Neural Correlates of Emotion Regulation and Adolescent Suicidal Ideation

The role of affective control, strategy repertoire and subjective emotion regulation success in developmental internalising psychopathology

Adolescence poses significant challenges for emotion regulation (ER) and is thus a critical phase in the emergence of various mental disorders, specifically internalising disorders such as anxiety and depression. Affective control, defined as the application of cognitive control in affective contexts, is crucial for effective ER. However, the relationship between ER and affective control is unclear. This study examined the predictive role of ER strategies and difficulties in affective control, measured as the congruency effect and error rate on an Emotional Stroop task (EST), in a sample of adolescents and young adults (aged 14-21, M = 17.28, 22% male). It was hypothesised that participants with internalising disorders would show higher congruency effects and error rates on the EST than healthy controls after a psychosocial stress induction, indicating lower affective control. Surprisingly, our findings revealed no significant differences in these measures between the groups. However, higher depression scores were associated with increased EST errors. While ER strategies and difficulties did not predict affective control, exploratory analyses unveiled associations between depression scores and ER strategy repertoire, perceived ER success and the ER strategy Acceptance. These findings underscore the importance of implicit ER facets, particularly perceived ER success and flexibility to change between applied strategies for adolescents and young adults with elevated depressive symptoms.

Neural correlates of automatic emotion regulation and their association with suicidal ideation in adolescents during the first 90-days of residential care

BACKGROUND

Suicide is the second leading cause of death for adolescents in the United States. However, relatively little is known about the forms of atypical neuro-cognitive function that are correlates of suicidal ideation (SI). One form of cognitive/affective function that, when dysfunctional, is associated with SI is emotion regulation. However, very little work has investigated the neural correlates of emotion dysregulation in adolescents with SI.

METHODS

Participants (N = 111 aged 12-18, 32 females, 31 [27.9%] reporting SI) were recruited shortly after their arrival at a residential care facility where they had been referred for behavioral and mental health problems. Daily reports of SI were collected during the participants' first 90-days in residential care. Participants were presented with a task-fMRI measure of emotion regulation - the Affective Number Stroop task shortly after recruitment. Participants were divided into two groups matched for age, sex and IQ based on whether they demonstrated SI.

RESULTS

Participants who demonstrated SI showed increased recruitment of regions including dorsomedial prefrontal cortex/supplemental motor area and parietal cortex during task (congruent and incongruent) relative to view trials in the context of emotional relative to neutral distracters.

CONCLUSIONS

Participants with SI showed increased recruitment of regions implicated in executive control during the performance of a task indexing automatic emotion regulation. Such data might suggest a relative inefficiency in the recruitment of these regions in individuals with SI.

A Systematic Review of MRI Studies and the "Emotional paiN and social Disconnect (END)" Brain Model of Suicidal Behavior in Youth

Introduction

Risk of suicidal ideation and suicidal behaviors greatly increases during adolescence, and rates have risen dramatically over the past two decades. However, few risk factors or biomarkers predictive of suicidal ideation or attempted suicide have been identified in adolescents. Neuroimaging correlates hold potential for early identification of adolescents at increased risk of suicidality and risk stratification for those at high risk of suicide attempt.

Methods

In this systematic review, we evaluated neural regions and networks associated with suicidal ideation and suicide attempt in adolescents derived from magnetic resonance imaging (MRI) studies. A total of 28 articles were included in this review.

Results

After descriptively synthesizing the literature, we propose the Emotional paiN and social Disconnect (END) model of adolescent suicidality and present two key neural circuits: (1) the emotional/mental pain circuit and (2) the social disconnect/distortion circuit. In the END model, the emotional pain circuit-consisting of the cerebellum, amygdala, and hippocampus-shows similar aberrations in adolescents with suicidal ideation as in those with a history of a suicide attempt (but to a smaller degree). The social disconnect circuit is unique to adolescent suicide attempters and includes the lateral orbitofrontal cortex (OFC), the temporal gyri, and the connections between them.

Conclusion

Our proposed END brain model of suicidal behavior in youth, if confirmed by future prospective studies, can have implications for clinical goals of early detection, risk stratification, and intervention development. Treatments that target emotional pain and social disconnect may be ideal interventions for reducing suicidality in adolescents.

Machine learning based identification of structural brain alterations underlying suicide risk in adolescents

Suicide is the third leading cause of death for individuals between 15 and 19 years of age. The high suicide mortality rate and limited prior success in identifying neuroimaging biomarkers indicate that it is crucial to improve the accuracy of clinical neural signatures underlying suicide risk. The current study implements machine-learning (ML) algorithms to examine structural brain alterations in adolescents that can discriminate individuals with suicide risk from typically developing (TD) adolescents at the individual level. Structural MRI data were collected from 79 adolescents who demonstrated clinical levels of suicide risk and 79 demographically matched TD adolescents. Region-specific cortical/subcortical volume (CV/SCV) was evaluated following whole-brain parcellation into 1000 cortical and 12 subcortical regions. CV/SCV parameters were used as inputs for feature selection and three ML algorithms (i.e., support vector machine [SVM], K-nearest neighbors, and ensemble) to classify adolescents at suicide risk from TD adolescents. The highest classification accuracy of 74.79% (with sensitivity = 75.90%, specificity = 74.07%, and area under the receiver operating characteristic curve = 87.18%) was obtained for CV/SCV data using the SVM classifier. Identified bilateral regions that contributed to the classification mainly included reduced CV within the frontal and temporal cortices but increased volume within the cuneus/precuneus for adolescents at suicide risk relative to TD adolescents. The current data demonstrate an unbiased region-specific ML framework to effectively assess the structural biomarkers of suicide risk. Future studies with larger sample sizes and the inclusion of clinical controls and independent validation data sets are needed to confirm our findings.

