The Interaction Effects of Suicidal Ideation and Childhood Abuse on Brain Structure and Function in Major Depressive Disorder Patients

Exploring neural changes associated with suicidal ideation and attempts in major depressive disorder: A multimodal study

Suicidal ideation (SI) and suicide attempts (SA) are highly prevalent in individuals with major depressive disorder (MDD). To explore the structural and functional neural changes associated with SI and SA, we analyzed multimodal Magnetic Resonance Imaging (MRI) data from 159 participants, including those with MDD with suicide attempts (SA group, n = 34), those with MDD with suicidal ideation but not attempts (SI group, n = 53), those with MDD without suicidal ideation (NSI group, n = 14), and healthy controls (HC, n = 59). Voxel-based morphometry (VBM) analysis was performed to estimate and compare gray matter volume (GMV) across groups. Subsequently, a seed-based resting-state functional connectivity (rsFC) analysis was conducted to explore the functional networks associated with the structural brain changes related to suicidal ideation and suicide attempts. Compared with the HC and NSI groups, the SI group showed decreased GMV in the left dorsolateral prefrontal cortex (DLPFC), insula, fusiform gyrus, right posterior cerebellum, and right middle temporal gyrus. Additionally, when compared to the HC and SI groups, the SA group demonstrated smaller GMV in the right superior medial frontal gyrus (SFGmed), left superior and inferior occipital gyri, and superior temporal gyrus (STG), and right cuneus, but larger GMV in the right STG. Moreover, GMV in the insula, cerebellum posterior lobe, and SFGmed was negatively correlated with the scores of the Beck Scale for Suicide Ideation (BSSI). The rsFC analysis revealed weaker rsFC between the left insula and the left SFG as well as between the bilateral middle frontal orbital gyrus and the right SFGmed and the left middle occipital gyrus, but stronger rsFC of the right cerebellum posterior lobe with the left precentral gyrus and right parahippocampal gyrus among the SI group compared to the NSI group and HCs. Additionally, the SA group demonstrated weaker rsFC between the right cerebellum posterior lobe and the left cerebellum posterior lobe as well as the right lingual gyrus, but stronger rsFC between the right SFGmed and the left middle temporal gyrus and right inferior parietal lobule compared to the SI group. Our results indicate that structural and functional changes related to insula, DLPFC and cerebellum posterior lobe are associated with the generation and escalation of SI in MDD, while the structural and functional changes related to SFGmed and STG play a crucial role in the transformation from SI to SA in MDD.

Joint and distinct neural structure and function deficits in major depressive disorder with suicidality: a multimodal meta-analysis of MRI studies

BACKGROUND

Suicide risk is a major concern for patients with major depressive disorder (MDD). Neuroimaging studies have demonstrated that patients with MDD with suicidal ideation or suicide attempt (MDD-S) are accompanied by neurostructural or functional abnormalities, but there is no consensus of opinion on neural substrate alterations involved in MDD-S.

METHODS

We performed a whole-brain multimodal meta-analysis of existing magnetic resonance imaging (MRI) studies to identify conjoint and separate alterations of grey matter volume (GMV) and spontaneous brain activity characteristics (regional homogeneity and amplitude of low-frequency fluctuations) between patients with MDD-S and patients with MDD without suicidal ideation or suicidal attempt (MDD-NS) via the seed-based d mapping software. We excluded studies that used other modalities, had overlapping data, or had insufficient information.

RESULTS

Our systematic search identified 13 structural MRI studies (471 patients with MDD-S and 508 patients with MDD-NS) and 16 resting-state functional MRI studies (704 patients with MDD-S and 554 patients with MDD-NS) published up to Dec. 5, 2023. Compared with patients with MDD-NS, those with MDD-S showed increased GMV with hypoactivity in the left postcentral gyrus, decreased GMV with hypoactivity in the right inferior parietal gyri, decreased GMV with hyperactivity in the right insula, and separate GMV and functional changes within the bilateral parietal, occipital, and frontal lobes, and the left thalamus.

LIMITATIONS

We were unable to analyze the association between brain features and clinical detail because of a lack of data. Included studies showed considerable heterogeneity and publication bias.

CONCLUSION

These findings provide a comprehensive overview of brain morphological and spontaneous functional impairments linked to impulsivity, impaired positive reward modulation, emotional disturbances, abnormal emotional processing, and cognitive deficits in MDD-S. These results support an understanding of the relationship between neural substrates and clinical symptoms in MDD-S, and these alterations provide useful insight into pathophysiological mechanisms and intervention strategies to decrease suicide risk in MDD.

