Suicide is linked to impaired value-based decision-making and impulsivity, but whether these risk factors share neural underpinnings is unclear. Disrupted ventromedial prefrontal cortex (vmPFC) value signals may underlie this behavioral phenotype. We investigated vmPFC value signals, vmPFC-frontoparietal connectivity, and the impact of impulsivity during decision-making in depressed individuals with and without suicidal behavior. Middle-aged and older adults (n = 116; 35 with a history of suicide attempts, 25 with ideation only, 25 depressed controls with no ideation, and 31 nonpsychiatric controls) completed a decision-making task with drifting reward probabilities during fMRI. Values of choices, estimated by a reinforcement learning model, were regressed against BOLD signal. VmPFC value activation was compared between groups. Moderating effects of impulsivity on vmPFC-frontoparietal connectivity were assessed in nonpsychiatric controls and compared among patient groups. VmPFC value responses in participants with a history of suicide attempts were reduced relative to nonpsychiatric controls (p < 0.05). In nonpsychiatric controls, vmPFC-frontoparietal connectivity was negatively moderated by impulsivity (pFWE corrected < 0.05). This effect was preserved in comparison patient groups but abolished in suicide attempters (p < 0.001). This change in neural connectivity patterns also affected behavior: people with a history of suicide attempts showed a disrupted effect of vmPFC-frontoparietal connectivity, impulsivity, and reinforcement on choice quality (p < 0.001). These effects were specific to vmPFC and not to striatum. In summary, findings from this study largely support disrupted vmPFC value signals in suicidal behavior. In addition, it uncovers an altered pattern of vmPFC-frontoparietal connectivity in impulsive people with suicidal behavior, which may underlie disrupted choice processes in a suicidal crisis.

中文翻译：

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自杀行为和冲动决策过程中的腹内侧前额叶价值信号和功能连接。

自杀与基于价值的决策受损和冲动有关，但这些风险因素是否具有共同的神经基础尚不清楚。腹内侧前额叶皮层 (vmPFC) 值信号中断可能是这种行为表型的基础。我们研究了 vmPFC 价值信号、vmPFC-额顶叶连接，以及有或没有自杀行为的抑郁个体决策过程中冲动的影响。中年和老年人（n = 116；35 名有自杀企图史，25 名仅有意念，25 名没有意念的抑郁对照组，31 名非精神病对照）在功能磁共振成像期间完成了奖励概率漂移的决策任务。通过强化学习模型估计的选择值根据 BOLD 信号进行回归。比较各组之间的 VmPFC 值激活情况。在非精神病对照组中评估了冲动对 vmPFC-额顶叶连接的调节作用，并在患者组之间进行了比较。与非精神病对照组相比，有自杀企图史的参与者的 VmPFC 值反应有所降低 (p < 0.05)。在非精神病对照组中，vmPFC-额顶叶连接受到冲动的负面调节（pFWE 校正< 0.05）。这种效应在比较患者组中得以保留，但在自杀未遂者中被消除（p < 0.001）。神经连接模式的这种变化也影响了行为：有自杀企图史的人表现出 vmPFC-额顶叶连接、冲动性和选择质量强化的破坏效应 (p < 0.001)。这些影响是 vmPFC 特有的，而不是纹状体的。总之，这项研究的结果在很大程度上支持了自杀行为中 vmPFC 值信号的破坏。此外，它还揭示了有自杀行为的冲动人群中 vmPFC-额顶叶连接模式的改变，这可能是自杀危机中选择过程中断的基础。