McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montréal, Canada.
Department of Psychiatry, McGill University, Montréal, Canada.
Mol Psychiatry. 2024 Jul;29(7):2135-2144. doi: 10.1038/s41380-024-02485-w. Epub 2024 Feb 29.
The occurrence of suicidal behaviors increases during adolescence. Hypersensitivity to negative social signals and deficits in cognitive control are putative mechanisms of suicidal behaviors, which necessitate confirmation in youths. Multidomain functional neuroimaging could enhance the identification of patients at suicidal risk beyond standard clinical measures. Three groups of adolescents (N = 96; 78% females, age = 11.6-18.1) were included: patients with depressive disorders and previous suicide attempts (SA, n = 29); patient controls with depressive disorders but without any suicide attempt history (PC, n = 35); and healthy controls (HC, n = 32). We scanned participants with 3T-MRI during social inclusion/exclusion (Cyberball Game) and response inhibition (Go-NoGo) tasks. Neural activation was indexed by the blood-oxygenation-level dependent (BOLD) of the hemodynamic response during three conditions in the Cyberball Game ("Control condition", "Social Inclusion", and "Social Exclusion"), and two conditions in Go-NoGo task ("Go" and "NoGo" blocks). ANCOVA-style analysis identified group effects across three whole-brain contrasts: 1) NoGo vs. Go, 2) Social inclusion vs. control condition, 3) Social exclusion vs. control condition. We found that SA had lower activation in the left insula during social inclusion vs. control condition compared to PC and HC. Moreover, SA compared to PC had higher activity in the right middle prefrontal gyrus during social exclusion vs. control condition, and in bilateral precentral gyri during NoGo vs. Go conditions. Task-related behavioral and self-report measures (Self-reported emotional reactivity in the Cyberball Game, response times and number of errors in the Go-NoGo Task) did not discriminate groups. In conclusion, adolescent suicidal behaviors are likely associated with neural alterations related to the processing of social perception and response inhibition. Further research, involving prospective designs and diverse cohorts of patients, is necessary to explore the potential of neuroimaging as a tool in understanding the emergence and progression of suicidal behaviors.
自杀行为在青少年中更为常见。对负性社会信号的过度敏感和认知控制缺陷是自杀行为的潜在机制，这需要在年轻人中得到证实。多领域功能神经影像学可以增强对自杀风险患者的识别，超越标准临床评估。我们纳入了三组青少年（N=96；78%为女性，年龄为 11.6-18.1 岁）：有抑郁障碍和既往自杀未遂史的患者（SA，n=29）；有抑郁障碍但无自杀未遂史的患者（PC，n=35）；和健康对照者（HC，n=32）。我们使用 3T-MRI 对参与者进行扫描，在社交排斥/接纳（Cyberball Game）和反应抑制（Go-NoGo）任务中。神经激活通过 Cyberball Game 中三种条件（“控制条件”、“社交接纳”和“社交排斥”）和 Go-NoGo 任务中两种条件（“Go”和“NoGo”块）的血液氧合水平依赖（BOLD）的血流动力学反应来索引。ANCOVA 式分析确定了整个大脑三个对比的组间效应：1）NoGo 与 Go；2）社交接纳与控制条件；3）社交排斥与控制条件。我们发现，与 PC 和 HC 相比，SA 在社交接纳时左侧脑岛的激活较低。此外，与 PC 相比，SA 在社交排斥时右侧中前额叶回和双侧中央前回的活动更高，而在 NoGo 与 Go 条件时，SA 的行为和自我报告测量（Cyberball Game 中的自我报告情绪反应、Go-NoGo 任务中的反应时间和错误数）没有区分组间差异。总之，青少年自杀行为可能与与社会感知和反应抑制处理相关的神经改变有关。需要进一步的研究，包括前瞻性设计和不同患者群体，以探索神经影像学作为理解自杀行为出现和进展的工具的潜力。
