Every year, there are more than 30,000 suicides and ten times as many suicide attempts in the United States. Suicide is the third greatest cause of death in young people.
Unfortunately, the death and injury rates due to suicide attempts have not declined over the last two decades, suggesting that we need a paradigm shift in prevention to meaningfully reduce the suicide rate. Better and more successful prevention requires improving our knowledge regarding the causes of suicidal behavior.
Conte Center Focus
The Conte Center at Columbia University and The New York State Psychiatric Institute is funded by the National Institute of Mental Health and employs a multidisciplinary approach to study how reported childhood adversity can mold the predisposition or diathesis for suicidal behavior and affect suicide risk from the teenage years to old age.
We know that a combination of genes and early childhood experience determine how likely vulnerable people are to respond to psychiatric illness and stressful life events with a suicide attempt. We have learned that suicide is a complication of psychiatric illness in over 90% of cases, but that in addition to a psychiatric illness, the group at-risk for suicide, has a distinct set of other differences that collectively account for their vulnerability.
Those differences include being more pessimistic, being less flexible and creative in problem solving, and finally being more likely to act on powerful emotions.
Combined, these factors contribute to making a person feel more profoundly impaired by the pain of depression, more hopeless about offers of help or treatment being able to provide them with relief, feeling trapped or stuck in this situation with no way out, and more likely to act on such feelings by attempting to seek relief from this emotional pain by ending their lives.
The brain plays the key role in these characteristics. Studies of suicides and of patients who have survived a suicide attempt, have revealed that these differences in the context of major depression are associated with abnormalities in neurotransmitters that are responsible for regulation of mood, subjective perception of mood, reaction to stress and decision-making.
These differences in brain circuitry are now known to be partly inherited, and partly the product of childhood adversity. To learn how childhood adversity impacts on our genes and brain development to increase the risk of suicide, we will carry out a series of five integrated studies or projects.
Project 1
Project 1 (directed by Dr. Victoria Arango) will use postmortem brain tissue from individuals who suffered from major depressive disorder (MDD) and tragically died by suicides. We seek to examine the relationship of childhood adversity (determined by an interview with family members-a method called a psychological autopsy) to gene expression in key brain regions involved in depression such as the prefrontal cortex, anterior cingulate cortex and hippocampus. The relationship between childhood adversity and cell growth/death, the HPA axis stress response system and key brain circuits involved in mood regulation and decision-making will also be examined. Correlations with suicide and aggressive traits will be determined using this information.
Please click here for information on how to participate in this study as a patient, offspring of a suicide attempter, or healthy volunteer.
Project 2
Project 2 (directed by Dr. Frances Champagne) will use a maternal deprivation mouse model and study aggressive behaviors in order to examine the effects of parental negligence on gene chemistry as well as the brain circuits involved in mood/emotion regulation, decision-making, depression and anxiety.
This project will also test the potential benefits of an enriched caregiving environment as a potential way to reverse the adverse effects of prolonged maternal deprivation. If effective, these findings could help guide early depression prevention interventions with children from high-risk homes.
Please click here for information on how to participate in this study as a patient, offspring of a suicide attempter, or healthy volunteer.
Project 3 and Project 4
Project 3 (directed by Dr. J. John Mann) and Project 4 (directed by Dr. Kevin Ochsner) will study the same set of patients with major depression using brain imaging technology–namely positron emission tomography (PET) and magnetic resonance imaging (MRI).
Patients will be divided into two groups. One group will have major depression and a history of a suicide attempt indicating they are at-risk for suicidal behavior. The second group of patients will have a major depression and have never made a suicide attempt indicating they are less vulnerable to responding by suicidal behavior. In terms of suicidal behavior, this group is more resilient.
Comparison of these two groups tells us about the vulnerability to suicidal behavior, a vulnerability that is distinct from that of major depression. Comparing these two groups of patients to healthy volunteers will identify the abnormalities in mood regulation, cognition, stress response and brain function that plays a role in major depression.
These two projects will quantify neurotransmitters in the brain and MRI brain circuit responses to evaluate cognitive control of emotion, both of which are relevant to major depression and suicidal behavior. They will then evaluate the relationship of identified circuitry changes to reported childhood adversity.
Please click here for information on how to participate in these studies as a patient, offspring of a suicide attempter, or healthy volunteer.
Project 5
Project 5 (directed by Dr. Barbara Stanley) aims to clinically diagnosis all subjects in the two brain imaging projects and then determine the relationship of reported childhood adversity to aggressive traits (reactive and proactive aggression). Aggression type will then be examined in relation to stress responsiveness and type of suicidal behavior.
Aggression and stress responses will be measured both by laboratory tests and by real world evaluations using mobile devices that ask the person “in real time” how they are doing and what stresses they are coping with throughout the day. This approach, which aims to assess patients in their daily life and natural settings, is a new frontier in medicine and is called Ecological Momentary Assessment (EMA). Their performance on stress response measures and aggressive responses in the laboratory tests will be compared with their reactions in every day life.
Their test results will then be compared to the brain imaging findings and reported childhood adversity as well as to the function of key sets of genes that regulate stress responses and brain circuit formation/maintenance.
A final group-namely, children of patients who suffer from major depression or have attempted suicide, will be studied and will offer crucial insight into cause and effect relationships and prevention opportunities.This group will be studied while they are quite young, before any of them have manifested major depression or suicidal behavior.
More specifically, we will seek inherited or acquired abnormalities in brain biology, genes, mood control and problem solving that will indicate a risk for suicidal behavior.
Please click here for information on how to participate in this study as a patient, offspring of a suicide attempter, or healthy volunteer.
In sum, these projects will help reveal how early negative life experiences affect gene expression and brain biology to increase risk of suicidal behavior later in life. By doing so we seek clues as to where and how we can prevent this progression towards major depression and towards potential suicide.
Other Ongoing Research Studies
In addition to the studies listed here, we have several ongoing studies involving novel treatment and psychotherapy at Columbia Psychiatry:
Depression Medication Studies
- The Antidepressant Action of Ketamine: Brain Chemistry
- High Affinity Serotonin 1A Receptor Binding in Major Depression
- Ketamine versus Midazolam: Testing Rapid Relief of Suicide Risk in Depression
- Ketamine versus Midazolam in Bipolar Depression
- Novel Mechanisms Underlying Depression: PET Imaging of the Kappa Opioid Receptor
- SSRI Versus Bupropion in High-Risk Major Depressive Disorder
- Ketamine for Major Depression
Depression Psychotherapy Studies
- Predictors of Treatment Outcome with Cognitive Behavioral Therapy for Depression
- Mindfulness-Based Cognitive Therapy & Safety Planning for Suicidal Behavior: A Treatment Development Study
Borderline Personality Disorder
Healthy Volunteers
- High Affinity Serotonin 1A Receptor Binding in Major Depression
- Novel Mechanisms Underlying Depression: PET Imaging of the Kappa Opioid Receptor
- Predictors of Treatment Outcome with Cognitive Behavioral Therapy for Depression
- The Antidepressant Action of Ketamine: Brain Chemistry
- Pilot PET Study Characterizing [1-11C] Arachidonic Acid in Bipolar Disorder