Thinking Under Stress and the Risk of Suicide
Principal Investigator: 

When people are under stress, they naturally find it more difficult to think clearly and to deal with the sorts of problems that arise in daily living. And two VA researchers, Beeta Homaifar and Melissa Amick, believe that this is likely to be even more true for those people who are constantly dealing with thoughts of suicide. Judging from her and Amick’s clinical experiences with these individuals, Homaifar says, “there must be something that overtaxes their system so they’re even less able to make use of the cognitive resources they have.” The result is that when these people find themselves in stressful situations, they feel overwhelmed and unable to decide what they should do. This in turn can lead to even greater feelings of stress.

Previous research has found that thinking is different in suicidal people. “We hypothesize that it takes less to stress these people out than other individuals,” Homaifar says. So in a study being carried out at the VA medical center in Boston, Homaifar and Amick are examining differences in the effects that stress has on the thinking of people with suicidal thoughts versus those who do not have suicidal thoughts.

For the study Homaifar and Amick are recruiting 90 Veterans, 30 who have regular thoughts of suicide as well as the possible presence of depression or post-traumatic stress disorder, 30 with no thoughts of suicide but who are otherwise similar to the first group in the distribution of depression and post-traumatic stress disorder, and 30 healthy Veterans. They test the Veterans on memory tasks while subjecting them to different types of stresses, and they use a brain imaging technique called functional magnetic resonance imaging (fMRI) to observe the activity in various parts of their brains as they carry out the memory tasks.

It is not possible to bring real-life stresses into the lab, Homaifar notes. “We can’t put them in a scanner and have their wife and kids come into room and start yelling at them,” she says. So she and Amick are applying stress in a different, more practical way. To apply cognitive stress, they make the tasks increasingly more difficult so that the Veterans have to work harder and harder to come up with the correct answer. And to apply emotional stress, distracting faces with negative emotions are displayed on the computer screen flanking the information to be remembered.

Homaifar and Amick expect to find the task performance of the Veterans who experience regular suicidal thoughts will be much more affected than the performance of the other Veterans when the difficulty of the task is increased and when the faces showing negative emotions are added. Furthermore, they expect to see specific differences in brain activity between the suicidal Veterans and the others, with less activity in a part of the brain (the dorsolateral prefrontal cortex) that is involved in problem solving and more activity in a part of the brain (the amygdala) that is involved in emotional reactions.

The research has several potential applications in diagnosis and treatment of Veterans at high risk of suicide, Homaifar said. For example, if it is indeed the case that those with suicidal thoughts are more likely to have their cognitive abilities affected by stress and to have differences in brain activity that can be observed with fMRI, this may point the way to identifying Veterans at risk of developing suicidal behavior. Concerning treatment, the VA already uses problem-solving therapy in an effort to help Veterans cope better with the problems in their lives, but this research could indicate ways that such therapy could be modified or improved to better address the issues that suicidal Veterans face.

The period of transitioning home from active duty is known to be a time of increased stress, Homaifar notes, so it is important to examine these veterans in particular. By developing a better understanding the relationship between the effect of stress on thinking and suicide, she and Amick hope to make that transition an easier and safer one.

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