Unveiling convergent and divergent intrinsic brain network alternations in depressed adolescents engaged in non‐suicidal self‐injurious behaviors with and without suicide attempts

Aims Limited understanding exists regarding the neurobiological mechanisms underlying non‐suicidal self‐injury (NSSI) and suicide attempts (SA) in depressed adolescents. The maturation of brain network is crucial during adolescence, yet the abnormal alternations in depressed adolescents with NSSI or NSSI+SA remain poorly understood. Methods Resting‐state functional magnetic resonance imaging data were collected from 114 depressed adolescents, classified into three groups: clinical control (non‐self‐harm), NSSI only, and NSSI+SA based on self‐harm history. The alternations of resting‐state functional connectivity (RSFC) were identified through support vector machine‐based classification. Results Convergent alterations in NSSI and NSSI+SA predominantly centered on the inter‐network RSFC between the Limbic network and the three core neurocognitive networks (SalVAttn, Control, and Default networks). Divergent alterations in the NSSI+SA group primarily focused on the Visual, Limbic, and Subcortical networks. Additionally, the severity of depressive symptoms only showed a significant correlation with altered RSFCs between Limbic and DorsAttn or Visual networks, strengthening the fact that increased depression severity alone does not fully explain observed FC alternations in the NSSI+SA group. Conclusion Convergent alterations suggest a shared neurobiological mechanism along the self‐destructiveness continuum. Divergent alterations may indicate biomarkers differentiating risk for SA, informing neurobiologically guided interventions.