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Distinct patterns of altered quantitative T1ρ and functional BOLD response associated with history of suicide attempts in bipolar disorder


Despite the high risk for suicide, relatively few studies have explored the relationship between suicide and brain imaging measures in bipolar disorder. In addition, fewer studies have explored the possibility that altered brain metabolism may be associated with suicide attempt. To begin to fill in these gaps, we evaluated functional (task based fMRI) and metabolic (quantitative T1ρ) differences associated with suicide attempt in participants with bipolar disorder. Thirty-nine participants with bipolar disorder underwent fMRI during a flashing checkerboard task and 27 also underwent quantitative T1ρ. The relationship between neuroimaging and history of suicide attempt was tested using multiple regression while adjusting for age, sex, and current mood state. Differences between two measures of suicide attempt (binary: yes/no and continuous: number of attempts) were quantified using the corrected Akaike Information Criterion. Participants who had attempted suicide had greater fMRI task-related activation in visual areas and the cerebellum. The number of suicide attempts was associated with a difference in BOLD response in the amygdala, prefrontal cortex, and cerebellum. Increased quantitative T1ρ was associated with number of suicide attempts in limbic, basal ganglia, and prefrontal cortex regions. This study is a secondary analysis with a modest sample size. Differences between measures of suicide history may be due to differences in statistical power. History of suicide was associated with limbic, prefrontal, and cerebellar alterations. Results comparing those with and without suicide attempts differed from results using number of suicide attempts, suggesting that these variables have different neurobiological underpinnings.

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The authors would like to thank Janie Myers, Ashley Schumacher, Robin Follmer, Lois Warren, Autumn Craig, and Marla Kleingartner for their help in recruiting and assessing study participants.


This study was supported in part by a generous donation by Roger Koch to the University of Iowa Foundation and NIH [R01MH111578]. Archive and storage of imaging data was supported by the University of Iowa Institute for Clinical and Translational Science [U54TR001013].

J.A.W. was supported by the Department of Veterans Affairs (Merit Award), NIMH [5R01MH085724], NHLBI [R01HL113863] and a NARSAD Independent Investigator Award.

J.G.F. was supported by the NIMH [K23MH083695] and NHLBI [P01HL014388].

C.P.J. was supported in part by a NARSAD Young Investigator Award.

V.A.M. was supported in part by a NARSAD Independent Investigator Award. These funding sources did not have a role in the study design, data collection, analysis, or interpretation.

All work described here was performed with approval from the University of Iowa Institutional Review Board. All research participants provided written informed consent.

Author information




JJS was principally responsible for performing the data analysis and writing the manuscript.

VW, JGF, GEC, AJW provided technical expertise in suicide, psychiatry, and imaging and assisted with editing and revising the manuscript.

JDL provided biostatistical expertise and assisted with editing and revising the manuscript.

CPJ helped to design the imaging study, collected and analyzed data, and assisted with editing and revising the manuscript.

SLS assisted with preparation of research data and figures and assisted with editing and revising the manuscript.

JW and VAM served as the senior researchers for this project and were also heavily involved in editing and revising the manuscript.

Corresponding author

Correspondence to Vincent A. Magnotta.

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Histogram showing the distribution of total number of suicide attempts for participants in the fMRI sample (left) and qT1ρ sample (right). Supplementary file1 (JPG 204 kb)

Supplementary file2 (DOCX 19 kb)

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Shaffer, J.J., Willour, V., Fiedorowicz, J.G. et al. Distinct patterns of altered quantitative T1ρ and functional BOLD response associated with history of suicide attempts in bipolar disorder. Brain Imaging and Behavior (2021).

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  • Bipolar disorder
  • Suicide
  • MRI
  • T1ρ
  • fMRI