Table 1.

Neuroimaging studies of groups with suicide attempters

Authors and year	Group with history of suicide attempts	Group(s) without attempts	Methods	Findings
Structural Magnetic Resonance Imaging Studies of Gray Matter and White Matter
Aguilar et al 20083	13 M with SCZ, MA 37 yrs	24 DCs	VBM of GM density	↓ OFC and superior temporal GM density, relative to DCs
Baldacara et al 201110	20 with BD, MA 40 yrs	20 DCs, 22 HCs	VBM of GM and WM brain volume; ROI volume	No significant differences in total brain volume or cerebellar volume
Benedetti et al 20112	19 with BD, MA 45 yrs	38 DCs	VBM of GM volume	↓ GM volume in DLPFC, OFC, ACC, superior temporal, parietal and occipital cortex and ↑ in bilateral superior termporal gyrus, relative to DCs. With lithium ↑ GM volume in same regions (DLPFC, OFC, ACC, superior temporal, parietal and occipital cortex) and ↓ in bilateral superior temporal gyrus
Giakoumatos et al 20136	148 with SCZ, SZA or BD-P, MA 36 yrs	341 DCs, 262 HCs	VBM of GM volume	↓ GM volume in bilateral superior/middle frontal, and inferior/superior temporal regions, left superior parietal and supramarginal regions, and right insula and thalamus, relative to DCs and HCs. High (vs. low) lethality showed ↓ in left lingual area and right cuneus
Matsuo et al 201012	10 F with BD, MA 36 yrs	10 DCs, 27 HCs	ROI area	Anterior CC genu area associated with impulsivity
Monkul et al 20071	7 F with MDD, MA 31 yrs	10 DCs, 17 HCs	ROI volume	↓ OFC GM, relative to HCs. ↓ amyg volumes, relative to DCs
Riisch et al 200811	10 with SCZ, MA 30 yrs	45 DCs, 55 HCs	VBM of GM and WM	↑ bilateral inferior frontal WM volume, relative to DCs. In SCZ ↑ inferior frontal related to self-aggression
Soloff et al 20124	44 with BPD (25 high lethality), MA 30 yrs	24 DCs, 52 HCs	ROI volume	↓ insula GM, relative to DCs. ↓ in high lethality attempters in OFC, middle/superior temporal gyrus, insula, fusifrom gyrus, lingual gyrus and parahippocampal gyrus
Spoletini et al 20115	14 with SCZ, MA 43 yrs	36 DCs, 50 HCs	ROI volume	↑ amyg, relative to DCs and HCs. In the SCZ group, ↑ amyg volume associated with self-aggression
Vang et al 20109	7 (4 with MDD, 2 AD), MA 38 yrs	6 HCs	1231-β-CIT methods to separate 5-HTT and DAT uptake in ROIs	↓ GP and caudate, relative to HCs and correlated with 5-HTT binding. In attempters, GP volumes inversely correlated with non-impulsive temperament
Wagner et al 20117	15 with MDD (10 with suicide behavior, 5 with first degree relatives with suicidal behavior), MA 41 yrs	15 DCs, 30 HCs	VBM of GM density	↓ inferior frontal cortex, ACC, caudate, amyg/HP formation, relative to HCs. ↓ ACC and caudate, relative to DCs
Wagner et al 20128	Same sample as in Wagner et al 2011 above	15 DCs, 30 HCs	Cortical thickness	↓ ventrolateral PFC, DLPFC and ACC, relative to DCs and HCs
Older Adults
Cyprien et al 201149	21 (85.7% MDD, 36.8% AXD, 10.5% BD), MA 72 yrs	180 DCs, 234 HCs	ROI area	↓ posterior third of CC, relative to DCs and HCs
Dombrovski et al 201247	13 with MDD, MA 66 yrs	20 DCs, 19 HC	ROI voxel counts	↓ putamen GM, relative to DCs and HCs. ↓ in associative and ventral striatum, relative to DCs. Suicide attempters with ↓ putamen GM had higher delayed discounting
