Suicidal decision: Relative clues from fMRI

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  • Published: Sep 1, 2015
  • Author: David Bradley
  • Channels: MRI Spectroscopy
thumbnail image: Suicidal decision: Relative clues from fMRI

Familial corroboration

New clues from functional magnetic resonance imaging studies (fMRI) corroborates the results of a series of studies on a familial link with risky decision making and suicidal tendencies.

New clues from neuropsychological and functional magnetic resonance imaging studies (fMRI) in close relatives of suicide completers corroborates the results of a series of studies on a link between risky decision making and suicidal behaviour. Mental illness, and in particular depressive disorders is a significant but not sufficient risk factor for suicide. Difficulty making good choices is one of the additional factors that may make certain people more vulnerable to suicide when depressed. The studies showed that the way in which a person makes decisions could be an important factor in whether a person is vulnerable to suicidal tendencies, and if their parent is a high-risk decision-maker then this reinforces the possibility of suicidal tendencies to be inherited.

Fabrice Jollant, Assistant Professor of Psychiatry at McGill University, in Montreal, Quebec, Canada, has spent many years working to pin down this link between decision-making and suicidal vulnerability. His latest study published in the Journal of Psychiatric Research showed more risky decision-making in biological relatives of individuals who committed suicide and additional findings from the same study suggest deficient activity in a particular brain region. This could lead to new approaches for reducing suicidal vulnerability and perhaps even preventing suicides.

Jollant's team and other researchers are well aware that suicidal thoughts must be studied indirectly. In earlier work, the focus has been on individuals who have attempted suicide. But, there is a familial angle that might also prove fruitful in understanding mental health in this context and so Jollant and his colleagues at the Douglas Mental Health University Institute have looked at the close relatives of people who have committed suicide, including parents, brothers and sisters who are themselves considered to be of good mental health. The researchers carried out neuropsychological tests that helped pinpoint certain character traits that are linked to suicide vulnerability, even in people who have not attempted suicide nor even had suicidal thoughts.

Betting game

One of the tests used in the study is a betting game, for assessing risk taking and decision-making. In this game, players must win as much money as possible by choosing cards from among several piles. Some piles carry more risk: they sometimes pay off big, but they lose over the long term. Other piles are safer: the payoff is small, but so too are the losses. While individuals from families without suicides learn to choose the piles that pay off over the long term, the relatives of people who have committed suicide seem to continue to make high-risk choices, even after numerous attempts. This perhaps indicates a higher degree of difficulty in learning from their experiences or that those people choose to ignore their negative experiences in the betting game and persist in the riskier strategy in the hope that it will eventually pay off. The functional MRI studies of the volunteers' brains confirmed that certain areas of the prefrontal cortex used in decision-making show different activity among those individuals than those who learn to opt for a lower risk strategy. The same areas are active in those people have attempted suicide.

Suicide solution

"People who have a tendency to make risky decisions lean toward solutions that provide short-term benefits despite the high risk, instead of solutions that are safer over the long term," explains Jollant. "They also have difficulty identifying alternative solutions when faced with a problem." This suggests that bad decision making is indeed linked to suicidal tendencies. "Within the context of a major depression, this difficulty making good decisions can translate into choosing death, which is a solution that ends the suffering immediately, despite its irreparable consequences, without seeing any alternative solutions," Jollant explains. Moreover, inappropriate life choices can exacerbate depression and the inclination to remove oneself from the game, as it were. "We have specifically demonstrated that individuals who make risky decisions experience more problems in their personal relationships, which represent classic triggers for suicidal crises," he adds.

The team also found that close relatives of suicide victims who were in good mental health performed other tests successfully suggesting that they have greater control of their thoughts and decisions which perhaps counterbalance inherent problems and protect them from suicidal acts. "We can foresee developing psychotherapies that focus on decision-making and other cognitive functions in order to reduce the vulnerability to suicide," Jollant suggests.

"We have also recently shown that stimulating the ventral prefrontal cortex with transcranial direct current stimulation (tDCS) allows us to improve decision-making performance in healthy individuals," Jollant told SpectroscopyNOW. "We will soon test this in depressed patients. Future studies will need to assess if improving deficient cognitive traits may reduced the risk of suicidal acts."

Related Links

J Psychiatr Res, 201568, 192-197: "First-degree relatives of suicide completers may have impaired decision-making but functional cognitive control"

Article by David Bradley

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

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