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    Suicidal behavior in older adults with depression is linked to altered brain responses to reward value. Different patterns emerge based on suicide attempt lethality, suggesting distinct neurobiological pathways.

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    Area of Science:

    • Neuroscience
    • Psychiatry
    • Decision Science

    Background:

    • Late-life depression is a significant risk factor for suicidal behavior.
    • Understanding the neurobiological underpinnings of decision-making in suicidal behavior is crucial.

    Purpose of the Study:

    • To investigate temporal dynamics of reward value encoding in relation to suicidal behavior in older adults with depression.
    • To differentiate neurobiological profiles associated with varying lethality of suicide attempts.

    Main Methods:

    • Retrospective case-control study involving 134 older adults.
    • Utilized an explore-exploit decision-making task during functional MRI (fMRI).
    • Applied multilevel models to analyze fMRI time series, focusing on reward value encoding.

    Main Results:

    • Suicidal behavior was associated with blunted ventral prefrontal cortex (vPFC) value signals.
    • Low-lethality attempts linked to abolished value update responses in the default network (vPFC, striatum, amygdala, hippocampus).
    • High-lethality attempts showed sustained negative value responses in vPFC, striatum, and hippocampus.

    Conclusions:

    • Divergent decision-related neural responses may indicate different pathways toward suicidal behavior.
    • Impaired value updating in low-lethality attempters suggests failure to integrate outcomes, potentially increasing stress reactivity.
    • Increased control network activity in high-lethality attempters may reflect cognitive constriction and limited problem-solving.