Hwang et al 201048	27 M with MDD, MA overall MDD sample 79 yrs	43 DCs, 26 HCs	VBM of GM and WM	↓ GM and WM volume in the frontal, parietal, and temporal regions, insula, lentiform nucleus, midbrain, and cerebellum, relative to DCs
Magnetic Resonance Imaging Studies of Hyperintensities on T2-weighted Images
Ehrlich et al 200514	62 MDD, MA overall sample 27 yrs	40 DCs	Assessment of WMH	↑ PVH
Pompili et al 200813	44 with BD I or II or MDD, MA 46 yrs	55 DCs	Assessment of WMH	↑ PVH
Older Adults
Ahearn et al 200145	20 MDD, MA 66 yrs	20 DCs	Assessment of WMH	↑ subcortical GM hyperintensities, and trend towards more PVH
Children and Adolescents
Ehrlich et al 200352	43 inpatients with varying diagnoses MA overall sample 15 yrs	110 DCs	Assessment of WMH	↑ deep WMH in right parietal lobe associated with suicide attempts
Ehrlich et al 200453	43 inpatients with varying diagnoses (25 MDD) MA overall sample 15 yrs, MA MDD subgroup 15 yrs	110 DCs (23 MDD)	Assessment of WMH	Within the MDD subgroup ↑ in WMH, particularly PVH
Diffusion Tensor Imaging Studies
Jia et al 201020	16 with MDD, MA 34 yrs	36 DCs, 52 HCs	Voxel-based analyses of FA	↓ FA in the ALIC, relative to DCs and HCs, ↓ FA in the frontal lobe, relative to HCs, and ↓ FA in the lentiform nucleus, relative to DCs
Jia et al 201322	23 with MDD, MA 36 yrs	40 DCs, 46 HCs	Tractography, ROI of FA	↓ mean percentage of fibers through the ALIC to the left OFC and thalamus, relative to DCs. ↓ FA in medial frontal cortex, OFC, thalamus, and total ALIC fibers, relative to HCs
Lopez- Larson et al 201323	19 with TBI, MA 38	40 DCs, 15 HCs	ROI of FA	↑ FA in bilateral thalamic radiations, relative to DCs and HCs
Mahon et al 201219	14 with BD, MA 33 yrs	15 DCs, 15 HCs	Tract-based spatial statistical and voxel-based analyses	↓ FA in OFC WM, relative to DCs. In BD with attempts, OFC WM FA inversely correlated with motor impulsivity
Olvet et al 201421	13 with MDD, MA 33 yrs	39 DCs, 46 HCs	ROI and tract- based spatial statistical of FA and ADC	↓ FA in dorsomedial PFC, relative to DCs and HCs. No difference in ADC
Single Photon Emission Tomography Studies
Audenaert et al 200134	9 (4 with MDD, 4 AD, 1 brief psychotic disorder, 4 comorbid PDs), MA 32 yrs	12 HCs	123I-5-I-R91150 for 5-HT2a receptors in PFC	↓ PFC binding potential of 5-HT2a receptors
Audenaert et al 200224	20 MDD, MA 32 yrs	20 HCs	99mTc-Ethyl Cystine Dimer rCBF SPECT during letter and category fluency tasks	↓ PFC response during letter and category fluency paradigms, relative to HCs
Bah et al 200833	9 unmedicated M (6 with MDD, 1 AD, and/or 5 PDs), MA 41 yrs	9 HCs	1231-β-CIT for 5- HTT availability, assessment of SLC6A4 polymorphisms	In attempters, ↓ 5-HTT availability associated with the “s” allele of 5-HTTLPR and 12 repeat allele of STin2
van Heeringen et al 200335	9 (3 with MDD, 4 AD, 1 brief psychotic and/or 4 PDs), MA 32 yrs	13 HCs	123I-5-I-R91150 for 5-HT2a receptors in PFC	↓ PFC binding potential of 5-HT2a receptors. ↓ 5-HT2a binding associated with ↑ hopelessness and harm avoidance
Lindström et al 200436	12 (3 with MDD, 3 MDD + SA, 3 AD, 1 DE-NOS, 1 SP, 3 undiagnosed), MA 39 yrs	12 HCs	1231-β-CIT methods to separate 5-HTT and DAT uptake	No significant differences in 5-HTT or DAT. In attempters, ↑ impulsivity associated with ↓ whole brain 5-HTT binding.
