Childhood trauma and social support affect symptom profiles through cortical thickness abnormalities in major depressive disorder: A structural equation modeling analysis

Changes in network centrality of anxiety and depression symptoms associated with childhood trauma among Chinese college students

BACKGROUND

Childhood trauma is strongly linked to anxiety and depression, significantly increasing the risk of negative outcomes in adulthood. This study employed network analysis to investigate the complex interplay of anxiety and depression symptoms among Chinese college students, focusing on identifying the core symptoms most directly affected by childhood trauma and those exerting the greatest influence on others.

METHODS

Data were collected from December 2020 to January 2021 from 2,266 college students at 16 institutions in southwestern and eastern coastal China. Depression, anxiety, and childhood trauma were assessed using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Childhood Trauma Questionnaire-28, respectively. Separate symptom networks were constructed for participants with and without childhood trauma experiences. Central indices were employed to identify the central symptom within each network. The accuracy and stability of the networks were then evaluated. Finally, a network comparison test was used to analyze differences in network properties between the trauma and non-trauma groups.

RESULTS

Loss of Energy and Worry too much were the central symptoms in the non-trauma group, while anhedonia and nervousness were the central symptoms in the trauma group. There was a significant difference in the global strength of the network between the trauma group and the non-trauma group (pFDR< 0.01), but no significant difference in the distribution of edge weights between the two networks (pFDR =0.14). Anhedonia, Suicide ideation and Feeling afraid in the trauma group showed increased network centrality compared with the non-trauma group.

CONCLUSIONS

This study demonstrates the profound impact of childhood trauma on the central symptoms of anxiety and depression in college students. Further research is warranted to investigate the specific pathways through which these symptoms develop, with the goal of developing targeted interventions for this vulnerable population.

The Reward Positivity Mediates the Association Between Adverse Childhood Experiences and Anhedonia in Young Adults With Drug-Naïve Major Depressive Disorder

BACKGROUND

Current clinical studies have indicated that major depressive disorder (MDD) concurrent with adverse childhood experiences (ACEs) is associated with greater anhedonia. However, little is known about whether the change in reward sensitivity among young individuals with MDD and ACEs is related to anhedonia.

METHODS

We evaluated anhedonia and ACEs in 86 patients with MDD (31 with no or 1 ACE and 55 with 2 or more ACEs) and 44 healthy control participants. Then, participants completed the Iowa Gambling Task during electroencephalography to measure the reward positivity (RewP) and its difference (ΔRewP; gains minus losses). Furthermore, we constructed a mediation model to assess whether aberrant ΔRewP mediated the relationship between ACEs and anhedonia.

RESULTS

Compared with healthy control participants and MDD patients with no or 1 ACE, MDD patients with 2 or more ACEs had the most severe symptoms of anhedonia and impaired decision making and showed significantly reduced reward sensitivity (most blunted ΔRewP). More importantly, ΔRewP mediated the relationship between ACEs and anhedonia in MDD.

CONCLUSIONS

We found that the ΔRewP partially mediated the association between ACEs and anhedonia in patients with MDD, which provides evidence for the neurobiological basis of abnormal changes in the reward system in MDD individuals with early adverse experiences.

Meta-Analysis of Brain Volumetric Abnormalities in Patients with Remitted Major Depressive Disorder

Although patients with major depressive disorder (MDD) achieve remission after antidepressant treatment, >90% of those in remission have at least one residual depressive symptom, which may be due to neural damage linked with MDD. To better understand the structural impairments in patients with remitted MDD, we conducted a meta-analysis comparing grey matter volume (GMV) abnormalities between patients with remitted MDD and healthy controls (HCs). There were 11 cross-sectional datasets that investigated 275 patients with remitted MDD versus 437 HCs, and 7 longitudinal datasets that investigated 167 patients with remitted MDD. We found that GMV in the left insula, inferior parietal gyri, amygdala, and right superior parietal gyrus was decreased in patients with remitted MDD than in HCs. Additionally, patients with remitted MDD had lower GMV in the bilateral gyrus rectus than those in the nonremission state. Moreover, increased GMV in the bilateral anterior cingulate cortex, right striatum, middle temporal gyrus, and superior frontal gyrus was observed in patients with remitted MDD than in HCs. Furthermore, patients with remitted MDD had a larger GMV in the bilateral median cingulate/paracingulate gyri, left striatum, putamen, amygdala, hippocampus, and parahippocampal gyrus at follow-up than at baseline. Based on the brain morphological abnormalities in patients with remitted MDD after electroconvulsive therapy and pharmacological treatment, we proposed a schematic diagram of targeted intervention approaches for residual symptoms. In summary, our findings provide neurobiology-based evidence for multitarget treatment of depression to reduce residual symptoms and improve social function in patients with MDD.