Neuroimaging alterations of the suicidal brain and its relevance to practice: an updated review of MRI studies

Suicide is a leading cause of death in the United States. Historically, scientific inquiry has focused on psychological theory. However, more recent studies have started to shed light on complex biosignatures using MRI techniques, including task-based and resting-state functional MRI, brain morphometry, and diffusion tensor imaging. Here, we review recent research across these modalities, with a focus on participants with depression and Suicidal Thoughts and Behavior (STB). A PubMed search identified 149 articles specific to our population of study, and this was further refined to rule out more diffuse pathologies such as psychotic disorders and organic brain injury and illness. This left 69 articles which are reviewed in the current study. The collated articles reviewed point to a complex impairment showing atypical functional activation in areas associated with perception of reward, social/affective stimuli, top-down control, and reward-based learning. This is broadly supported by the atypical morphometric and diffusion-weighted alterations and, most significantly, in the network-based resting-state functional connectivity data that extrapolates network functions from well validated psychological paradigms using functional MRI analysis. We see an emerging picture of cognitive dysfunction evident in task-based and resting state fMRI and network neuroscience studies, likely preceded by structural changes best demonstrated in morphometric and diffusion-weighted studies. We propose a clinically-oriented chronology of the diathesis-stress model of suicide and link other areas of research that may be useful to the practicing clinician, while helping to advance the translational study of the neurobiology of suicide.

Changes in gray matter volume following electroconvulsive therapy in adolescent depression with suicidal ideation: A longitudinal structural magnetic resonance imaging study

Objective

We aimed to investigate changes in whole-brain gray matter volumes (GMVs) before and after electroconvulsive therapy (ECT) in adolescents with major depressive disorder (MDD) and suicidal ideation (SI).

Methods

Thirty adolescents with MDD and SI were observed, and structural magnetic resonance imaging (sMRI) was performed at baseline and after ECT for each patient. But Twenty-five healthy controls (HCs) were scanned only at baseline. The voxel-based morphometry (VBM) techniques were used to examine GMVs.

Results

Compared with HCs, MDDs at baseline showed decreased GMVs in the left middle temporal gyrus, right superior temporal gyrus, right middle temporal gyrus, left precuneus, right precuneus, and left superior frontal gyrus. After ECT, MDDs showed increased GMVs in the right superior frontal gyrus and right superior temporal gyrus. Pearson's correlation found that Beck Scale for Suicide Ideation (BSSI) scores at baseline were negatively correlated with GMVs in the left superior frontal gyrus and HAMD and BSSI scores after ECT were negatively correlated with GMVs in the right superior temporal gyrus.

Conclusion

Frontal-temporal-precuneus structure changes may be a potential cause of depressive and suicidal symptoms in adolescents. ECT may improve depressive and suicidal symptoms in adolescents by regulating brain structures to compensate original defects.

Altered Regional Homogeneity and Amplitude of Low-Frequency Fluctuations Induced by Electroconvulsive Therapy for Adolescents with Depression and Suicidal Ideation

Resting-state functional magnetic resonance imaging (rs-fMRI) was used to investigate the effects of electroconvulsive therapy (ECT) causing brain function changes in adolescents who suffered from depression and suicidal ideation (SI). A total of 30 patients (MDDs) and 25 healthy controls (HCs) matched by gender, age, and education level were enrolled. The amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) were used to compare differences between HCs and MDDs at baseline, and differences in ALFF and ReHo pre/post ECT in MDDs. Pearson correlation analysis was used to evaluate the relationship between altered brain function and clinical symptoms. At baseline, MDDs showed decreased ALFF in the left inferior temporal gyrus and right amygdala, decreased ReHo in left inferior temporal gyrus, and increased ReHo in the right inferior frontal gyrus, opercular part and left middle occipital gyrus. After ECT, MDDs showed increased ALFF in the right middle occipital gyrus, decreased ALFF in left temporal pole, left inferior frontal gyrus, opercular part, and right frontal middle gyrus, increased ReHo in the right middle occipital gyrus, and left inferior temporal gyrus. Pearson correlation found HAMD scores at baseline were negatively correlated with ALFF in the left inferior temporal gyrus, and HAMD and BSSI scores after ECT were negatively correlated with ALFF in the right middle occipital gyrus. The abnormal activities of amygdala, inferior temporal gyrus and middle occipital gyrus might be related to depressive and suicidal symptoms in adolescents.

Life stress, sleep disturbance and depressive symptoms: The moderating role of prefrontal activation during emotion regulation

OBJECTIVES

Evidence suggests that emotion regulation difficulty may play an important role in the association between life stress, sleep disturbance and depressive symptoms. We proposed two models depicting the possible moderating roles of prefrontal cortex activation during emotion regulation in the associations among these variables and tested them. We hypothesized that (1) the association between stress and sleep disturbance would differ across prefrontal cortex activation during emotion regulation (moderation model) and (2) the indirect effects of stress on depressive symptoms through sleep disturbance would depend on prefrontal cortex activation during emotion regulation (moderated mediation model).

METHODS

Forty-eight healthy adults without sleep disorders based on nocturnal polysomnography participated in this study. They received functional magnetic resonance imaging scans while performing an emotion regulation task. They also completed questionnaires assessing life stress, sleep disturbance and depressive symptoms. The proposed models were tested using the PROCESS macro for SPSS.

