The Choice of a Violent Suicidal Means: a MRI Study With Computational Modeling of Decision-making (SUICIDE_DECIDE)

The study authors hypothesize a combination of cognitive, brain structural, brain functional and brain connectivity impairments in Suicide Attempters compared to Patient Controls and Healthy Controls, with deficits more marked in suicide attempters using violent suicidal means including:

1. Impaired choices at the reversal learning task with responses influenced by immediate outcome. This deficit would be correlated with brain activity in ventromedial Prefrontal Cortex during resting state and with several peripheral markers of the 5HT-system.
2. Reduced loss aversion. These deficits would be related to altered dynamics of Blood-Oxygen Level Dependent signal in the dorsal and ventral striatum as well as in ventral Prefrontal Cortex/ orbitofrontal cortex during the loss aversion task. These deficits would also be correlated with several peripheral markers of the 5HT-system.
3. Increased pain tolerance facilitating the execution of a violent and possibly painful act. These deficits measured with the algometer would be correlated with several peripheral markers of the 5HT-system.
4. Reduced behavioral inhibition in aversive context at the orthogonalized GoNoGo task facilitating the choice of a violent means. These deficits would be associated with altered Blood-Oxygen Level Dependent signal in ventral Prefrontal Cortex/ orbitofrontal cortex and parietal cortex during the resting state and correlated with several peripheral markers of the 5HT-system.

Study Overview

• Status: Completed
• Conditions: Suicide, Attempted
• Intervention / Treatment: Other: Algometer test; Other: functional MRI

• Study Type: Observational
• Enrollment (Actual): 40

Contacts and Locations

Study Locations

• France
  • Nîmes, France
    • CHU de Nîmes

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 56 years (Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Four groups of participants will be recruited:

1. 20 individuals with personal history of mood disorder (bipolar disorder or depressive disorders) and at least one suicidal act committed with a violent means within the last 12 months.
2. 20 individuals with personal history of mood disorder (bipolar disorder or depressive disorders) and at least one suicidal act conducted within the last 12 months but no lifetime history of suicidal act with a violent means.
3. 20 individuals with personal history of mood disorder (bipolar disorder or depressive disorders) who never attempted suicide and have no family history of suicidal behavior up to the second biological degree.
4. 20 individuals with no personal history of major mental disorder or suicidal act and no family history of suicidal behavior up to the second biological degree.

Description

Inclusion Criteria:

• Right-handed (as assessed with the Edinburgh Handedness Scale).
• Agreement to participate and sign the informed consent form.
• Is insured or beneficiary of a health insurance plan.
• Speaks French.

• Suicide Attempters using Violent Means group:

  • a personal history of mood disorder (bipolar disorder or depressive disorders according to DSM-5 criteria measured with the MINI 7.0);
  • at least one suicidal act committed with a violent means within the last 5 years.

• Suicide Attempters using Non-Violent Means group:

  • a personal history of mood disorder (bipolar disorder or depressive disorders according to DSM-5 criteria measured with the MINI 7.0);
  • at least one suicidal act conducted within the last 5 years;
  • no lifetime history of suicidal act with a violent means.

• Patient Control group:

  • a personal history of mood disorder (bipolar disorder or depressive disorders according to DSM-5 criteria measured with the MINI 7.0);
  • never attempted suicide in their lifetime;
  • no family history of suicidal behavior up to the second biological degree.

• Healthy Control group:

  • no personal history of major mental disorder according to the MINI 7.0;
  • never attempted suicide in their lifetime;
  • no family history of suicidal behavior up to the second biological degree.

Exclusion Criteria:

• Current participation or in the exclusion period of another research protocol in a category 1 RIPH
• Currently under judicial protection, or under adult guardianship.
• Refusal to participate.
• Is pregnant or breast feeding.
• The suicide attempt may have impacted the brain functioning (e.g. following hanging, asphyxia by drowning, head trauma following jumping from height, bullet impact, etc). This criteria will be assessed clinically by the investigator.
• Mental retardation (known or observed during the interview).
• Current psychotic disorder (according to the MINI 7.0).
• Current hypomanic episode (according to the MINI 7.0).
• Current manic, mixed, rapid cycling episodes (according to the MINI 7.0).
• Alcohol or substance disorder within last 3 months (according to the MINI 7.0).
• Past major brain trauma (with loss of consciousness > 1 minute).
• Contra-indication to MRI (metal in body (including due to suicidal act), claustrophobia, impossibility to lie still on the back during one hour).
• Electroconvulsive therapy within the last three months.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Prospective