Insula-cortico-subcortical networks predict interoceptive awareness and stress resilience

BACKGROUND

Interoception, the neural sensing of visceral signals, and interoceptive awareness (IA), the conscious perception of interoception, are crucial for life survival functions and mental health. Resilience, the capacity to overcome adversity, has been associated with reduced interoceptive disturbances. Here, we sought evidence for our Insula Modular Active Control (IMAC) model that suggest that the insula, a brain region specialized in the processing of interoceptive information, realizes IA and contributes to resilience and mental health via cortico-subcortical connections.

METHODS

64 healthy participants (32 females; ages 18-34 years) answered questionnaires that assess IA and resilience. Mental health was evaluated with the Beck Depression Inventory II that assesses depressive mood. Participants also underwent a 15 minute resting-state functional resonance imaging session. Pearson correlations and mediation analyses were used to investigate the relationship between IA and resilience and their contributions to depressive mood. We then performed insula seed-based functional connectivity analyzes to identify insula networks involved in IA, resilience and depressive mood.

RESULTS

We first demonstrated that resilience mediates the relationship between IA and depressive mood. Second, shared and distinct intra-insula, insula-cortical and insula-subcortical networks were associated with IA, resilience and also predicted the degree of experienced depressive mood. Third, while resilience was associated with stronger insula-precuneus, insula-cerebellum and insula-prefrontal networks, IA was linked with stronger intra-insula, insula-striatum and insula-motor networks.

CONCLUSIONS

Our findings help understand the roles of insula-cortico-subcortical networks in IA and resilience. These results also highlight the potential use of insula networks as biomarkers for depression prediction.

Subcortical neural mechanisms of childhood trauma impacts on personality traits

This study aims to explore the relationships between childhood trauma (CT), personality traits, and subcortical structures. 171 healthy individuals completed the Childhood Trauma Questionnaire (CTQ), the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI), and underwent 3D T1-weighted MRI scans. Linear regression analyses indicated the complex relationship between CT, personality traits, and subcortical gray matter volume (GMV). Mediation analyses revealed that the right hippocampal GMV partially mediated the effects of CT on neuroticism. These findings suggest that CT affects the development of the Big Five personality traits, and alterations in subcortical structures are closely related to this process. Altered GMV in the right hippocampus may be a key neural mechanism for CT-induced neuroticism.

A structural equation modeling approach using behavioral and neuroimaging markers in major depressive disorder

Major depressive disorder (MDD) has consistently proven to be a multifactorial and highly comorbid disease. Despite recent depression-related research demonstrating causalities between MDD-related factors and a small number of variables, including brain structural changes, a high-statistical power analysis of the various factors is yet to be conducted. We retrospectively analyzed data from 155 participants (84 healthy controls and 71 patients with MDD). We used magnetic resonance imaging and diffusion tensor imaging data, scales assessing childhood trauma, depression severity, cognitive dysfunction, impulsivity, and suicidal ideation. To simultaneously evaluate the causalities between multivariable, we implemented two types of MDD-specified structural equation models (SEM), the behavioral and neurobehavioral models. Behavioral SEM showed significant results in the MDD group: Comparative Fit Index [CFI] = 1.000, Root Mean Square Error of Approximation [RMSEA]) = 0.000), with a strong correlation in the scales for childhood trauma, depression severity, suicidal ideation, impulsivity, and cognitive dysfunction. Based on behavioral SEM, we established neurobehavioral models showing the best-fit in MDD, especially including the right cingulate cortex, central to the posterior corpus callosum, right putamen, pallidum, whole brainstem, and ventral diencephalon, including the thalamus (CFI >0.96, RMSEA <0.05). Our MDD-specific model revealed that the limbic-associated regions are strongly connected with childhood trauma rather than depression severity, and that they independently affect suicidal ideation and cognitive dysfunction. Furthermore, cognitive dysfunction could affect impulsivity.