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Default Mode and Salience Network Alterations in Suicidal and Non-Suicidal Self-Injurious Thoughts and Behaviors in Adolescents with Depression

Thu, April 8, 2:45 to 4:15pm EDT (2:45 to 4:15pm EDT), Virtual

Abstract

Suicide is currently the second leading cause of death in adolescents and young adults ages 15-24 years (Curtin, 2019). While suicides are relatively rare, the prevalence of suicidal ideation (SI) and self-harming behaviors (including non-suicidal self-injury, or NSSI) among adolescents is alarmingly prevalent, with estimates as high as 38% (Nock et al., 2013, Plener et al., 2015). Because SI and NSSI are two distinct yet often co-occurring risk factors for suicide, elucidating the neurobiological patterns that specifically characterize these behaviors in adolescents is needed to inform the use of neural markers in intervention studies and to develop brain-based treatment targets.

Here, we recruited 49 adolescents with a depressive disorder and 21 healthy controls (ages 13-18 years; 68.57% female) and used multiple clinical interviews to assess SI and NSSI history. 28 of the depressed adolescents had a history of SI and 29 had a history of NSSI (20 overlapping participants). All participants underwent an 8-minute resting-state fMRI scan at 3T. We conducted a group-level independent component analysis (ICA) using FSL 6.0 MELODIC software version 3.14, and identified 25 probabilistic ICA components from the whole sample in order to compute individual-level metrics of network coherence (defined as the strength of the associations among timecourses of all voxels within a given network; Ordaz et al., 2017). Guided by previous studies (Auerbach et al., 2020), we compared SI and NSSI groups in network coherence of the central executive networks (CEN), default mode networks (DMNs), and salience network (SNs).

Depressed adolescents with and without SI differed significantly in history of suicide attempt and frequency of past-month ideation, and depressed adolescents with and without NSSI differed significantly in frequency of past-month NSSI thoughts and actions (all ps<0.00013). Critically, participants with SI (and NSSI) did not differ from those without SI (and without NSSI) on history of NSSI (and SI), age, gender distribution, medication status, and depression severity scores (all ps>0.085).

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<0.033). Depressed adolescents with NSSI had lower coherence in the anterior DMN and in insula-SN (all ps<0.029) compared to those without NSSI and healthy controls (all ps<0.038). Lower network coherence in all DMN subnetworks and insula-SN were associated with higher SI across all depressed participants (all ps<0.00007). SI and NSSI groups did not differ in within-network coherence of the CENs (all ps>0.139).

In a sample of depressed adolescents, history of SI and NSSI are both 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. Although future research is needed to replicate these findings in larger sample sizes and in patients with more clinical heterogeneity (e.g., bipolar disorder, borderline personality disorder), our findings highlight potential neural markers of SI and NSSI that may be useful biomarkers and that may eventually contribute to the development of brain-based treatments of these co-occurring behaviors in adolescents.

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