RESULTS

As hypothesized, there was a significant moderating effect of prefrontal cortex activation during emotion regulation on the association between life stress and sleep disturbance. Furthermore, right lateral prefrontal cortex activation had a moderating role in the indirect effect of life stress on depressive symptoms through sleep disturbance.

CONCLUSION

These findings highlight the important role of prefrontal cortex function during emotion regulation in the associations between stress, sleep disturbance and depressive symptoms. Increasing lateral prefrontal cortex recruitment when regulating the emotional response to negative life events may be critical for the prevention and intervention of depression as well as sleep problems.

Detecting Suicide Ideation in the Era of Social Media: The Population Neuroscience Perspective

Social media platforms are increasingly used across many population groups not only to communicate and consume information, but also to express symptoms of psychological distress and suicidal thoughts. The detection of suicidal ideation (SI) can contribute to suicide prevention. Twitter data suggesting SI have been associated with negative emotions (e.g., shame, sadness) and a number of geographical and ecological variables (e.g., geographic location, environmental stress). Other important research contributions on SI come from studies in neuroscience. To date, very few research studies have been conducted that combine different disciplines (epidemiology, health geography, neurosciences, psychology, and social media big data science), to build innovative research directions on this topic. This article aims to offer a new interdisciplinary perspective, that is, a Population Neuroscience perspective on SI in order to highlight new ways in which multiple scientific fields interact to successfully investigate emotions and stress in social media to detect SI in the population. We argue that a Population Neuroscience perspective may help to better understand the mechanisms underpinning SI and to promote more effective strategies to prevent suicide timely and at scale.

Alteration of Whole Brain ALFF/fALFF and Degree Centrality in Adolescents With Depression and Suicidal Ideation After Electroconvulsive Therapy: A Resting-State fMRI Study

Major depressive disorder (MDD) is one of the most widespread mental disorders and can result in suicide. Suicidal ideation (SI) is strongly predictive of death by suicide, and electroconvulsive therapy (ECT) is effective for MDD, especially in patients with SI. In the present study, we aimed to determine differences in resting-state functional magnetic resonance imaging (rs-fMRI) in 14 adolescents aged 12–17 with MDD and SI at baseline and after ECT. All participants were administered the Hamilton Depression Scale (HAMD) and Beck Scale for Suicide Ideation (BSSI) and received rs-fMRI scans at baseline and after ECT. Following ECT, the amplitude of low frequency fluctuation (ALFF) and fractional ALFF (fALFF) significantly decreased in the right precentral gyrus, and the degree centrality (DC) decreased in the left triangular part of the inferior frontal gyrus and increased in the left hippocampus. There were significant negative correlations between the change of HAMD (ΔHAMD) and ALFF in the right precentral gyrus at baseline, and between the change of BSSI and the change of fALFF in the right precentral gyrus. The ΔHAMD was positively correlated with the DC value of the left hippocampus at baseline. We suggest that these brain regions may be indicators of response to ECT in adolescents with MDD and SI.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.

Informing the study of suicidal thoughts and behaviors in distressed young adults: The use of a machine learning approach to identify neuroimaging, psychiatric, behavioral, and demographic correlates

Young adults are at high risk for suicide, yet there is limited ability to predict suicidal thoughts and behaviors. Machine learning approaches are better able to examine a large number of variables simultaneously to identify combinations of factors associated with suicidal thoughts and behaviors. The current study used LASSO regression to investigate extent to which a number of demographic, psychiatric, behavioral, and functional neuroimaging variables are associated with suicidal thoughts and behaviors during young adulthood. 78 treatment seeking young adults (ages 18-25) completed demographic, psychiatric, behavioral, and suicidality measures. Participants also completed an implicit emotion regulation functional neuroimaging paradigm. Report of recent suicidal thoughts and behaviors served as the dependent variable. Five variables were identified by the LASSO regression: Two were demographic variables (age and level of education), two were psychiatric variables (depression and general psychiatric distress), and one was a neuroimaging variable (left amygdala activity during sad faces). Amygdala function was significantly associated with suicidal thoughts and behaviors above and beyond the other factors. Findings inform the study of suicidal thoughts and behaviors among treatment seeking young adults, and also highlight the importance of investigating neurobiological markers.

Functional alterations of the suicidal brain: a coordinate-based meta-analysis of functional imaging studies

Altered brain activities in suicidal subjects have been reported in a number of neuroimaging studies. However, the activity aberrances were inconsistent in previous investigations. Thus, we aimed to address activity abnormalities in suicidal individuals. Databases were searched to perform a meta-analysis of whole-brain functional MRI studies of suicidal individuals through January 14, 2020. Meta-analyses were conducted using Seed-based d Mapping software. Based on a meta-analysis of 17 studies comprising 381 suicidal individuals and 642 controls, we mainly found that increased activity in the bilateral superior temporal gyrus, left middle temporal gyrus, and bilateral middle occipital gyrus, along with decreased activity in the right putamen and left insula, were detected in suicidal individuals compared with nonsuicidal subjects. To reduce methodological heterogeneity between the included studies, subanalyses of behavioral domains were conducted, and the right superior temporal gyrus was found to increase in all subanalyses of domains. In subanalyses of suicidal attempters and ideators, suicide attempters displayed hyperactivation in the bilateral superior temporal gyrus and left middle temporal gyrus and blunted responses in the left insula relative to controls. Suicidal ideators demonstrated elevated activation in the right middle occipital gyrus and reduced activity in the right putamen relative to controls. The bilateral superior temporal gyrus was the most robust finding, replicable in all data sets in the jackknife sensitive analysis. Moreover, increased activity in the right superior temporal gyrus, left middle temporal gyrus, and right middle occipital gyrus was found to be involved with higher suicide ideation scores. This study revealed several brain regions associated with suicidality. These findings may contribute to our understanding of the pathophysiology of suicide and have important implications for suicide prevention and interventions.