Structural brain changes in the anterior cingulate cortex of major depressive disorder individuals with suicidal ideation: Evidence from the REST-meta-MDD project

BACKGROUND

Suicidal ideation (SI) is very common in patients with major depressive disorder (MDD). However, its neural mechanisms remain unclear. The anterior cingulate cortex (ACC) region may be associated with SI in MDD patients. This study aimed to elucidate the neural mechanisms of SI in MDD patients by analyzing changes in gray matter volume (GMV) in brain structures in the ACC region, which has not been adequately studied to date.

METHODS

According to the REST-meta-MDD project, this study subjects consisted of 235 healthy controls and 246 MDD patients, including 123 MDD patients with and 123 without SI, and their structural magnetic resonance imaging data were analyzed. The 17-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms. Correlation analysis and logistic regression analysis were used to determine whether there was a correlation between GMV of ACC and SI in MDD patients.

RESULTS

MDD patients with SI had higher HAMD scores and greater GMV in bilateral ACC compared to MDD patients without SI (all p < 0.001). GMV of bilateral ACC was positively correlated with SI in MDD patients and entered the regression equation in the subsequent logistic regression analysis.

CONCLUSIONS

Our findings suggest that GMV of ACC may be associated with SI in patients with MDD and is a sensitive biomarker of SI.

Neuroimaging studies in major depressive disorder with suicidal ideation or behaviour among Chinese patients: implications for neural mechanisms and imaging signatures

Major depressive disorder (MDD) with suicidal ideation or behaviour (MDSI) is associated with an increased risk of future suicide. The timely identification of suicide risk in patients with MDD and the subsequent implementation of interventions are crucially important to reduce their suffering and save lives. However, the early diagnosis of MDSI remains challenging across the world, as no objective diagnostic method is currently available. In China, the challenge is greater due to the social stigma associated with mental health problems, leading many patients to avoid reporting their suicidal ideation. Additionally, the neural mechanisms underlying MDSI are still unclear, which may hamper the development of effective interventions. We thus conducted this narrative review to summarise the existing neuroimaging studies of MDSI in Chinese patients, including those involving structural magnetic resonance imaging (MRI), functional MRI, neuronal electrophysiological source imaging of the brain dynamics with electroencephalography and magnetoencephalography. By synthesising the current research efforts in neuroimaging studies of Chinese patients with MDSI, we identified potential objective neuroimaging biomarkers, which may aid in the early identification of patients with MDSI who are at high suicide-related risk. Our findings also offer insights into the complex neural mechanisms underlying MDSI and suggest promising therapeutic targets. Furthermore, we propose future directions to discover novel imaging signatures, improve patient care, as well as help psychiatrists and clinical investigators plan their future research.

Interaction Effect of Childhood Abuse History and Suicidality on 12-Month Antidepressant Response in Patients With Depressive Disorder

OBJECTIVE

We aimed to identify the individual and interactive effects of childhood abuse and suicidal ideation on antidepressant treatment response in 12 months.

METHODS

In this prospective research, 1,262 depressive patients were asked about their childhood abuse history, suicidal ideation, and other clinical characteristics and socio-demographic features at baseline, and 1,015 of them were followed during 1 year of stepwise pharmacotherapy. The individual and interactive relationships of the childhood abuse history and suicidal ideation on 12-month antidepressant non-remission were explored by logistic regression with relevant covariates.

RESULTS

Having a childhood abuse history and higher suicidal ideation significantly predicted a non-remission state in 12 months respectively. The interaction term of childhood abuse and suicidal ideation was also significantly related to a non-remission state at 12 months. To be specific, in the low suicidal ideation group, depressive patients with a childhood abuse history were more likely to be in a non-remission state after 12 months of medication. In the high suicidal ideation group, however, childhood abuse history was not significantly associated with the non-remission state at 12 months.

CONCLUSION

The childhood abuse history and the level of suicidal ideation are informative factors predicting the long-term results of antidepressant treatment, especially when they are combined. Clinicians may consider antidepressants with a higher affinity for patients with childhood abuse history even if they don't have suicidal ideation. The cognitive intervention for suicidal ideation might be helpful in addition to pharmacological treatment.

Repetitive Transcranial Magnetic Stimulation Reversing Abnormal Brain Function in Mood Disorders with Early Life Stress: from preclinical models to clinical applications

BACKGROUND

Early life stress (ELS) significantly increases the risk of mood disorders and affects the neurodevelopment of the primary cortex.

