Neuropsychological dysfunction in depressed suicide attempters

Objective: Neuropsychological deficits in the context of psychiatric diseas e may be associated with suicide risk. In this study, neuropsychological pe rformance was compared among depressed patients with at least one prior sui cide attempt of high lethality, depressed patients with low-lethality prior attempts, depressed patients with no prior suicide attempts, and nonpatien ts. Method: Fifty unmedicated patients in a major depressive episode (21 with n o history of suicide attempts and 14 and 15 patients with previous attempts of low and high lethality, respectively) and 22 nonpatients were assessed. Groups were comparable in age, education, occupational level, and estimate d premorbid intelligence. The neuropsychological battery produced scores wi thin five composite domains: general intellectual functioning (current), mo tor functioning, attention, memory, and executive functioning. Results: Patients whose prior suicide attempts were of high lethality perfo rmed significantly worse than all groups on tests of executive functioning and were the only group to perform significantly worse than nonpatients on tests of general intellectual Functioning, attention, and memory. A discrim inant function analysis revealed two prominent dimensions in the data: one that discriminated high-lethality suicide attempters from all other groups (primarily associated with performance on tests of executive functioning) a nd another that discriminated all depressed patient groups from nonpatients (associated with performance on measures of attention and memory). For the patients with high-lethality prior suicide attempts, deficits did not appe ar to reflect diffuse brain damage from past attempts, since the results of tests commonly affected by diffuse injury were not selectively impaired. Conclusions: Neuropsychological deficits in depressed patients with high-le thality prior suicide attempts suggest impairment of executive functioning beyond that typically found in major depression. This more extensive neurop sychological jmpairment in the context of depression may be a risk factor f or severe suicide attempts.