Ryding et al 200637	12 (5 with MDD, 3 AD, 1 AXD and/or 6 PDs), MA 39 yrs	12 HCs	1231-β-CIT methods to separate 5-HTT and DAT uptake	In attempters, ↑ impulsivity associated with ↓ 5-HTT binding in OFC, temporal regions, midbrain, thalamus, basal ganglia, and cerebellum, and ↑ mental energy with ↓ DAT binding in basal ganglia
Willeumier et al 201125	21 scanned previously who completed suicide with mood disorders, MA 36 yrs	36 DCs, 27 HCs	99mTc HMPAO SPECT to assess rCBF	↓ rCBF in superior PFC, operculum, postcentral gyrus, precuneus, caudate and insula.↓ rCBF in the subgenual ACC in 18 of the 21 subjects
Positron Emission Tomography Studies
Cannon et al 200630	8 BD with current depressive episode, MA 30 yrs (overall BD sample)	10 DCs, 37 HCs	5-HTT binding potential measured with 11C-DASB	↓ 5-HTT binding in the midbrain and ↑ in the ACC, relative to DCs and HCs
Leyton et al 200629	10 high lethality suicide attempters (2 with mood disorder, 8 cluster B PD, 6 SA), MA 38 yrs	16 HCs	Alpha-11C- methyl-L- tryptophan trapping as index of 5-HT synthesis	↓ 5-HT synthesis in OFC and ventromedial PFC
Miller et al 201331	15 with MDD, MA 39 yrs	36 DCs, 32 HCs	11C-DASB to quantify in vivo regional brain 5- HTT binding	↓ 5-HTT binding in midbrain, relative to DCs and HCs
Nye et al 201332	11 with MDD, MA 39 yrs	10 HC	11C-ZIENT PET to measure 5-HTT	↓ 5-HTT in the midbrain/pons and putamen
Oquendo et al 200328	16 with MDD with high lethality attempts/9 MDD with low lethality attempts, MA 43 yrs/30 yrs		18F-FDG PET, fenfluramine vs. placebo challenge	↓ rCMRglu in ventral, medial, and lateral PFC, compared to low-lethality attempters, more pronounced after fenfluramine.↓ ventromedial PFC activity associated with ↓ impulsivity and ↑ suicidal planning. ↓ rCMRglu associated with ↓ verbal fluency
Soloff et al 200326	13 ↑ with BPD (12 with attempts), MA 25 yrs	9 HCs	18F-FDG PET during rest	Bilateral ↓ rCMRglu in the medial OFC
Sublette et al 201327	13 with MDD or BD, MA 36 yrs	16 DCs	18F-FDG PET, fenfluramine vs. placebo	↓ rCMRglu in right DLPFC, more pronounced after fenfluramine, ↑ ventromedial PFC activity, not detected after fenluramine. Suicide ideation correlated negatively with rCMRglu in an overlapping DLPFC region
Functional Magnetic Resonance Imaging Studies
Jollant et al 200838	13 M with MDD, MA 40 yrs	14 DCs, 16 HCs	Response to intense or mild, angry or happy face stimuli, compared to responses to neutral face stimuli	↑ response in lateral and ↓ in superior frontal cortex to angry vs. neutral, ↑ anterior cingulate gyrus to mild happy vs. neutral, ↑ cerebellum to mild angry vs. neutral, relative to DCs
Jollant et al 201039	13 M with MDD, MA age 38 yrs	12 DCs, 15 HCs	Iowa Gambling Task, ROIs	↓ lateral OFC and occipital cortex activation during risky relative to safe choices, relative to DCs. Poorer gambling task performance, relative to DCs
Marchand et al 201240	6 M with MDD with self-harm, 5 with attempts, MA 28 yrs (overall MDD sample )	16 DCs	Motor activation task	↓ putamen activation and altered functional connectivity in a network involving bilateral motor/sensory cortices and striatum, left temporal and inferior parietal lobule regions and right posterior cortical midline structures