Alterations in neural circuits underlying emotion regulation following child maltreatment: a mechanism underlying trauma-related psychopathology

BACKGROUND

Disruptions in neural circuits underlying emotion regulation (ER) may be a mechanism linking child maltreatment with psychopathology. We examined the associations of maltreatment with neural responses during passive viewing of negative emotional stimuli and attempts to modulate emotional responses. We investigated whether the influence of maltreatment on neural activation during ER differed across development and whether alterations in brain function mediated the association between maltreatment and a latent general psychopathology ('p') factor.

METHODS

Youth aged 8-16 years with (n = 79) and without (n = 72) exposure to maltreatment completed an ER task assessing neural responses during passive viewing of negative and neutral images and effortful attempts to regulate emotional responses to negative stimuli. P-factor scores were defined by a bi-factor model encompassing internalizing and externalizing psychopathology.

RESULTS

Maltreated youth had greater activation in left amygdala and salience processing regions and reduced activation in multiple regions involved in cognitive control (bilateral superior frontal gyrus, middle frontal gyrus, and dorsal anterior cingulate cortex) when viewing negative v. neutral images than youth without maltreatment exposure. Reduced neural recruitment in cognitive control regions mediated the association of maltreatment with p-factor in whole-brain analysis. Maltreated youth exhibited increasing recruitment with age in ventrolateral prefrontal cortex during reappraisal while control participants exhibited decreasing recruitment with age. Findings were similar after adjusting for co-occurring neglect.

CONCLUSIONS

Child maltreatment influences the development of regions associated with salience processing and cognitive control during ER in ways that contribute to psychopathology.

Multimodal Neuroimaging of Suicidal Thoughts and Behaviors in a U.S. Population-Based Sample of School-Age Children

OBJECTIVE

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.

METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

Neural Correlates Associated With Suicide and Nonsuicidal Self-injury in Youth

There is no definitive neural marker of suicidal thoughts and behaviors (STBs) or nonsuicidal self-injury (NSSI), and relative to adults, research in youth is more limited. This comprehensive review focuses on magnetic resonance imaging studies reporting structural and functional neural correlates of STBs and NSSI in youth to 1) elucidate shared and independent neural alternations, 2) clarify how developmental processes may interact with neural alterations to confer risk, and 3) provide recommendations based on convergence across studies. Forty-seven articles were reviewed (STBs = 27; NSSI = 20), and notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years. Structural magnetic resonance imaging research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STBs, and there is reduced anterior cingulate cortex volume related to STBs and NSSI. With regard to functional alterations, blunted striatal activation may characterize STB and NSSI youth, and there is reduced frontolimbic task-based connectivity in suicide ideators and attempters. Resting-state functional connectivity findings highlight reduced positive connectivity between the default mode network and salience network in attempters and show that self-injurers exhibit frontolimbic alterations. Together, suicidal and nonsuicidal behaviors are related to top-down and bottom-up neural alterations, which may compromise approach, avoidance, and regulatory systems. Future longitudinal research with larger and well-characterized samples, especially those integrating ambulatory stress assessments, will be well positioned to identify novel targets that may improve early identification and treatment for youth with STBs and NSSI.

The Association Between Resting State Functional Connectivity and the Trait of Impulsivity and Suicidal Ideation in Young Depressed Patients With Suicide Attempts

Suicide is a leading cause of death among youth and is strongly associated with major depressive disorder (MDD). However, the neurobiological underpinnings of suicidal behaviour and the identification of risk for suicide in young depressed patients are not yet well-understood. In this study, we used a seed-based correlation analysis to investigate the differences in resting-state functional connectivity (RSFC) in depressed youth with or without a history of suicide attempts and healthy controls (HCs). Suicidal attempters (ATT group, n = 35), non-suicide attempters (NAT group, n = 18), and HCs exhibited significantly different RSFC patterns with the left superior prefrontal gyrus (L-SFG) and left middle prefrontal gyrus (L-MFG) serving as the regions of interest (ROIs). The ATT group showed decreased RSFC of the left middle frontal gyrus with the left superior parietal gyrus compared to the NAT and HC groups. Decreased RSFC between the left superior frontal gyrus and the right anterior cingulate cortex (rACC) was found in the ATT group compared to the NAT and HC groups. Furthermore, the left prefrontal-parietal connectivity was associated with suicidal ideation and levels of impulsivity, but RSFC of the left prefrontal cortex with the rACC was correlated exclusively with impulsivity levels and was not related to suicidal ideation in the ATT group. Our results demonstrated that altered RSFC of the prefrontal-parietal and prefrontal-rACC regions was associated with suicide attempts in depressed youth, and state-related deficits in their interconnectivity may contribute to traits, such as cognitive impairments and impulsivity to facilitate suicidal acts. Our findings suggest that the neural correlates of suicidal behaviours might be dissociable from those related to the severity of current suicidal ideation. Neural circuits underlying suicide attempts differ from those that underlie suicidal ideation.

