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This research investigates the link between alexithymia, self-harm behaviors, and resting-state connectivity in adolescents with depression.

April 12, 2026Annals of General Psychiatry0 citationsOpen Access

Alexithymia and self-harm in depressed adolescents: the mediating role of resting-state functional connectivity of the ventral hippocampal-fusiform gyrus

YMYing MaGuangdong Province Women and Children Hospital YZYongjie ZhouShenzhen Maternity and Child Healthcare Hospital HFHuihang FuGuangdong Pharmaceutical University

Key Points

This research investigates the link between alexithymia, self-harm behaviors, and resting-state connectivity in adolescents with depression.
Recruited 129 adolescents from Shenzhen Mental Health Center with depressive symptoms.
Measured self-harm behaviors, alexithymia, and emotional regulation using validated scales.
Used functional MRI to assess resting-state functional connectivity within emotion regulation neural circuits.
Found positive association between externally oriented thinking and suicide attempts.
Adolescents with suicide attempts showed stronger connectivity in emotion regulation brain regions.
Mediation analysis indicated that vHC-FG connectivity fully mediates the link between externally oriented thinking and suicide attempts.

Abstract

Alexithymia is implicated in self-harm behaviors, including nonsuicidal self-injury (NSSI), suicide attempt (SA). However,, the neurobiological mechanisms underlying this association remain poorly understood, especially among clinically referred adolescents with depressive symptoms. A total of 129 adolescents with depressive symptoms were recruited from Shenzhen Mental Health Center. NSSI, SA, alexithymia and its dimensions were measured using validated scales. Resting-state functional connectivity (rs-FC) was measured using functional magnetic resonance imaging (fMRI) within a predefined set of emotion regulation (ER)-related regions of interest (ROIs). Of the analytic sample, 37 adolescents met the criteria for NSSI and 59 met the criteria for SA. The externally oriented thinking (EOT) subscale scores were positively associated with SA (adjusted OR = 1.21, 95% CI, 1.03–1.43). Adolescents with SA exhibited heightened connectivity within ER regions compared to controls, including between the left orbitofrontal cortex and right medial orbital superior frontal gyrus (z score = 0.19, P < 0.001), left medial orbitofrontal cortex and left inferior occipital gyrus (z score = 0.16; P < 0.001), left dorsolateral prefrontal cortex and right medial orbital of the superior frontal gyrus (z score = 0.17; P < 0.001), right parahippocampal gyrus and right fusiform gyrus (z score = 0.17; P < 0.001), and between the right ventral hippocampus (vHC) and the right fusiform gyrus (FG) (z = 0.17; P < 0.001). Mediation analysis showed that the association between EOT and SA was fully mediated by right vHC-right FG connectivity (indirect effect β = 0.096, 95% CI, 0.027–0.190). No significant associations between alexithymia or rs-FC within ER regions and NSSI were found. In clinically referred adolescents with depressive symptoms, EOT-related alexithymia is associated with SA, and this association appears to be fully mediated by enhanced vHC-FG connectivity. The vHC-FG circuit, which plays a key role in ER, may represent a novel neurobiological target for interventions aimed at preventing self-harm behaviors in this vulnerable population.

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