitting ideators, despite comparable current ideation severity at baseline. Fast-remitting ideators had higher risk than low/non-ideators with no attempts or suicides (P < .001). Chronic severe ideators displayed the most severe dysfunction across personality, social characteristics, and impulsivity measures, whereas highly variable and fast-remitting ideators displayed specific deficits.Conclusions: Assessing suicidal ideation over months/years has clinical relevance, as it enabled the identification of distinct ideation patterns associated with substantive differences in clinical presentation and risk of future suicidal behavior despite similar ideation levels at baseline.

Life-Satisfaction, Engagement, Mindfulness, Flourishing, and Social Support: Do they Predict Depression, Suicide Ideation, and History of Suicide Attempt in Late Life?

OBJECTIVE: Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults. METHODS: Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt. RESULTS: Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96). CONCLUSION: Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.

Comparison of approximate intermolecular potentials for ab initio fragment calculations on medium sized N-heterocycles.

The ground state intermolecular potential of bimolecular complexes of N-heterocycles is analyzed for the impact of individual terms in the interaction energy as provided by various, conceptually different theories. Novel combinations with several formulations of the electrostatic, Pauli repulsion, and dispersion contributions are tested at both short- and long-distance sides of the potential energy surface, for various alignments of the pyrrole dimer as well as the cytosine-uracil complex. The integration of a DFT/CCSD density embedding scheme, with dispersion terms from the effective fragment potential (EFP) method is found to provide good agreement with a reference CCSD(T) potential overall; simultaneously, a quantum mechanics/molecular mechanics approach using CHELPG atomic point charges for the electrostatic interaction, augmented by EFP dispersion and Pauli repulsion, comes also close to the reference result. Both schemes have the advantage of not relying on predefined force fields; rather, the interaction parameters can be determined for the system under study, thus being excellent candidates for ab initio modeling.

Delay discounting in suicidal behavior: Myopic preference or inconsistent valuation?

Prior studies sought to explain the predisposition to suicidal behavior in terms of myopic preference for immediate versus delayed reward, generating mixed evidence. Data from gambling and bandit tasks, however, suggest that suboptimal decisions in suicidal individuals are explained by inconsistent valuation rather than myopic preferences. We tested these two alternative hypotheses using a delay discounting task in 622 adults (suicide attempters with depression, suicide ideators with depression, nonsuicidal participants with depression, and healthy controls) recruited across three sites through inpatient psychiatric units, mood disorders clinics, primary care, and advertisements. Multilevel models revealed group differences in valuation consistencies in all three samples, with high-lethality suicide attempters exhibiting less consistent valuation than all other groups in Samples 1 and 3 and less consistent valuation than the healthy controls or participants with depression in Sample 2. In contrast, group differences in preference for immediate versus delayed reward were observed only in Sample 1 and were due to the high-lethality suicide attempters displaying a weaker preference for immediate reward than low-lethality suicide attempters. The findings were robust to confounds such as cognitive functioning and comorbidities. Seemingly impulsive choices in suicidal behavior are explained by inconsistent reward valuation rather than a true preference for immediate reward. In a suicidal crisis, this inconsistency may result in a misestimation of the value of suicide relative to constructive alternatives and deterrents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Role of Perceived and Objective Social Connectedness on Risk for Suicidal Thoughts and Behavior in Late-Life and Their Moderating Effect on Cognitive Deficits.

OBJECTIVE: Impaired cognition increases suicide risk while social connectedness protects against suicide risk in late life. We examined the independent and interactive effects of social connectedness and cognition on suicide risk in late life. METHODS: Participants included 570 individuals aged 50+ from a late-life suicide study. The Interpersonal Support Evaluation List and Social Network Index were used to assess perceived and objective social connectedness, respectively, while the Mattis Dementia Rating Scale and Executive Interview were used to assess cognition. RESULTS: Suicide attempters and ideators reported lower perceived social connectedness and exhibited worse executive function than non-suicidal depressed and healthy comparison participants, while only attempters had worse objective social connectedness relative to the other groups. Executive dysfunction was linked to low objective social connectedness in attempters but higher objective social connectedness in healthy comparisons. CONCLUSION: Interventions targeting suicide risk may consider bolstering social connectedness, particularly in those with low cognitive health.

