Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Major Depressive Disorder with prior suicide attempts (n=121). Intervention: Dynamic amplitude of low-frequency fluctuations (dALFF) variability vs. MDD without suicide attempts (MDD-NSA) and Healthy Controls (HC). Primary outcome: Discrimination of MDD-SA from MDD-NSA using combined dALFF variability (left IFG, right insula, SMA/SFG) (AUC 0.969, 95% CI 0.902-1).

Xiaofang Cheng; Jiangshan Chen; Xiaofei Zhang; Ting Wang; Jiaqi Sun; Yanling Zhou; Ruilan Yang; Yeyu Xiao; Amei Chen; Ziyi Song; Pinrui Chen; Chanjuan Yang; QiuxiaWu; Taifeng Lin; Yingmei Chen; Liping Cao; Xinhua Wei

doi:10.1007/s00787-023-02242-4

June 7, 2023European Child & Adolescent PsychiatryOpen Access

Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts

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Key result

Combined brain dALFF variability discriminates depressed adolescents with suicide attempts from those without yielding ~0.97 AUC.

AUC 0.969
95% CI 0.902-1
n=121

Figures

Why the study?

The neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown.

Does dALFF variability measured by resting-state fMRI differentiate depressed adolescents with prior suicide attempts from those without?

Study Design

Type

Observational (n=121)

Multicenter

No

Structured PICO

Does dALFF variability measured by resting-state fMRI differentiate depressed adolescents with prior suicide attempts from those without?

P

Population

121 adolescents (10-17 years, Han Chinese, right-handed), including 76 with first-episode major depressive disorder (38 with prior suicide attempts, 38 without) and 45 healthy controls.

I

Intervention

Resting-state functional MRI (R-fMRI) to measure dynamic amplitude of low-frequency fluctuations (dALFF)

C

Comparator

Healthy controls and depressed adolescents without prior suicide attempts

O

Outcome

Differences in dALFF variability across groups and its diagnostic performance in discriminating MDD with and without suicide attemptssurrogate

Main Result

Effect estimate: AUC 0.969 (95% CI 0.902-1)

Dynamic ALFF variability measured by resting-state fMRI may serve as a sensitive imaging biomarker to identify suicidal vulnerability in depressed adolescents.

Limitations

fMRI scans with higher temporal resolution (i.e., multiband technique) would be better for investigating temporal dynamics
LOOCV model used in predicting SI intensity may produce higher variance in prediction errors
Could not completely rule out the possible influence of medications
Cross-sectional design cannot identify risk markers of future suicide attempts
Small sample size requires replication in further research

Implication

May support imaging-based risk stratification in depressed adolescents; leaves open prospective validation before clinical use.

Abstract

Converging evidence has revealed disturbances in the corticostriatolimic system are associated with suicidal behaviors in adults with major depressive disorder. However, the neurobiological mechanism that confers suicidal vulnerability in depressed adolescents is largely unknown. A total of 86 depressed adolescents with and without prior suicide attempts (SA) and 47 healthy controls underwent resting-state functional imaging (R-fMRI) scans. The dynamic amplitude of low-frequency fluctuations (dALFF) was measured using sliding window approach. We identified SA-related alterations in dALFF variability primarily in the left middle temporal gyrus, inferior frontal gyrus, middle frontal gyrus (MFG), superior frontal gyrus (SFG), right SFG, supplementary motor area (SMA) and insula in depressed adolescents. Notably, dALFF variability in the left MFG and SMA was higher in depressed adolescents with recurrent suicide attempts than in those with a single suicide attempt. Moreover, dALFF variability was capable of generating better diagnostic and prediction models for suicidality than static ALFF. Our findings suggest that alterations in brain dynamics in regions involved in emotional processing, decision-making and response inhibition are associated with an increased risk of suicidal behaviors in depressed adolescents. Furthermore, dALFF variability could serve as a sensitive biomarker for revealing the neurobiological mechanisms underlying suicidal vulnerability.

Discussion

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Cite This Study

Cheng et al. (2023) conducted an observational in Major Depressive Disorder with prior suicide attempts (n=121). Dynamic amplitude of low-frequency fluctuations (dALFF) variability vs. MDD without suicide attempts (MDD-NSA) and Healthy Controls (HC) was evaluated on Discrimination of MDD-SA from MDD-NSA using combined dALFF variability (left IFG, right insula, SMA/SFG) (AUC 0.969, 95% CI 0.902-1). Combining dynamic amplitude of low-frequency fluctuations (dALFF) variability in the left inferior frontal gyrus, right insula, and SMA/SFG discriminated depressed adolescents with suicide attempts from those without with an AUC of 0.969.

synapsesocial.com/papers/6a1ab89e5448f1e38b45fd27 https://doi.org/10.1007/s00787-023-02242-4

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Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Characterizing the temporal dynamics of intrinsic brain activities in depressed adolescents with prior suicide attempts

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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