Examining Associations Between Child Abuse and Neglect Experiences With Emotion Regulation Difficulties Indicative of Adolescent Suicidal Ideation Risk

Objective: Preliminary work indicates one specific aspect of emotion dysregulation (i.e., limited access to emotion regulation strategies) uniquely associates with adolescent suicide ideation. An optimal score cut point on a measure of this emotion dysregulation impairment has been identified to indicate risk for past-year suicidal ideation. Examining types of child abuse and neglect associated with being above cut-off on this measure may point to interactive environmental effects associated with subsequent risk for suicidal ideation. The primary aim of this study was to investigate the relations between multiple types of child abuse and neglect with being above cutoff on a measure of limited access to emotion regulation strategies in a psychiatrically severe adolescent sample. Method: The full sample included 203 psychiatric adolescents (Mean age = 15.31 years; 66.5% female; 74.4% White), assigned to two groups: (1) those at or above cutoff on the access to emotion regulation strategies subscale (n = 139); and (2) those below cutoff (n = 64). Results: Significant differences were only evidenced between the emotion regulation cutoff groups on emotional abuse, after covarying for other types of abuse and neglect; significant group differences were not evidenced on any other type of abuse or neglect (sexual or physical abuse, emotional or physical neglect). Conclusion: Relative to other types of abuse and neglect, emotional abuse may be differentially related to experiencing limited access to emotion regulation strategies, at the level indicative of suicide ideation risk. Clinical implications are discussed.

A Comparative Study of Suicidality and Its Association with Emotion Regulation Impairment in Large ASD and US Census-Matched Samples

Evidence suggests increased rates of suicidality in autism spectrum disorder (ASD), but the research has rarely used comparison samples and the role of emotion dysregulation has not been considered. We compared the prevalence of parent-reported suicidality ideation and considered the role of emotion dysregulation in 330 psychiatric inpatient youth with ASD, 1169 community youth with ASD surveyed online, and 1000 youth representative of the US census. The prevalence of suicidal ideation was three and five times higher in the community and inpatient ASD samples, respectively, compared to the general US sample. In the ASD groups, greater emotion dysregulation was associated with suicidal ideation. Implications include consideration of emotion regulation as a potential mechanism and treatment target for suicidality in ASD.

The Child and Parent Emotion Study: protocol for a longitudinal study of parent emotion socialisation and child socioemotional development

INTRODUCTION

Parents shape child emotional competence and mental health via their beliefs about children's emotions, emotion-related parenting, the emotional climate of the family and by modelling emotion regulation skills. However, much of the research evidence to date has been based on small samples with mothers of primary school-aged children. Further research is needed to elucidate the direction and timing of associations for mothers and fathers/partners across different stages of child development. The Child and Parent Emotion Study (CAPES) aims to examine longitudinal associations between parent emotion socialisation, child emotion regulation and socioemotional adjustment at four time points from pregnancy to age 12 years. CAPES will investigate the moderating role of parent gender, child temperament and gender, and family background.

METHODS AND ANALYSIS

CAPES recruited 2063 current parents from six English-speaking countries of a child 0-9 years and 273 prospective parents (ie, women/their partners pregnant with their first child) in 2018-2019. Participants will complete a 20-30 min online survey at four time points 12 months apart, to be completed in December 2022. Measures include validated parent-report tools assessing parent emotion socialisation (ie, parent beliefs, the family emotional climate, supportive parenting and parent emotion regulation) and age-sensitive measures of child outcomes (ie, emotion regulation and socioemotional adjustment). Analyses will use mixed-effects regression to simultaneously assess associations over three time-point transitions (ie, T1 to T2; T2 to T3; T3 to T4), with exposure variables lagged to estimate how past factors predict outcomes 12 months later.

ETHICS AND DISSEMINATION

Ethics approval was granted by the Deakin University Human Research Ethics Committee and the Deakin University Faculty of Health Human Research Ethics Committee. We will disseminate results through conferences and open access publications. We will invite parent end users to co-develop our dissemination strategy, and discuss the interpretation of key findings prior to publication.

TRIAL REGISTERATION

Protocol pre-registration: DOI 10.17605/OSF.IO/NGWUY.

Delta Event-Related Oscillations Are Related to a History of Extreme Binge Drinking in Adolescence and Lifetime Suicide Risk

Alcohol exposure typically begins in adolescence, and heavy binge drinking is associated with health risk behaviors. Event-related oscillations (EROs) may represent sensitive biomarkers or endophenotypes for early alcohol exposure as well as other risk behaviors such as suicidal thoughts and actions. In this study, young adults (age 18-30 years) of American Indian (AI) (n = 479) and Mexican American (MA) (n = 705) ancestry were clinically assessed, and EROs were generated to happy, sad and neutral faces. Extreme adolescent binge drinking (10+ drinks) was common (20%) in this population of AI/MA and associated with a significantly increased risk of a lifetime history of suicidal acts (SA, suicide attempts, deaths) but not suicidal thoughts (ST, ideation, plans). ST were reported among MA participants, whereas SA were more common among AI young adults. Extreme adolescent binge drinking was also associated with errors in detection of sad and neutral faces, increases in delta ERO energy, and decreases in phase locking (PL), particularly in parietal areas. A lifetime history of ST was associated with increases in delta ERO energy and PL, whereas SA were associated with decreases in both. These studies suggest that ERO measures may represent important potential biomarkers of adolescent extreme binge drinking and risk for suicidal behaviors.