Age effects on clinical and neurocognitive risk factors for suicide attempt in depression - Findings from the AFSP lifespan study.

BACKGROUND: Studies of risk factors for suicidal behavior are typically restricted to narrow age ranges, making it difficult to determine if they have the same relevance or potency across the full adult lifespan. METHODS: This study examined selected clinical and neurocognitive risk factors for suicidal behavior - borderline personality traits, aggression, depressive rumination, memory performance, and language fluency- in a multi-site sample (N = 309, ages 16-80) of depressed patients with a recent (last 5 years) suicide attempt or no history of attempt, and demographically similar non-psychiatric controls. We examined cross-sectional age and attempter/non-attempter differences on these risk factors, and whether certain risk factors were more prominent discriminators of past suicide attempt earlier or later in the lifespan. Correlations with age were computed, and logistic regression was used to classify attempter status based on each risk factor and its interaction with age. RESULTS: Nearly all risk factors were negatively correlated with age. Borderline traits, aggression, memory, and category fluency each predicted attempter status (p < 0.05), but these effects were not different across ages. In contrast, the association between rumination and suicide attempt status differed across the lifespan, becoming a stronger discriminator of past suicidal behavior at older ages. LIMITATIONS: The cross-sectional design limits our developmental findings. CONCLUSIONS: Despite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in later life.

Late-Onset Suicide: A Dementia Prodrome?

OBJECTIVES: This study examined whether late-onset (versus early-onset) suicidal behavior is associated with worse cognition. METHODS: Participants included 278 adults aged 50+ years (56 nonpsychiatric comparison group; 67 nonsuicidal depressed older adults; 63 depressed suicide ideators; and 44 late-onset (55+ years) and 48 early-onset suicide attempters (<55 years). Using a case-control design, this study examined group differences in global cognition, episodic memory, information processing speed, and executive functioning, assessed using the Repeatable Battery of Neuropsychological Status and the Trail Making Test from the Delis-Kaplan Executive Function System. Linear regression was used for data analyses. RESULTS: Both attempter groups displayed worse executive functioning than nonsuicidal depressed older adults. Late-onset attempters additionally displayed poorer global cognition and processing speed than nonsuicidal depressed older adults and poorer memory than early-onset attempters. CONCLUSIONS: Late-onset suicidal behavior is associated with worse performance in a broad range of cognitive domains, possibly reflective of a dementia prodrome.

Status, rivalry and admiration-seeking in narcissism and depression: A behavioral study.

Humans seek admiration to boost their social rank and engage in rivalry to protect it when fearing defeat. Traits such as narcissism and affective states such as depression are thought to influence perception of rank and motivation for dominance in opposite ways, but evidence of the underlying behavioral mechanisms is scant. We investigated the effects of dimensionally-assessed narcissism and depression on behavioral responses to social defeat in a rigged video game tournament designed to elicit rivalry (stealing points from opponents) and admiration-seeking (paying for rank). We tested an undergraduate sample (N = 70, mean age = 21.5 years) and a clinical sample of predominantly depressed elderly (N = 85, mean age = 62.6 years). Both rivalry and admiration-seeking increased with time on task and were particularly enhanced in individuals high in narcissism. Participants engaged in more rivalry when pitted against high-ranked opponents, but depression partially mitigated this tendency. Our findings provide behavioral evidence that narcissism manifests in increased rivalry and admiration-seeking during social contests. Depression does not suppress general competitiveness but selectively inhibits upward-focused rivalry.

Suicide in the Time of COVID-19: Review and Recommendations.

The coronavirus (COVID-19) pandemic presents us with unusual challenges to the global health system and economics. The pandemic may not have an immediate impact on suicide rates, however, given that it is likely to result in a confluence of risk factors for suicide and economic crisis, it is highly possibly that it will lead to increases in suicide rates in the long-run. Elderly persons are more likely to live alone, be socially isolated during COVID-19 and have physical health problems, which are risk factors for suicide. Young children and health professionals may also be population at risk. Isolation, quarantine and the economic crisis that follows may impact mental health significantly. The International Academy of Suicide Research (IASR) is an organization dedicated to promote high standards of research and scholarship in the field of suicidal behaviour to support efforts to prevent suicide globally. This IASR's board position paper gives recommendations for suicide research during the COVID-10 pandemic. Clinical research has to be modified due to COVID-19 shutdown.

