Abstract
Suicidal ideation (SI) and non-suicidal self-injury (NSSI) are two distinct yet often co-occurring risk factors for suicide deaths in adolescents. Elucidating the neurobiological patterns that specifically characterize SI and NSSI in adolescents is needed to inform the use of these markers in intervention studies and to develop brain-based treatment targets. Here, we clinically assessed 70 adolescents—49 adolescents with depression and 21 healthy controls—to determine SI and NSSI history. Twenty-eight of the depressed adolescents had a history of SI and 29 had a history of NSSI (20 overlapping). All participants underwent a resting-state fMRI scan. We compared groups in network coherence of subdivisions of the central executive network (CEN), default mode network (DMN), and salience network (SN). We also examined group differences in between-network connectivity and explored brain-behavior correlations. Depressed adolescents with SI and with NSSI had lower coherence in the ventral DMN compared to those without SI or NSSI, respectively, and healthy controls (all ps < 0.043, uncorrected). Depressed adolescents with NSSI had lower coherence in the anterior DMN and in insula-SN (all ps < 0.030, uncorrected), and higher CEN–DMN connectivity compared to those without NSSI and healthy controls (all ps < 0.030, uncorrected). Lower network coherence in all DMN subnetworks and insula-SN were associated with higher past-month SI and NSSI (all ps < 0.001, uncorrected). Thus, in our sample, both SI and NSSI are related to brain networks associated with difficulties in self-referential processing and future planning, while NSSI specifically is related to brain networks associated with disruptions in interoceptive awareness.
Highlights
Suicide is currently the second leading cause of death in adolescents and young adults ages 15–24 years[1]
Study designs with clinical controls are necessary for the field to generate specific, in contrast to illness-general, biomarkers and to inform neurobiologically-based treatment targets for SI and NSSI in adolescents. We addressed these issues by examining differences in network coherence of the central executive network (CEN), default mode network (DMN), and salience network (SN) in depressed adolescents with suicidal ideation (SI + ) compared to those without suicidal ideation (SI−) and psychiatrically healthy adolescents (CTL), as well as depressed adolescents with non-suicidal self-injury (NSSI + ) compared to those without non-suicidal self-injury (NSSI−) and CTL
An additional strength of our study is our use of a multivariate data-driven approach to characterize intrinsic networks in order to resolve subnetworks of the DMN and SN, which are the two primary networks for which investigators have reported inconsistent patterns of resting-state functional alterations associated with SI and NSSI in adolescents
Summary
Suicide is currently the second leading cause of death in adolescents and young adults ages 15–24 years[1]. Elucidating the specific neurobiological patterns that characterize SI and NSSI in adolescents may shed insight into the diverse etiology of these behaviors, help to refine brain-based conceptual models[11,12], and identify neural circuits that are sufficiently sensitive to assess the efficacy of targeted interventions[13]. The CEN is composed of dorsolateral prefrontal cortex (PFC) and posterior parietal regions that subserve working memory, executive attention, and other cognitive control functions. It is imperative that we investigate patterns of intrinsic (i.e., task-independent) functional connectivity if we are to facilitate comparisons across samples and studies, and to identify specific neurobiological targets in clinical research studies
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