HYPOTHESIS

Modulating the primary cortex through neural intervention can ameliorate the impact of ELS on brain development and consequently alleviate its effects on mood disorders.

METHOD

We induced the chronic unpredictable mild stress (CUMS) model in adolescent rats, followed by applying repetitive transcranial magnetic stimulation (rTMS) to their primary cortex in early adulthood. To assess the applicability of primary cortex rTMS in humans, we recruited individuals aged 17-25 with mood disorders who had experienced ELS and performed primary cortex rTMS on them. Functional magnetic resonance imaging (fMRI) and depression-related behavioral and clinical symptoms were conducted in both rats and human subjects before and after the rTMS.

RESULTS

In animals, fMRI analysis revealed increased activation in the primary cortex of CUMS rats and decrease subcortical activation. Following the intervention of primary cortex rTMS, the abnormal functional activity was reversed. Similarly, in mood disorders patients with ELS, increased activation in the primary cortex and decreased activation in the frontal cortex were observed. During rTMS intervention, similar neuroimaging improvements were noted, particularly decreased activation in the primary cortex. This suggests that targeted rTMS in the primary cortex can reverse the abnormal neuroimaging.

CONCLUSION

This cross-species translational study has identified the primary cortex as a key region in mood disorders patients with ELS. Targeting the primary cortex with rTMS can correct abnormal functional activity while improving symptoms. Our study provides translational evidence for therapeutics targeting the ELS factor of mood disorders patients.

Altered regional brain activity moderating the relationship between childhood trauma and depression severity

OBJECTIVE

Childhood trauma (CT) is a major environmental risk factor for an adverse course and treatment outcome of major depressive disorder (MDD). Evidence suggests that an altered regional brain activity may play a crucial role in the relationship between CT and MDD. This study aimed to clarify the relationship between CT, regional brain activity, and depression severity.

METHODS

In this study, 96 patients with MDD and 82 healthy controls (HCs) participated. Regional brain activity was measured using the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo). These measures were compared between the MDD and HC groups, and the values of different brain regions were extracted as moderators.

RESULTS

Increased fALFF and ReHo values were observed in the left middle temporal gyrus in the MDD group compared with the HC group (p < 0.001). Furthermore, the fALFF and ReHo values moderated the positive correlation between the Childhood Trauma Questionnaire (CTQ) score, 17-item Hamilton Depression Rating Scale (HAMD-17) total score, and retardation factor score in the MDD group (all, p < 0.05). Finally, as the fALFF and ReHo values increased, the positive correlations between CTQ, HAMD-17 total, and retardation dimension scores became stronger.

CONCLUSION

Our study highlighted the crucial role of altered brain function in connecting childhood maltreatment with depressive symptoms. Our findings indicate that an altered regional brain activity could explain the potential neurobiological mechanisms of MDD symptoms, offering the opportunity to function as a powerful diagnostic biomarker.

The effects of childhood maltreatment on cortical thickness and gray matter volume: a coordinate-based meta-analysis

Childhood maltreatment has been suggested to have an adverse impact on neurodevelopment, including microstructural brain abnormalities. Existing neuroimaging findings remain inconsistent and heterogeneous. We aim to explore the most prominent and robust cortical thickness (CTh) and gray matter volume (GMV) alterations associated with childhood maltreatment. A systematic search on relevant studies was conducted through September 2022. The whole-brain coordinate-based meta-analysis (CBMA) on CTh and GMV studies were conducted using the seed-based d mapping (SDM) software. Meta-regression analysis was subsequently applied to investigate potential associations between clinical variables and structural changes. A total of 45 studies were eligible for inclusion, including 11 datasets on CTh and 39 datasets on GMV, consisting of 2550 participants exposed to childhood maltreatment and 3739 unexposed comparison subjects. Individuals with childhood maltreatment exhibited overlapped deficits in the median cingulate/paracingulate gyri simultaneously revealed by both CTh and GM studies. Regional cortical thinning in the right anterior cingulate/paracingulate gyri and the left middle frontal gyrus, as well as GMV reductions in the left supplementary motor area (SMA) was also identified. No greater regions were found for either CTh or GMV. In addition, several neural morphology changes were associated with the average age of the maltreated individuals. The median cingulate/paracingulate gyri morphology might serve as the most robust neuroimaging feature of childhood maltreatment. The effects of early-life trauma on the human brain predominantly involved in cognitive functions, socio-affective functioning and stress regulation. This current meta-analysis enhanced the understanding of neuropathological changes induced by childhood maltreatment.