Predictors of serious suicidal behavior in late-life depression.

The present study aimed to identify pathways to suicidal behavior in late life that can guide identification of those most at risk and improve treatment. In a longitudinal study of late-life depression, we prospectively assessed risk factors specifically associated with fatal and near-fatal as compared to less lethal suicidal behavior. We enrolled 401 participants (age 66+9.9): 311 with unipolar non-psychotic depression and 90 non-psychiatric controls. The median follow-up was 5.4 years. Results indicated that history of suicide attempt predicted a two-fold increase in the risk of dying from natural causes. In univariate models, male gender, higher income, current depression and current and worst lifetime suicidal ideation severity, cognitive control deficits, and low levels of non-planning impulsivity predicted fatal and near-fatal suicidal behavior. In contrast, incident less lethal suicidal behavior was mostly associated with maladaptive personality traits, impulsivity, and severity of psychiatric illness in univariate models. In multipredictor models, male gender, worst lifetime suicidal ideation, and deficits in cognitive control independently predicted fatal/near-fatal suicidal behavior, while introversion, history of suicide attempt, and earlier age of onset of depression predicted less lethal suicidal behavior. While clinicians may be familiar with suicide risk factors identified in younger samples such as dysfunctional personality, impulsivity, and co-morbid substance use, in late life these characteristics only pertain to lower-lethality suicidal behavior. Cognitive control deficits, which likely play a greater role in old age, predict serious suicidal behavior.

Ventromedial prefrontal value signals and functional connectivity during decision-making in suicidal behavior and impulsivity.

Suicide is linked to impaired value-based decision-making and impulsivity, but whether these risk factors share neural underpinnings is unclear. Disrupted ventromedial prefrontal cortex (vmPFC) value signals may underlie this behavioral phenotype. We investigated vmPFC value signals, vmPFC-frontoparietal connectivity, and the impact of impulsivity during decision-making in depressed individuals with and without suicidal behavior. Middle-aged and older adults (n = 116; 35 with a history of suicide attempts, 25 with ideation only, 25 depressed controls with no ideation, and 31 nonpsychiatric controls) completed a decision-making task with drifting reward probabilities during fMRI. Values of choices, estimated by a reinforcement learning model, were regressed against BOLD signal. VmPFC value activation was compared between groups. Moderating effects of impulsivity on vmPFC-frontoparietal connectivity were assessed in nonpsychiatric controls and compared among patient groups. VmPFC value responses in participants with a history of suicide attempts were reduced relative to nonpsychiatric controls (p < 0.05). In nonpsychiatric controls, vmPFC-frontoparietal connectivity was negatively moderated by impulsivity (pFWE corrected < 0.05). This effect was preserved in comparison patient groups but abolished in suicide attempters (p < 0.001). This change in neural connectivity patterns also affected behavior: people with a history of suicide attempts showed a disrupted effect of vmPFC-frontoparietal connectivity, impulsivity, and reinforcement on choice quality (p < 0.001). These effects were specific to vmPFC and not to striatum. In summary, findings from this study largely support disrupted vmPFC value signals in suicidal behavior. In addition, it uncovers an altered pattern of vmPFC-frontoparietal connectivity in impulsive people with suicidal behavior, which may underlie disrupted choice processes in a suicidal crisis.

Personality of late- and early-onset elderly suicide attempters.