Emotion Regulation as a Risk Factor for Suicide Ideation among Adolescents and Young Adults: The Mediating Role of Belongingness

Thwarted belongingness is an established predictor of suicide ideation. Emerging theory suggests belongingness may be a crucial pathway through which risk factors such as dysfunctional emotion regulation influence suicide ideation. This study examined whether belongingness mediated the relationship between emotion regulation and suicide ideation in young people (16-25 years). Participants (n = 1699; 63.6% females, M = 20.24 years, SD = 2.45 years) completed measures of these constructs, including the emotion regulation domains of internal-functional, internal-dysfunctional, external-functional, and external-dysfunctional. Belongingness mediated over half of the association between three emotion regulation domains and suicide ideation (internal-functional: 55.6%, internal-dysfunctional: 54.1%, and external-functional: 64.8%). Consistent with current etiological suicidality models, results suggest low belongingness is an important precursor to suicide ideation in young people, and that there is an inter-relationship between emotional regulation styles and belongingness.

Calcium-binding proteins are altered in the cerebellum in schizophrenia

Alterations in the cortico-cerebellar-thalamic-cortical circuit might underlie the diversity of symptoms in schizophrenia. However, molecular changes in cerebellar neuronal circuits, part of this network, have not yet been fully determined. Using LC-MS/MS, we screened altered candidates in pooled grey matter of cerebellum from schizophrenia subjects who committed suicide (n = 4) and healthy individuals (n = 4). Further validation by immunoblotting of three selected candidates was performed in two cohorts comprising schizophrenia (n = 20), non-schizophrenia suicide (n = 6) and healthy controls (n = 21). We found 99 significantly altered proteins, 31 of them previously reported in other brain areas by proteomic studies. Transport function was the most enriched category, while cell communication was the most prevalent function. For validation, we selected the vacuolar proton pump subunit 1 (VPP1), from transport, and two EF-hand calcium-binding proteins, calmodulin and parvalbumin, from cell communication. All candidates showed significant changes in schizophrenia (n = 7) compared to controls (n = 7). VPP1 was altered in the non-schizophrenia suicide group and increased levels of parvalbumin were linked to antipsychotics. Further validation in an independent cohort of non-suicidal chronic schizophrenia subjects (n = 13) and non-psychiatric controls (n = 14) showed that parvalbumin was increased, while calmodulin was decreased in schizophrenia. Our findings provide evidence of calcium-binding protein dysregulation in the cerebellum in schizophrenia, suggesting an impact on normal calcium-dependent synaptic functioning of cerebellar circuits. Our study also links VPP1 to suicide behaviours, suggesting a possible impairment in vesicle neurotransmitter refilling and release in these phenotypes.

Suicidal Ideation in Adolescence: A Perspective View on the Role of the Ventromedial Prefrontal Cortex

Suicide in adolescence is a worldwide issue, and it continues to present a serious problem in terms of its prevention. Among the various aspects of suicide, a very interesting area of research is represented by suicidal ideation. Recently, neuroimaging-based methods have made it possible to study the cognitive processes involved in several social situations and clinical conditions. This theoretical perspective article with an interdisciplinary approach integrates evidence from developmental psychology and social neuroscience with the aim of investigating the role of the brain area responsible for regulating negative emotions during the cognitive processes of suicidal ideation: the ventromedial prefrontal cortex. By highlighting the role of brain areas in the few studies published so far, it is possible to develop perspectives of considerable impact. Studying and understanding the role of brain areas involved in suicidal thoughts in adolescents could facilitate the creation of new perspectives on prevention programs and interventions.

Suicidal Ideation Among Anxious Youth: A Preliminary Investigation of the Role of Neural Processing of Social Rejection in Interaction with Real World Negative Social Experiences

Suicidal ideation increases in adolescence, especially for anxious youth, and is a frequent precursor to suicide. This study examined whether neural processing of social rejection interacted with negative social experiences to predict suicidal ideation. Thus, to our knowledge this is the first study to examine how brain function may interact with the environment to contribute to suicidal ideation in youth, consistent with a developmental psychopathology perspective. Thirty-six anxious youth (ages 11 to 16) completed diagnostic interviews and questionnaires, an ecological momentary assessment (EMA) protocol, and a functional magnetic resonance imaging paradigm. Results showed that youth experienced greater severity of suicidal ideation when they exhibited heightened activation to social rejection in the right anterior insula and also experienced high levels of peer victimization or EMA-measured daily negative social experiences. Findings provide preliminary evidence that alterations in neural processing of social rejection interacts with exposure to negative social experiences to contribute to suicidal ideation.

Altered resting-state functional network connectivity is associated with suicide attempt in young depressed patients

The purpose of this study was to investigate the changes in resting-state brain functional network connectivity (FNC) in young depressed patients with and without suicidal behavior, and the relationship between FNC and suicidal attempts in depressed youths using resting-state fMRI (RS-fMRI). We conducted independent component analysis (ICA) to identify intrinsically connected neural networks and analyze the alterations of intra- and inter-network connectivity using FNC analysis in 35 depressed youth with suicidal attempts (SU group), 18 patients without suicidal attempts (NSU group) and 47 healthy controls (HC), and investigate brain-behavior associations between the FNC coefficients and clinical behavior in the SU group. SU group showed significantly decreased internetwork connectivity between anterior default mode network (aDMN) and salience network (SN), as well as the right frontal-parietal network (rFPN). However, the internetwork connectivity between the SN and rFPN in SU group was higher than that in NSU group. Moreover, decreased aDMN-rFPN connectivity was negatively correlated with BHS scores, and the differences in SN-rFPN and aDMN-pDMN connectivity were negatively associated with the HAMD score in the SU group. Our findings may provide new insights into the patterns of functional organization in the brain of suicidal depressed patients.

