Social and Behavioral Science Branch, National Institute of Child Health and Human Development, Bethesda, Md. (Vidal-Ribas); Section of Clinical and Computational Psychiatry (COMP-ψ), NIMH, Bethesda, Md. (Vidal-Ribas, Pornpattananangkul, Nielson, Stringaris); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Janiri, Doucet, Frangou); Department of Neurology and Psychiatry, Sapienza University of Rome (Janiri); Boys Town National Research Hospital, Omaha (Doucet); Department of Psychology, University of Otago, Dunedin, New Zealand (Pornpattananangkul); and Centre for Brain Health, University of British Columbia, Vancouver, Canada (Frangou).
Am J Psychiatry. 2021 Apr 1;178(4):321-332. doi: 10.1176/appi.ajp.2020.20020120. Epub 2021 Jan 21.
Suicide deaths and suicidal thoughts and behaviors are considered a public health emergency, yet their underpinnings in the brain remain elusive. The authors examined the classification accuracy of individual, environmental, and clinical characteristics, as well as multimodal brain imaging correlates, of suicidal thoughts and behaviors in a U.S. population-based sample of school-age children.
Children ages 9-10 years (N=7,994) from a population-based sample from the Adolescent Brain Cognitive Development study were assessed for lifetime suicidal thoughts and behaviors. After quality control procedures, structural MRI (N=6,238), resting-state functional MRI (N=4,134), and task-based functional MRI (range, N=4,075-4,608) were examined. Differences with Welch's t test and equivalence tests, with observed effect sizes (Cohen's d) and their 90% confidence intervals <|0.15|, were examined. Classification accuracy was examined with area under precision-recall curves (AUPRCs).
Among the 7,994 unrelated children (females, N=3,757, 47.0%), those with lifetime suicidal thoughts and behaviors based on child (N=684, 8.6%), caregiver (N=654, 8.2%), and concordant (N=198, 2.5%) reports had higher levels of social adversity and psychopathology, among themselves and their caregivers, compared with never-suicidal children (N=6,854, 85.7%). Only one imaging test survived statistical correction: caregiver-reported suicidal thoughts and behaviors were associated with a thinner left bank of the superior temporal sulcus. On the basis of the prespecified bounds of |0.15|, approximately 48% of the group mean differences for child-reported suicidal thoughts and behaviors comparisons and approximately 22% for caregiver-reported suicidal thoughts and behaviors comparisons were considered equivalent. All observed effect sizes were relatively small (d≤|0.30|), and both non-imaging and imaging correlates had low classification accuracy (AUPRC ≤0.10).
Commonly applied neuroimaging measures did not reveal a discrete brain signature related to suicidal thoughts and behaviors in youths. Improved approaches to the neurobiology of suicide are critically needed.
自杀死亡和自杀念头与行为被视为公共卫生紧急事件，但它们在大脑中的基础仍难以捉摸。作者研究了美国基于人群的学龄儿童样本中个体、环境和临床特征以及多模态脑影像学相关性对自杀念头与行为的分类准确性。
来自基于人群的青少年大脑认知发展研究的 9-10 岁儿童（N=7994）接受了终生自杀念头和行为的评估。在质量控制程序后，对结构磁共振成像（N=6238）、静息态功能磁共振成像（N=4134）和任务态功能磁共振成像（范围，N=4075-4608）进行了检查。采用 Welch t 检验和等效检验，观察效应大小（Cohen's d）及其 90%置信区间 <|0.15|，进行差异检验。采用精确召回曲线下面积（AUPRC）检验分类准确性。
在 7994 名无亲缘关系的儿童（女性，N=3757，47.0%）中，基于儿童（N=684，8.6%）、照顾者（N=654，8.2%）和一致（N=198，2.5%）报告的终生自杀念头和行为的儿童中，与无自杀念头和行为的儿童（N=6854，85.7%）相比，他们自身及其照顾者具有更高水平的社会逆境和精神病理学。只有一项影像学检查在统计学上得到纠正：照顾者报告的自杀念头和行为与左优势颞上回的变窄有关。基于 |0.15| 的预设界限，大约 48%的儿童报告的自杀念头和行为比较的组间均值差异和约 22%的照顾者报告的自杀念头和行为比较的组间均值差异被认为是等效的。所有观察到的效应大小都相对较小（d≤|0.30|），非影像学和影像学相关性的分类准确性都较低（AUPRC ≤0.10）。
常用的神经影像学方法并未揭示与青少年自杀念头和行为相关的离散大脑特征。迫切需要改进对自杀神经生物学的研究方法。
