Summary: Neuroimaging research finds subtle reductions in the surface area of a prefrontal brain region in young people with mood disorders who have attempted suicide.
Source: USC
Suicide is the second leading cause of death in the United States for young people aged approximately 10 to 33. Despite national and international prevention efforts, suicide attempts among children and adolescents continue to rise, highlighting an urgent need for better understanding and new approaches to prevention.
To advance knowledge about the biological and clinical factors that underlie suicidal thoughts and behaviors, large-scale collaboration across institutions and disciplines is essential. Pooling data from many studies increases statistical power and helps researchers identify subtle neurobiological signatures that smaller samples cannot reliably detect.
A global team of researchers led in part by Neda Jahanshad, PhD, at the Keck School of Medicine of USC’s Mark and Mary Stevens Neuroimaging and Informatics Institute (Stevens INI), has reported subtle structural differences in the prefrontal cortex of young people with mood disorders who have engaged in suicidal behavior. The findings appear in the journal Molecular Psychiatry.
Working through the ENIGMA Suicidal Thoughts and Behaviors (ENIGMA-STB) working group — a National Institute of Mental Health–funded initiative within the larger ENIGMA Consortium — investigators combined neuroimaging data from 21 international studies to look for brain morphology differences linked to suicidal thoughts and actions in youth.
“Suicidal behaviors occur across many mental illnesses. Rather than studying a single disorder in small, isolated samples, we brought together researchers who had data on suicidal thoughts and behaviors in young people and coordinated a large-scale collaborative effort focused on youth,” said Jahanshad.
The research team conducted analyses in three stages, moving from the most homogeneous sample to increasingly diverse and transdiagnostic samples, as detailed by first author Laura van Velzen, PhD, a postdoctoral research fellow at the Centre for Youth Mental Health, University of Melbourne.
First, the investigators analyzed a homogeneous group of 577 young people with mood disorders whose suicidal thoughts and behaviors were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). In this sample, young people with a history of an actual suicide attempt (N = 163) showed a modest but statistically significant reduction in the surface area of the frontal pole — a region of the prefrontal cortex — compared with those who had not attempted suicide (N = 323). The effect survived correction for multiple comparisons (FDR-p = 0.035) and had a small-to-moderate effect size (Cohen’s d = 0.34).
Second and third, the researchers examined larger and more heterogeneous samples that included participants assessed with a variety of clinical instruments and with a wider range of psychiatric diagnoses. These analyses contrasted healthy controls, clinical controls with mood disorders but no suicidal behaviors, individuals with current suicidal ideation, and those with a history of attempted suicide. In these more diverse samples the team did not find consistent, significant associations between brain structure and suicidal ideation or attempts.
These results suggest that lower frontal pole surface area may be related to vulnerability for making a suicide attempt in young people with mood disorders, while also underscoring that structural differences are subtle and not present in every sample. “The structural brain differences we found were very subtle,” van Velzen noted. “Most people with a history of suicidal behaviors do not have dramatically different brains compared with people without that history, which is an important reassurance. At the same time, these small differences can help us better understand mechanisms involved in suicidal behavior and may point to targets for future prevention strategies.”
The study highlights both the promise and the challenges of large-scale, multi-site neuroimaging research: combining data from 21 studies made it possible to detect a modest effect in a well-characterized sample but also showed the difficulty of finding consistent markers across heterogeneous assessments and diagnoses. The authors emphasize the need for further harmonized studies that include more participants across a broader age range and examine additional brain features, including connectivity and function.
Beyond the neuroimaging findings, the study illustrates the value of connecting research with community-based efforts. Jahanshad serves as faculty sponsor for Trojan Support, a peer support organization at USC founded by Armand Amini, who conducted research on brain mapping and suicide risk while at Stevens INI. Trojan Support offers students a chance to connect with trained peers for support and conversation when professional help may feel out of reach.
Arthur W. Toga, PhD, director of the Stevens INI, commented on the collaborative model: “The goal of the ENIGMA Consortium is to bring researchers together from around the world so we can combine existing data samples and improve our ability to study the brain in these potentially devastating mental illnesses. Our faculty and former students are committed to translating research into practical benefits for the community.”
Note: If you or someone you know is experiencing suicidal thoughts or is in crisis, please reach out immediately to the Suicide and Crisis Lifeline by dialing 988.
About this mental health and neuroscience research news
Author: Laura LeBlanc
Source: USC
Contact: Laura LeBlanc – USC
Image: The image is credited to USC Stevens INI
Original Research: Open access. “Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium” by Laura van Velzen et al. Molecular Psychiatry
Abstract
Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium
Identifying brain alterations linked to suicidal thoughts and behaviors (STBs) in young people is essential to understanding how risk develops and to improving early intervention and prevention. The ENIGMA-STB consortium analyzed harmonized neuroimaging data from multiple sites to examine brain morphology associated with STBs in youth.
Analyses proceeded in three stages across samples that varied from most to least homogeneous in terms of suicide assessment instrument and psychiatric diagnosis. In the homogeneous C-SSRS sample of young people with mood disorders, lower frontal pole surface area was observed in those with a history of an actual suicide attempt compared with those without such a history (FDR-p = 0.035, Cohen’s d = 0.34). No reliable associations with suicidal ideation were detected. In more heterogeneous and transdiagnostic samples, significant associations were not consistently observed.
These findings indicate that reduced frontal pole surface area could reflect vulnerability for a non-interrupted or non-aborted suicide attempt in some youths with mood disorders, but further research is required to clarify the nature of this relationship and its potential clinical implications.