# Predicting Suicidal Behavior in Veterans with Bipolar Disorder using Behavioral and Neuroimaging Based Impulsivity Phenotypes

> **NIH VA I01** · JAMES J PETERS VA  MEDICAL CENTER · 2021 · —

## Abstract

Project Summary
Studies examining the relationship between psychiatric illness and suicide from the Department of Veterans
Affairs indicate that individuals with bipolar disorder have the highest rate of suicide, which is even greater
compared to post-traumatic stress disorder, schizophrenia and major depression. When left untreated, bipolar
disorder has a 5-15% risk of death by suicide, making it a top priority for Veterans' mental health care.
Individuals with bipolar disorder behave impulsively – even during euthymic periods and understanding the
relationship between impulsivity and suicidal behavior in bipolar disorder may assist in the identification of
individuals at greatest risk for a future suicide attempt. Progress in understanding this relationship has been
significantly hampered, however, by the conflation of different measures of impulsivity. Impulsivity can be
measured as a relatively stable trait using self-report measures or as a state measure assessed through the
use of behavioral paradigms sensitive to changing environmental contingencies. Models of state impulsivity
have focused on (1) “rapid-response inhibition” involving difficulty inhibiting responses that are prepotent in the
context of changing environmental situations and (2) “choice impulsivity” defined as the inability to delay
gratification for a larger reward. These models correlate weakly, but strongly overlap with brain regions
implicated in the neurobiology of bipolar disorder. We propose investigating measures of state and trait
impulsivity in 40 euthymic Veterans with bipolar disorder (BD) and a suicide attempt history (BD+S), 40
euthymic Veterans with bipolar disorder and no suicide attempt history (BD-S) and 40 healthy controls (HC).
The primary suicide outcome measure in this study will be suicide attempts assessed using the Columbia
Suicide Severity Rating Scale and medical record review. This will be complemented through the use of a
broader composite suicide outcome measure based on the occurrence of any of 5 types of suicidal behavior
including: (1) death by suicide; (2) suicide attempt; (3) interrupted suicide attempt; (4) aborted suicide attempt;
or (5) preparatory suicidal acts. Following comprehensive baseline clinical, neuropsychological and
neuroimaging assessments all Veterans will subsequently complete 6- and 12-month in-person follow-up
clinical assessments of mood and suicidal behavior. Novel measures of trait impulsivity in this study will include
urgency and impulsive/premeditated aggression. We will assess the relationship between impulsive aggression
and social cognition, functional disability and neurocognitive functioning in BD+S. We will further investigate
two neural circuits tapping state measures of rapid response inhibition (using a go/no-go task) and choice
impulsivity (using a delay discounting task), respectively, using functional magnetic resonance imaging and
neurite orientation dispersion and density imaging, which will provide n...

## Key facts

- **NIH application ID:** 10111355
- **Project number:** 5I01CX002039-02
- **Recipient organization:** JAMES J PETERS VA  MEDICAL CENTER
- **Principal Investigator:** PHILIP R SZESZKO
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10111355

## Citation

> US National Institutes of Health, RePORTER application 10111355, Predicting Suicidal Behavior in Veterans with Bipolar Disorder using Behavioral and Neuroimaging Based Impulsivity Phenotypes (5I01CX002039-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10111355. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*