Suicidal risk and executive functions in major depressive disorder: a study protocol

Abstract

Background Suicide is a serious public health concern. Depression is the main gateway to suicidal behavior. The already established relationship between depression and suicidal risk should now focus on the investigation of more specific factors: recent studies have suggested an association between vulnerability to suicidal behavior and neurocognitive alterations, a nuclear symptom of depression. This project aims to identify alterations in the Executive Functions (EF) of patients suffering a first depressive episode that might constitute a risk factor for suicidal ideation, suicidal attempts and suicide, to allow for more adequate suicide prevention. Methods Prospective longitudinal design involving two groups (first depressive episodes with and without alterations in their EF) and four repeated measures (0, 6, 12 and 24 months). The estimated minimum sample size is 216 subjects. The variables and measurement instruments will include socio-demographic variables, clinical variables (age of illness onset, family and personal antecedents, psychopathological and medical comorbidity, suicidal ideation, suicide attempts and completed suicides, severity of depression, including melancholic or atypical, remission of the depressive episode), and neuropsychological variables (EF and decision-making processes evaluated through the Cambridge Neuropsychological Test Automated Battery (CANTAB)). Discussion First and foremost, the identification of clinical and neuropsychological risk factors associated with suicidal behavior will open the possibility to prevent such behavior in patients with a first depressive episode in the context of clinical practice. Secondly, interventions aimed at cognitive impairment (in particular: EF) derived from the study may be incorporated into strategies for the prevention of suicidal behavior. Finally, impaired neurocognitive function (even in early stages) could become an identifiable endophenotype or “marker” in clinical and neurobiological studies about suicidal behavior in depressive patients.

Cultural Adaptation and Psychometric properties of Brazilian and Peruvian versions of the Behavioral Activation for Depression Scale Short Form (BADS-SF)

“…MDD is the main risk factor associated with suicide [6], causing approximately 800 thousand deaths per year, the third leading cause of death among young people [7]. In Brazil, depressive disorders affect almost 6% of the population and correspond to 10.3% YLDs.…”

“…Depression can be long lasting and severe, impacting all areas of an individual's life, being listed among the main causes of disability, corresponding to 11% of the years lived with disability (YLDs) [4]. MDD is the main risk factor associated with suicide [6], causing approximately 800 thousand deaths per year, the third leading cause of death among young people [7]. In Brazil, depressive disorders affect almost 6% of the population and correspond to 10.3% YLDs.…”

Neurocognition and the Suicidal Process

“…Recently, Roca et al (2019) proposed a method for identifying longitudinal links between alterations in executive functioning and suicidal ideation and behavior. In a recent paper investigating performances in "cool" (processed without affective influence, e.g., logic) and "hot" (processed in an emotional setting, e.g., reward sensitivity) executive functioning, depressed suicide attempters showed deficits in general inhibition compared to depressed non-suicidal and healthy controls (Ho et al 2018).…”

Understanding the predisposing risk factors of young suicide

“…Such patients present self-injuring behavior, including suicide and suicide attempts, especially when confronted with stressful situations. 41 Dysfunctional EF could become an identifiable endophenotype or "marker" in clinical studies linking suicidal tendencies in depressive patients.…”