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Healthy Controls	Other: Algometer test; The computerized pressure algometer, AlgoMed (Medoc, Ramat Yishai, Israel), will be used for mechanical pain stimulation to assess information about pain threshold and tolerance. A constant rate of pressure is delivered by the examiner, and the pressure is recorded in Kilopascal (kPa). The stimulation will be applied between the medial and distal joints of the phalanges of the dominant hand.; Other: functional MRI; Two 8s sequences of spin echo field map with phase encoding AP and PA; A 12:00min bold sequence for resting-state; A 15:12min bold sequence for gambling task thickness=2mm, Matrix Size = 105×105, FOV=210×210mm2;; A 6:38min T1w MPR sequence; A 7:40min T1w MPR sequence; A 5:57min T2w SPC sequence; A 8:24min T2w SPC sequence; A 8:32min FLAIR T2w sequence; Two 8:26min Multi-echo GRE sequence; A 8:29min high resolution multi-echo GRE sequence; Two 6:46min multi-echo GRE sequence with and without magnetic transfer contrast; Two 6:03min diffusion weighted images with phase encoding AP and PA
Suicide Attempters using Violent Means; A violent suicidal act is any suicidal act conducted with any means except for medication overdose or superficial wrist cutting.	Other: Algometer test; The computerized pressure algometer, AlgoMed (Medoc, Ramat Yishai, Israel), will be used for mechanical pain stimulation to assess information about pain threshold and tolerance. A constant rate of pressure is delivered by the examiner, and the pressure is recorded in Kilopascal (kPa). The stimulation will be applied between the medial and distal joints of the phalanges of the dominant hand.; Other: functional MRI; Two 8s sequences of spin echo field map with phase encoding AP and PA; A 12:00min bold sequence for resting-state; A 15:12min bold sequence for gambling task thickness=2mm, Matrix Size = 105×105, FOV=210×210mm2;; A 6:38min T1w MPR sequence; A 7:40min T1w MPR sequence; A 5:57min T2w SPC sequence; A 8:24min T2w SPC sequence; A 8:32min FLAIR T2w sequence; Two 8:26min Multi-echo GRE sequence; A 8:29min high resolution multi-echo GRE sequence; Two 6:46min multi-echo GRE sequence with and without magnetic transfer contrast; Two 6:03min diffusion weighted images with phase encoding AP and PA
Patient Control	Other: Algometer test; The computerized pressure algometer, AlgoMed (Medoc, Ramat Yishai, Israel), will be used for mechanical pain stimulation to assess information about pain threshold and tolerance. A constant rate of pressure is delivered by the examiner, and the pressure is recorded in Kilopascal (kPa). The stimulation will be applied between the medial and distal joints of the phalanges of the dominant hand.; Other: functional MRI; Two 8s sequences of spin echo field map with phase encoding AP and PA; A 12:00min bold sequence for resting-state; A 15:12min bold sequence for gambling task thickness=2mm, Matrix Size = 105×105, FOV=210×210mm2;; A 6:38min T1w MPR sequence; A 7:40min T1w MPR sequence; A 5:57min T2w SPC sequence; A 8:24min T2w SPC sequence; A 8:32min FLAIR T2w sequence; Two 8:26min Multi-echo GRE sequence; A 8:29min high resolution multi-echo GRE sequence; Two 6:46min multi-echo GRE sequence with and without magnetic transfer contrast; Two 6:03min diffusion weighted images with phase encoding AP and PA
Suicide Attempters not using Violent Means	Other: Algometer test; The computerized pressure algometer, AlgoMed (Medoc, Ramat Yishai, Israel), will be used for mechanical pain stimulation to assess information about pain threshold and tolerance. A constant rate of pressure is delivered by the examiner, and the pressure is recorded in Kilopascal (kPa). The stimulation will be applied between the medial and distal joints of the phalanges of the dominant hand.; Other: functional MRI; Two 8s sequences of spin echo field map with phase encoding AP and PA; A 12:00min bold sequence for resting-state; A 15:12min bold sequence for gambling task thickness=2mm, Matrix Size = 105×105, FOV=210×210mm2;; A 6:38min T1w MPR sequence; A 7:40min T1w MPR sequence; A 5:57min T2w SPC sequence; A 8:24min T2w SPC sequence; A 8:32min FLAIR T2w sequence; Two 8:26min Multi-echo GRE sequence; A 8:29min high resolution multi-echo GRE sequence; Two 6:46min multi-echo GRE sequence with and without magnetic transfer contrast; Two 6:03min diffusion weighted images with phase encoding AP and PA

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brain activity between groups	Magnetic Resonance Imaging signal during the resting state and loss aversion task Blood-Oxygen Level Dependent sequences.	Day 0

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impaired reversal learning between groups	Proportion of participants in each group reaching the learning criterion of the Reversal learning task (8 consecutive correct trials) in each stage (acquisition and reversal).	Day 0
Loss aversion between groups	Level of acceptance/reject rate according to the size of the potential gain and loss in each trial of the Loss aversion task	Day 1
Pain tolerance between groups	Pressure pain tolerance threshold (mean of 3 consecutive trials) measured by algometer	Day 0
Behavioral inhibition in aversive context between groups	Response latencies in the reward-only condition vs. the reward+punishment condition in the inforced categorization task	Day 0

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire de Nīmes
• Investigators: Study Director: Fabrice Jollant, CHU Nimes

Publications and helpful links

General Publications

• Jollant F, Leon C. Suicidal transition rates and their predictors in the adult general population: a repeated survey over 21 years in France. Eur Psychiatry. 2024 Oct 29;67(1):e74. doi: 10.1192/j.eurpsy.2024.1782.
• Zerekidze A, Bahlmann L, Petzold J, Li M, Colic L, Walter M, Pereira F, Abbar M, Jollant F, Wagner G. Risk, reward, and suicide: how impulsivity and loss aversion influence decision-making in individuals who have attempted suicide. Front Psychiatry. 2026 Apr 16;17:1791411. doi: 10.3389/fpsyt.2026.1791411. eCollection 2026.

Study record dates

Study Major Dates

• Study Start (Actual): March 21, 2022
• Primary Completion (Actual): September 8, 2023
• Study Completion (Actual): September 20, 2023

Study Registration Dates

• First Submitted: January 28, 2022
• First Submitted That Met QC Criteria: January 28, 2022
• First Posted (Actual): February 8, 2022

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Neuroimaging; decision-making
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide; Behavior; Suicide, Attempted
• Other Study ID Numbers: LOCAL/2020/FJ-001; 2020-A03353-36 (Other Identifier: ANSM)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No