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

Neurobiological Markers of Resilience to Depression Following Childhood Maltreatment: The Role of Neural Circuits Supporting the Cognitive Control of Emotion

BACKGROUND

Childhood adversity is strongly linked to negative mental health outcomes, including depression and anxiety. Leveraging cognitive neuroscience to identify mechanisms that contribute to resilience in children with a history of maltreatment may provide viable intervention targets for the treatment or prevention of psychopathology. We present a conceptual model of a potential neurobiological mechanism of resilience to depression and anxiety following childhood adversity. Specifically, we argue that neural circuits underlying the cognitive control of emotion may promote resilience, wherein a child's ability to recruit the frontoparietal control network to modulate amygdala reactivity to negative emotional cues-such as during cognitive reappraisal-buffers risk for internalizing symptoms following exposure to adversity.

METHODS

We provide preliminary support for this model of resilience in a longitudinal sample of 151 participants 8 to 17 years of age with (n = 79) and without (n = 72) a history of childhood maltreatment who completed a cognitive reappraisal task while undergoing functional magnetic resonance imaging.

RESULTS

Among maltreated youths, those who were better able to recruit prefrontal control regions and modulate amygdala reactivity during reappraisal exhibited lower risk for depression over time. By contrast, no association was observed between neural functioning during reappraisal and depression among youths without a history of maltreatment.

CONCLUSIONS

These preliminary findings support the hypothesis that children who are better able to regulate emotion through recruitment of the frontoparietal network exhibit greater resilience to depression following childhood maltreatment. Interventions targeting cognitive reappraisal and other cognitive emotion regulation strategies may have potential for reducing vulnerability to depression among children exposed to adversity.

Atypical Dorsolateral Prefrontal Activity in Female Adolescents With Conduct Disorder During Effortful Emotion Regulation

Background

Conduct disorder (CD), which is characterized by severe aggressive and antisocial behavior, is linked to emotion processing and regulation deficits. However, the neural correlates of emotion regulation are yet to be investigated in adolescents with CD. Furthermore, it remains unclear whether CD is associated with deficits in emotional reactivity, emotion regulation, or both.

Methods

We used functional magnetic resonance imaging to study effortful emotion regulation by cognitive reappraisal in 59 female adolescents 15 to 18 years of age (30 with a CD diagnosis and 29 typically developing (TD) control adolescents).

Results

Behaviorally, in-scanner self-report ratings confirmed successful emotion regulation within each group individually but significant group differences in emotional reactivity and reappraisal success when comparing the groups (CD < TD). Functional magnetic resonance imaging results revealed significantly lower activation in left dorsolateral prefrontal cortex and angular gyrus in CD compared with TD adolescents during emotion regulation, but no group differences for emotional reactivity. Furthermore, connectivity between left dorsolateral prefrontal cortex and the bilateral putamen, right prefrontal cortex, and amygdala was reduced in CD compared with TD adolescents during reappraisal. Callous-unemotional traits were unrelated to neural activation, but these traits correlated negatively with behavioral reports of emotional reactivity.

Conclusions

Our results demonstrate reduced prefrontal brain activity and functional connectivity during effortful emotion regulation in female adolescents with CD. This sheds light on the neural basis of the behavioral deficits that have been reported previously. Future studies should investigate whether cognitive interventions are effective in enhancing emotion-regulation abilities and/or normalizing prefrontal and temporoparietal activity in female adolescents with CD.

Reduced dorsal striatal gray matter volume predicts implicit suicidal ideation in adolescents

Suicidal ideation (SI), a potent risk factor for suicide attempts, increases in adolescence. While alterations in dopaminergic functioning have been implicated in suicidal acts—particularly in adults—we do not know whether morphological alterations in dopamine-rich regions of the brain, such as the striatum, are vulnerability factors for the emergence of SI in adolescents. At baseline, a community sample of 152 adolescents (89 female; mean age: 11.41 ± 1.01 years) completed a magnetic resonance imaging (MRI) scan that was used to estimate gray matter volumes (GMVs) of three striatal structures: caudate, nucleus accumbens and putamen. At a 24 month follow-up session, participants completed a self-report measure of SI frequency [Suicidal Ideation Questionnaire (SIQ)] and the death version of the Implicit Association Test (IAT). Robust linear regression models were conducted to predict SIQ and IAT scores from striatal GMV. Bilateral putamen and left caudate GMV significantly predicted IAT scores (all Ps < 0.03). No other associations were significant (all Ps > 0.05). Our finding of reduced dorsal striatal GMV predicting implicit SI may indicate that downstream dopaminergic dysfunction is implicated in the development of overt suicidal behaviors. Self-reported SI was not associated with striatal GMV, suggesting that biological correlates of suicide risk may correlate specifically with objective measurements of SI in adolescents.

Adolescent Suicide as a Failure of Acute Stress-Response Systems

Suicide is the second leading cause of death worldwide for adolescents. Despite decades of research on correlates and risk factors for adolescent suicide, we know little about why suicidal ideation and behavior frequently emerge in adolescence and how to predict, and ultimately prevent, suicidal behavior among youths. In this review, we first discuss knowledge regarding correlates, risk factors, and theories of suicide. We then review why adolescence is a period of unique vulnerability, given changing biology and social network reorganization. Next, we present a conceptual model through which to interpret emerging findings in adolescent suicide research. We suggest that a promising area for future research is to examine adolescent suicide as a failure of biological responses to acute stress in the proximal moments of a suicidal crisis. After reviewing initial evidence for this conceptualization, we review future directions for studies on adolescent suicide.