Reisch et al 201041	8 F with attempts, MA 39 yrs	None	Activation during recall of mental pain and suicide action during recent suicide attempts	Recall of mental pain was associated with ↓ activation in DLPFC, rostral PFC and premotor regions. Recall of suicidal action was associated with ↑ activation in the medial PFC, ACC and HP
Older Adults
Dombrovski et al 201350	15 with MDD, MA 66 yrs	18 DCs, 20 HCs	Reward learning using reinforcement learning model, assessment of expected rewards	↓ pregenual cingulate response to high expected reward and associated with ↑ impulsivity
Children and Adolescents
Pan et al 201156	15 with MDD, MA 16 yrs	15 DCs, 14 HCs	Go-no-go response inhibition and motor control task	↓ ACC activation to go-no-go vs motor control, relative to DCs
Pan et al 201355	14 with MDD, (sample noted to overlap with 2011 study), MA 16 yrs	15 DCs, 15 HCs	Response to intense or mild, angry or happy face stimuli, compared to responses to neutral face stimuli	↑ ACC-DLPFC circuitry, primary sensory and temporal cortices to mildly angry faces, relative to DCs. Higher primary sensory cortex to mild angry, relative to HCs. ↓ in the fusiform gyrus to neutral faces during angry face runs, relative to DCs. ↓ in primary sensory cortex to intensely happy faces and in the anterior cingulate and medial PFC to neutral faces in the happy face runs. ↓ anterior cingulate-insula functional connectivity to mild angry faces, relative to DCs or HCs
Pan et al 201357	15 with MDD, MA 16 yrs	14 DCs, 13 HCs	Iowa Gambling Task	↓ activation in thalamus during high-risk decisions relative to DCs and ↑ activation in caudate relative to HCs

11C-DASB, (11 C)3-amino-4-(2-dimethylaminomethyl-phenylsulfanyl) benzonitrile; 11C-ZIENT, ( 11C)2β-carbomethoxy-3β-[4′-((Z)-2-iodoethenyl)phenyl]nortropane; 123I-β-CIT, (123I)β-carboxymethyoxy-3-β-(4-iodophenyl) tropane; 123I-5-I-R91150, 4-amino-N-[l-[3-(4-fluorophenoxy); 5-HT, Serotonin; 5-HT2a, Serotonin 2a; 5-HTT, Serotonin transporter; 5-HTTLPR, Serotonin-transporter-linked polymorphic region; 99mTc, Technetium-99m; ACC, Anterior cingulate cortex; AD, Adjustment disorder; ADC, Apparent diffusion coefficient; ALIC, Anterior limb of internal capsule; Amyg, Amygdala; AXD, Anxiety disorder; BD, Bipolar disorder; BD-P, Bipolar disorder w/ psychosis; BPD, Borderline personality disorder; CC, Corpus callosum; DAT, Dopamine transporter; DC, Diagnostic controls, i.e., subjects with the same diagnosis(es) as the group with attempts; DE-NOS, Depressive episode not otherwise specified; DLPFC, Dorsolateral prefrontal cortex; F, Females; FA, Fractional anisotropy; FDG, Fluorodeoxyglucose; GM, Gray matter; GP, Globus pallidus; HC, Healthy control subjects; HMPAO, Hexamethylpropylene amine oxime; HP, Hippocampus; M, Males; MA, Mean age; MDD, Major depressive disorder; OFC, Orbitofrontal cortex; PD, Personality disorder; PET, Positron emission tomography; PVH, Periventricular hyperintensities; PFC, Prefrontal cortex; rCBF, Regional cerebral blood flow; rCMRglu, Regional cerebral glucose metabolic rates; ROIs, Regions of interest; SA, Substance abuse; SCZ, Schizophrenia; SLC6A4, serotonin transporter gene; SP, Social phobia; SPECT, Single photon emission tomography; STin2, Serotonin transporter intron 2; SZA, Schizoaffective disorder; TBI, Traumatic brain injury; VBM, voxel-based morphometry; WM, White matter; WMH, White matter hyperintensities