OBJECTIVES: While suicidal behavior often manifests in adolescence and early adulthood, some people first attempt suicide in late life, often with remarkable lethal intent and determination. Given these individuals' more adaptive functioning earlier in life, they may possess traits that hinder adjustment to aging, such as high conscientiousness, rather than impulsive-aggressive traits associated with suicidal behavior in younger adults. METHODS: A cross-sectional case-control study was conducted in older adults aged ≥50 (mean: 65), divided into early- and late-onset attempters (age at first attempt ≤ or >50, mean: 31 vs 61), suicide ideators as well as non-suicidal depressed and healthy controls. Personality was assessed in terms of the five-factor model (FFM, n = 200) and five DSM personality disorders analyzed on the trait level as continuous scores (PDs, n = 160). Given our starting hypothesis about late-onset attempters, the FFM dimension conscientiousness was further tested on the subcomponent level. RESULTS: All clinical groups displayed more maladaptive profiles than healthy subjects. Compared to depressed controls, higher neuroticism, and borderline traits characterized both suicide ideators and early-onset attempters, while only early-onset attempters further displayed lower extraversion and higher antisocial traits. Late-onset attempters were similar to depressed controls on most measures, but scored higher than them on orderliness, a conscientiousness subcomponent. CONCLUSIONS: While neuroticism, introversion, and cluster B traits are prominent in early-onset suicidal behavior, late-onset cases generally lack these features. In contrast, higher levels of orderliness in late-onset suicidal behavior are compatible with the age-selective maladjustment hypothesis. Key points Personality of elderly attempters differed between those with early- and late-onset first attempts. Early-onset attempters possessed personality traits generally found in younger suicidal populations (high neuroticism, low extraversion, antisocial, and borderline PD traits), supporting that constitutional suicide risk factors persist into late life in some individuals. Late-onset suicide attempters had higher levels of orderliness than non-suicidal depressed participants, suggesting that this generally adaptive trait may facilitate suicidal behavior in a subset of depressed elderly.

Neurocomputational mechanisms of adaptive learning in social exchanges.

Prior work on prosocial and self-serving behavior in human economic exchanges has shown that counterparts' high social reputations bias striatal reward signals and elicit cooperation, even when such cooperation is disadvantageous. This phenomenon suggests that the human striatum is modulated by the other's social value, which is insensitive to the individual's own choices to cooperate or defect. We tested an alternative hypothesis that, when people learn from their interactions with others, they encode prediction error updates with respect to their own policy. Under this policy update account striatal signals would reflect positive prediction errors when the individual's choices correctly anticipated not only the counterpart's cooperation but also defection. We examined behavior in three samples using reinforcement learning and model-free analyses and performed an fMRI study of striatal learning signals. In order to uncover the dynamics of goal-directed learning, we introduced reversals in the counterpart's behavior and provided counterfactual (would-be) feedback when the individual chose not to engage with the counterpart. Behavioral data and model-derived prediction error maps (in both whole-brain and a priori striatal region of interest analyses) supported the policy update model. Thus, as people continually adjust their rate of cooperation based on experience, their behavior and striatal learning signals reveal a self-centered instrumental process corresponding to reciprocal altruism.

Motivations for attempting suicide in mid- and late-life.

ABSTRACTObjectives:To understand pathways to suicide by investigating the association between personality and suicidal motivations in mid- and late-life attempts. DESIGN: In a two-study approach, we measured different components of suicidal motivations using an existing self-report investigating reasons for suicide and a semi-qualitative assessment of motivational states preceding attempts. SETTING: Inpatient and outpatient psychiatric services in Pittsburgh, PA. PARTICIPANTS: Study 1 (n = 50, mean age at attempt = 60.4) was a smaller sample of suicide attempters included in Study 2 (n = 69, mean age at attempt = 60.9). Non-psychiatric healthy controls (n = 50, mean age = 67.1) were used as benchmarks for dispositional measures. MEASUREMENTS: Motives for suicide were measured by the Reasons for Attempting Suicide Questionnaire (RASQ). Participants' written descriptions of the thoughts and feelings preceding their attempt captured motivational states. Measures of personality for both studies included assessments of impulsivity, five-factor model, interpersonal dysfunction, and borderline traits. RESULTS: In study 1, escape/self-punishment motives on the RASQ were associated with multiple attempts and borderline pathology, while interpersonal motives were less frequently endorsed and associated with poorly planned attempts. In study 2, experiences of defeat (i.e. powerlessness, poor coping to threats to autonomy/status) were more frequently endorsed by men and associated with disagreeableness. CONCLUSIONS: Study 1 revealed that attempters high in dysfunctional psychopathology were more likely to report self-oriented escape motives for suicide, while study 2 identified a putative pathway to suicide in men involving antagonism and the experience of defeat.