Longitudinal decreases in suicidal ideation are associated with increases in salience network coherence in depressed adolescents

BACKGROUND

Suicidal ideation (SI) is an important predictor of suicide attempt, yet SI is difficult to predict. Given that SI begins in adolescence when brain networks are maturing, it is important to understand associations between network functioning and changes in severity of SI.

METHODS

Thirty-three depressed adolescents were administered the Columbia-Suicide Severity Rating Scale to assess SI and completed resting-state fMRI at baseline (T1) and 6 months later (T2). We computed coherence in the executive control (ECN), default mode (DMN), salience (SN), and non-relevant noise networks and then examined the association between changes in brain network coherence and changes in SI severity from T1 to T2.

RESULTS

A greater reduction in severity of SI was associated with a stronger increase in SN coherence from T1 to T2. There were no associations between the other networks and SI.

LIMITATIONS

We cannot generalize our findings to more psychiatrically diverse samples. More time-points are necessary to understand the trajectory of SI and SN coherence change.

CONCLUSIONS

Our finding that reductions in SI are associated with increases in SN coherence extends previous cross-sectional results documenting a negative association between SI severity and SN coherence. The SN is involved in coordinating activation of ECN and DMN in response to salient information. Given this regulatory role of the SN, the association between SN coherence and SI suggests that adolescents with reduced SN coherence might more easily engage in harmful thoughts. Thus, the SN may be particularly relevant as a target for treatment applications in depressed adolescents.

Amygdala Functional Connectivity During Self-Face Processing in Depressed Adolescents With Recent Suicide Attempt

OBJECTIVE

Suicide is the second leading cause of death among adolescents; however, objective biomarkers of suicide risk are lacking. Aberrant self-face amygdala activity is associated with suicide ideation, and its connectivity with neural regions that enable self-processing (eg medial prefrontal cortex) may be a suicide risk factor.

METHOD

Adolescents (aged 11-17 years; N = 120) were sorted into four groups: healthy controls (HC), depressed individuals with low suicide ideation (LS), depressed individuals with high suicide ideation (HS), and depressed suicide attempters (SA). Youth completed an emotional (Happy, Sad, Neutral) self-face recognition task in the scanner. Bilateral amygdala task-dependent functional connectivity was determined with psychophysiological interaction analysis. Connectivity was compared across groups and within Self versus Other faces across emotions and hemispheres. Voxelwise results were thresholded (p < .005, uncorrected) and corrected for multiple comparisons (p < .05, familywise error).

RESULTS

Both HS and SA displayed greater amygdala connectivity with the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and precuneus, compared to LS, who, in turn, showed greater connectivity than HC. Greater left amygdala-rostral anterior cingulate cortex (rACC) connectivity was observed in SA compared to all other groups, whereas right amygdala-rACC connectivity was greater in HS versus LS and HC.

CONCLUSION

Greater connectivity between amygdala and other regions implicated in self-face processing differentiated suicide ideation and suicide attempt groups. A dose-dependent response showed that greater rACC-left amygdala connectivity during self-face processing was associated with a recent suicide attempt, but that a greater rACC-right amygdala connectivity was associated with suicide ideation.

Biological responses to acute stress and suicide: A review and opportunities for methodological innovation

Purpose of Review

While rates of other medical illnesses have declined over the past several decades, rates of suicide have increased, particularly among adolescents. Prior research on biological underpinnings of suicide risk has remained limited. In this review, we describe a recent model conceptualizing suicide as a failure of biological responses to acute stress. According to this model, youth who fail to mount an adaptive stress response following exposure to a stressor are at acute risk for suicide.

Recent Findings

Although much more research is needed, early evidence suggests that abnormal biological responses to acute stress, such as altered autonomic nervous system activity and altered hypothalamic-pituitary-adrenal axis function, may underlie risk for suicide, particularly during the transition to adolescence.

Summary

Overall, initial evidence supports a link between biological responses to acute stress and suicide risk. However, future work that incorporates makers of other biological and environmental systems will sharpen our understanding of who is at suicide risk and when this risk is highest.

Emotion Reactivity and Regulation in Adolescent Girls Following an Interpersonal Rejection

Failures in emotion regulation, especially as a result of interpersonal stress, are implicated as transdiagnostic risk factors for psychopathology. This study examines the effects of an experimentally timed targeted interpersonal rejection on emotion reactivity and regulation in typically developing adolescent girls. Girls ( n = 33, ages 9-16 years, M = 12.47, SD = 2.20) underwent fMRI involving a widely used emotion regulation task. The emotion task involves looking at negative stimuli and using cognitive reappraisal strategies to decrease reactions to negative stimuli. Participants also engaged in a social evaluation task, which leads participants to believe a preselected peer was watching and evaluating the participant. We subsequently told participants they were rejected by this peer and examined emotion reactivity and regulation before and after this rejection. Adolescent girls evidence greater reactivity via higher self-reported emotional intensity and greater amygdala activation to negative stimuli immediately after (compared with before) the rejection. Self-reported emotional intensity differences before and after rejection were not observed during regulation trials. However, on regulation trials, girls exhibited increased prefrontal activation in areas supporting emotion regulation after compared with before the rejection. This study provides evidence that a targeted rejection increases self-report and neural markers of emotion reactivity and that girls increase prefrontal activation to regulate emotions after a targeted rejection.