Abnormal degree centrality in first-episode medication-free adolescent depression at rest: A functional magnetic resonance imaging study and support vector machine analysis

BACKGROUND

Depression in adolescents is more heterogeneous and less often diagnosed than depression in adults. At present, reliable approaches to differentiating between adolescents who are and are not affected by depression are lacking. This study was designed to assess voxel-level whole-brain functional connectivity changes associated with adolescent depression in an effort to define an imaging-based biomarker associated with this condition.

MATERIALS AND METHODS

In total, 71 adolescents affected by major depressive disorder (MDD) and 71 age-, sex-, and education level-matched healthy controls were subjected to resting-state functional magnetic resonance imaging (rs-fMRI) based analyses of brain voxel-wise degree centrality (DC), with a support vector machine (SVM) being used for pattern classification analyses.

RESULTS

DC patterns derived from 16-min rs-fMRI analyses were able to effectively differentiate between adolescent MDD patients and healthy controls with 95.1% accuracy (136/143), and with respective sensitivity and specificity values of 92.1% (70/76) and 98.5% (66/67) based upon DC abnormalities detected in the right cerebellum. Specifically, increased DC was evident in the bilateral insula and left lingual area of MDD patients, together with reductions in the DC values in the right cerebellum and bilateral superior parietal lobe. DC values were not significantly correlated with disease severity or duration in these patients following correction for multiple comparisons.

CONCLUSION

These results suggest that whole-brain network centrality abnormalities may be present in many brain regions in adolescent depression patients. Accordingly, these DC maps may hold value as candidate neuroimaging biomarkers capable of differentiating between adolescents who are and are not affected by MDD, although further validation of these results will be critical.

Genetic influence on brain volume alterations related to self-reported childhood abuse

As an important predictor of adulthood psychopathology, self-reported childhood abuse appears heritable and is associated with brain abnormalities. However, the specific genetic mechanisms behind these brain alterations remain largely unknown. This study recruited young adults who reported different degrees of childhood abuse from the community. In order to fully understand the influence of genes on brain changes related to self-reported childhood abuse, various experiments were conducted in this study. Firstly, volume changes of gray matter and white matter related to childhood abuse were investigated by using advanced magnetic resonance imaging techniques. After sequencing the whole exons, we further investigated the relationship between polygenic risk score, brain volume alterations, and childhood abuse score. Furthermore, transcription-neuroimaging association analysis was used to identify risk genes whose expressions were associated with brain volume alterations. The gray matter volumes of left caudate and superior parietal lobule, and white matter volumes of left cerebellum and right temporal lobe-basal ganglia region were significantly correlated with the childhood abuse score. More importantly, brain volume changes mediated the influence of polygenic risk on self-reported childhood abuse. Additionally, transcription-neuroimaging association analysis reported 63 risk genes whose expression levels were significantly associated with childhood abuse-related brain volume changes. These genes are involved in multiple biological processes, such as nerve development, synaptic transmission, and cell construction. Combining data from multiple perspectives, our work provides evidence of brain abnormalities associated with childhood abuse, and further indicates that polygene genetic risk and risk gene expression may affect the occurrence of childhood abuse by brain regulation, which provides insights into the molecularpathology and neuromechanism of childhood adversity. Paying attention to the physical and mental health of high-risk children may be a fundamental way to prevent childhood abuse and promote lifelong mental health.

Resting-state functional connectivity of the amygdala in major depressive disorder with suicidal ideation

Suicide is a common issue among major depressive disorder (MDD) patients and suicidal ideation (SI) is the first step toward it. There are no definitive objective biomarkers of SI relative to MDD. In this study, a seed-based correlation analysis was performed among 36 MDD patients with SI, 66 MDD patients without SI (NSI), and 57 healthy controls (HCs) using amygdala resting-state functional connectivity (RSFC). Furthermore, the correlation between amygdala RSFC and clinical features was examined in the SI group. When compared to the NSI group, SI group exhibited increased RSFC between the left amygdala seed and left medial superior frontal gyrus (SFGmed) as well as left middle frontal gyrus (MFG). In turn, a decreased RSFC was observed between the left amygdala seed and the following brain regions including the left inferior parietal lobule (IPL), right precentral gyrus (PrCG), and left superior parietal lobule (SPL) in SI group compared to NSI group. Moreover, the SI group exhibited increased RSFC of the right amygdala with left middle temporal gyrus (MTG); In addition, the RSFC of the left amygdala with left MFG was negatively associated with learning and memory (VSM), speed of processing (SOP). The RSFC of the amygdala is distinct between MDD patients with SI and without SI. Our findings reveal the neurobiological characteristics of MDD with respect to SI and provide new clues regarding vulnerability to mental illness. It is necessary to carry out repeated and more longitudinal researches using multimodal approaches on SI in the future.

