White matter hyperintensities and their associations with suicidality in patients with major affective disorders

  • Maurizio PompiliEmail author
  • Stefan Ehrlich
  • Eleonora De Pisa
  • J. John Mann
  • Marco Innamorati
  • Andrea Cittadini
  • Benedetta Montagna
  • Paolo Iliceto
  • Andrea Romano
  • Mario Amore
  • Roberto Tatarelli
  • Paolo Girardi



A large body of evidence suggests that predisposition to suicide, an important public health problem, is mediated to a certain extent by neurobiological factors. The objective of this cross-sectional study was to compare the prevalence of white matter hyperintensities (WMH) in patients with major affective disorders with and without histories of suicide attempts.


T2-weighted magnetic resonance images (MRI) of 65 psychiatric inpatients with major depressive disorder or bipolar disorder were rated for the presence of WMH. Diagnoses, presence or absence of suicide risk and substance abuse were determined by the Mini International Neuropsychiatric Interview (MINI). Medical charts were reviewed to ascertain history of suicide attempt and basic clinical variables. Fisher’s Exact Tests and logistic regression modeling were used to test the association between WMH and suicidality. Suicidal patients and controls were not matched for demographic variables and exposure to some risk factors.


Bivariate analysis showed that the prevalence of WMH was significantly higher in subjects with past suicide attempts (Fisher’s Exact Test, = 0.01) and other clinical indicators of elevated suicide risk. Logistic regression analyses controlling for age, sex, and several clinical risk factors supported this finding (odds ratio = 4.7; 95% confidence interval: 1.4, 16.1).


The increased prevalence of WMH in adults with major affective disorders and a history of suicide attempt, compared to similar patients without such a history, is consistent with previous findings in depressed children, youth and young adults. However, the association between WMH and suicidality holds true for both, depressed and bipolar patients. Our results suggest that WMH in patients with major affective disorders might be useful biological markers of suicidality.

Key words

mood disorders suicide white matter hyperintensities 


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Copyright information

© Springer 2007

Authors and Affiliations

  • Maurizio Pompili
    • 1
    • 2
    Email author
  • Stefan Ehrlich
    • 3
  • Eleonora De Pisa
    • 2
  • J. John Mann
    • 4
  • Marco Innamorati
    • 5
  • Andrea Cittadini
    • 2
  • Benedetta Montagna
    • 2
  • Paolo Iliceto
    • 2
  • Andrea Romano
    • 6
  • Mario Amore
    • 7
  • Roberto Tatarelli
    • 2
  • Paolo Girardi
    • 2
  1. 1.McLean Hospital—Harvard Medical SchoolBostonUSA
  2. 2.Department of PsychiatrySant’Andrea Hospital, University of Rome “La Sapienza”RomeItaly
  3. 3.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyCharité—Universitätsmedizin BerlinBerlinGermany
  4. 4.Division of NeuroscienceColumbia University, New York State Psychiatric InstituteNew YorkUSA
  5. 5.Università Europea of RomeRomeItaly
  6. 6.Depertment of Neuroscience, Division of NeuroradiologySant’Andrea Hospital, University of Rome “La Sapienza”RomeItaly
  7. 7.Department of Neuroscience, Division of PsychiatryUniversity of ParmaParmaItaly

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