ORIGINAL PAPER Maurizio Pompili Æ Stefan Ehrlich Æ Eleonora De Pisa Æ J. John Mann Æ Marco Innamorati Andrea Cittadini Æ Benedetta Montagna Æ Paolo Iliceto Æ Andrea Romano Æ Mario Amore Roberto Tatarelli Æ Paolo Girardi White matter hyperintensities and their associations with suicidality in patients with major affective disorders Received: 3 April 2007 / Accepted: 10 June 2007 / Published online: 27 September 2007 j Abstract Introduction 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. Methods 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 demo- graphic variables and exposure to some risk factors. Results Bivariate analysis showed that the prevalence of WMH was significantly higher in subjects with past suicide attempts (Fisher’s Exact Test, p = 0.01) and other clinical indicators of elevated suicide risk. Lo- gistic 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). Conclusions 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. How- ever, 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. j Key words mood disorders Æ suicide Æ white matter hyperintensities Introduction Major affective disorders are commonly associated with a high degree of suicidality. Epidemiological studies showed that 29% of individuals with a diag- nosis of Bipolar Disorder (BD) and 15% of those with Major Depressive Disorder (MDD) attempt suicide at least once in their lifetime [8]. About 10–15% of the EAPCN 755 M. Pompili, M.D. McLean Hospital—Harvard Medical School Boston, MA, USA E. De Pisa, M.D. Æ A. Cittadini, M.D. Æ B. Montagna, M.D. P. Iliceto, Ph.D. Æ R. Tatarelli, M.D. Æ P. Girardi, M.D. M. Pompili, M.D. (&) Department of Psychiatry Sant’Andrea Hospital, University of Rome ‘‘La Sapienza’’ Via di Grottarossa, 1035 Rome 00189, Italy E-Mail: maurizio.pompili@uniroma1.it, mpompili@mclean.harvard.edu S. Ehrlich, M.D. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy Charite ´—Universita ¨tsmedizin Berlin Berlin, Germany J.J. Mann, M.D. Division of Neuroscience Columbia University, New York State Psychiatric Institute New York, NY, USA M. Innamorati, Psy. D. Universita ` Europea of Rome Rome, Italy A. Romano, M.D. Department of Neuroscience, Division of Neuroradiology Sant’Andrea Hospital, University of Rome ‘‘La Sapienza’’ Rome, Italy M. Amore, M.D. Department of Neuroscience, Division of Psychiatry University of Parma Parma, Italy Eur Arch Psychiatry Clin Neurosci (2007) 257:494–499 DOI 10.1007/s00406-007-0755-x