Impaired Executive Function in Contemplated and Attempted Suicide in Late Life

Abstract

Objective Executive deficits may play an important role in late-life suicide. Yet, current evidence in this area is inconclusive and does not indicate whether these deficits are broadly associated with suicidal ideation or specific to suicidal behavior. This study examined global cognition and specifically executive function impairments as correlates of suicidal ideation and suicidal behavior in depressed older adults, with the goal of extending an earlier preliminary study. Design Case-control study. Setting University-affiliated psychiatric hospital. Participants All were aged 60+: 83 depressed suicide attempters, 43 depressed individuals having suicidal ideation with a specific plan, 54 non-suicidal depressed participants, and 48 older adults with no history of psychiatric disorders. Measurements Global cognitive function - Dementia Rating Scale (DRS), Executive function - Executive Interview (EXIT). Results Both suicide attempters and suicide ideators performed worse than the two comparison groups on the EXIT, with no difference between suicide attempters and suicide ideators. On the DRS total score, as well as on Memory and Attention subscales, suicide attempters and ideators and non-suicidal depressed subjects performed similarly and were impaired relative to with non-psychiatric control subjects. Controlling for education, substance use disorders, and medication exposure did not affect group differences in performance on either the EXIT or DRS. Conclusions Executive deficits, captured with a brief instrument, are associated broadly with suicidal ideation in older depressed adults but do not appear to directly facilitate suicidal behavior. Our data are consistent with the idea that different vulnerabilities may operate at different stages in the suicidal process.

Trajectories of suicidal ideation in depressed older adults undergoing antidepressant treatment

“…Gujral et al (2013) examined global cognition and executive function as correlates of suicidal ideation and suicidal behavior in depressed older adults. Both suicide attempters and suicide ideators performed worse on the Executive Interview (EXIT; Royall et al 1992) compared to non-suicidal depressed or non-psychiatric control subjects.…”

Cognitive Inhibition in Elderly High-lethality Suicide Attempters

“…The intermediate performance of suicide ideators in the current sample suggests a dose-response relationship between cognitive control deficits and the progression of the suicidal process. This dose-response relationship, however, was lacking in our previous analysis of a screening measure of cognitive control, EXIT25, in a larger, overlapping sample of older adults (Gujral et al, 2012), where suicide ideators performed as poorly as suicide attempters.…”

“…In addition to impulsive aggression (McGirr and Turecki, 2007) and persistent hopelessness (Beck et al, 1985, Szanto et al, 1998, several studies have now reported impairments in cognitive domains such as attentional/cognitive control, episodic memory, working memory, and language fluency (Keilp et al, 2013, Keilp et al, 2001, Raust et al, 2007, Richard-Devantoy et al, 2012 as well as in decision-making (Clark et al, 2011, Dombrovski et al, 2010, Jollant et al, 2005. Cognitive impairments may be particularly prominent in elderly suicide attempters (Dombrovski et al, 2008a, Dombrovski et al, 2010, Erlangsen et al, 2008, Gujral et al, 2012, McGirr et al, 2012. Age-related decline in cognitive control (Amieva et al, 2004, Drag et al, 2010 may be among the factors contributing to the increasing suicide rates in old age (Dombrovski et al, 2008b, Erlangsen et al, 2008.…”

Comparing the Relationship between Focus of Attention and Attention Bias in Suicide and Non-suicide Attempters

“…Executive deficits are broadly associated with suicidal preoccupation in older depressed adults but do not directly facilitate suicidal behavior (Gujral et al, 2014). Fundamental deficits in attention process may play a role in suicidal behavior risk.…”