Aberrant brain connectivity is associated with childhood maltreatment in individuals with major depressive disorder

Although childhood maltreatment confers a high risk for the development of major depressive disorder, the neurobiological mechanisms underlying this connection remain unknown. The present study sought to identify the specific resting-state networks associated with childhood maltreatment. We recruited major depressive disorder patients with and without a history of childhood maltreatment (n = 31 and n = 30, respectively) and healthy subjects (n = 80). We used independent component analysis to compute inter- and intra- network connectivity. We found that individuals with major depressive disorder and childhood maltreatment could be characterized by the following network disconnectivity model relative to healthy subjects: (i) decreased intra-network connectivity in the left frontoparietal network and increased intra-network connectivity in the right frontoparietal network, (ii) decreased inter-network connectivity in the posterior default mode network-auditory network, posterior default mode network-limbic system, posterior default mode network-anterior default mode network, auditory network-medial visual network, lateral visual network - medial visual network, medial visual network-sensorimotor network, medial visual network - anterior default mode network, occipital pole visual network-dorsal attention network, and posterior default mode network-anterior default mode network, and (iii) increased inter-network connectivity in the sensorimotor network-ventral attention network, and dorsal attention network-ventral attention network. Moreover, we found significant correlations between the severity of childhood maltreatment and the intra-network connectivity of the frontoparietal network. Our study demonstrated that childhood maltreatment is integrally associated with aberrant network architecture in patients with major depressive disorder.

Use of Self-Figure Drawing as an Assessment Tool for Child Abuse: Differentiating between Sexual, Physical, and Emotional Abuse

Child abuse is a worldwide phenomenon with adverse short- and long-term mental and physical negative consequences, with a huge gap between the prevalence of child abuse and disclosure rates. The study aimed to examine and validate the self-figure drawing as an assessment tool to differentiate between three forms of child abuse, i.e., child sexual abuse (CSA), child physical abuse (CPA), and child emotional abuse (CEA). Following the ethical approval, 1707 Thai children (13–18 years old) from the general population (schools) were asked to complete a self-report anonymous questionnaire consisting of four measures (Demographics, Childhood Trauma Questionnaire (CTQ), The Medical Somatic Dissociation Questionnaire (MSDQ), and The Disclosure of Trauma Questionnaire (DTQ)). After completion, they were asked to draw themselves. There was a significantly positive link between the reluctance to disclose and the experience of abuse, indicating that the more severe the abuse the higher the reluctance to disclose. The findings broaden the knowledge of movement and symbols as representations of inner personal conflictual material. Additionally, it substantiates self-figure drawing as an assessment tool and assists practitioners in early child abuse detection.

Cannabidiol microinjection into the nucleus accumbens attenuated nociceptive behaviors in an animal model of tonic pain

Cannabidiol, the major non-psychoactive constituent of Cannabis, has attracted much attention as a therapeutic agent for intractable chronic pain in many conditions. Nucleus accumbens (NAc) as a major site of action of cannabinoids is one of the main mediators of several analgesic agents especially in the persistent pain condition. The present study aimed to investigate the effect of cannabidiol microinjection into the NAc on the modulation of nociception induced by formalin injection into the rat's paw. Adult male Wistar rats weighing 220-250 g were underwent stereotaxic surgery for unilateral (right or left side) cannula placement into the NAc. After one week recovery period, intra-NAc administration of the cannabidiol or its vehicle, DMSO was performed in a volume of 0.5 µl, five minutes before the formalin test. The formalin test was performed using 50 µl injection of formalin (2.5%) into the plantar surface of the rat's hind paw. Intra-accumbal administration of cannabidiol attenuated the nociceptive responses during the early and late phases of the formalin test in a dose-dependent manner. However, the antinociceptive effect of cannabidiol was significantly higher in the late phase of the formalin test than that in the early phase. Therefore, a non-psychoactive cannabinoid, cannabidiol may be developed as therapeutic agents in conditions, such as persistent inflammatory pain for which primary treatments are insufficient or not possible.