A Pilot fMRI Study of Pain Circuitry in Adolescent Suicidality and Depression Symptomatology

Suicide is the second leading cause of death among adolescents and young adults, and understanding neurobiological features that distinguish youth experiencing suicidality remains a critical public health challenge. Converging evidence suggests that pain plays a key role in suicidality. Yet, no studies to date have examined the role of pain neurocircuitry in adolescent suicidality. Here, we present preliminary findings from an ongoing functional magnetic resonance imaging (fMRI) investigation of neural pain responses and their associations with suicidality and depression symptomatology in youth. Adolescents (age 12-21; N =24) with mild-to-severe depression completed diagnostic interviews; depression, anxiety, anhedonia, and suicidality scales; and the fMRI Electric Pain Task. Participants observed cues, received painful or non-painful electric stimuli, and rated subjective pain. Scans used high-spatiotemporal resolution 3T sequences and Human Connectome Project processing methodology. Results were evaluated using FSL FEAT at cluster-corrected p <0.05. Painful stimuli engaged canonical pain circuitry, including somatosensory, insula, and anterior-mid cingulate cortices. During pain ratings, adolescents with current suicidality ( n =12) had stronger activation in perigenual cingulate, fusiform, and orbitofrontal cortices. Across participants, suicidality severity correlated with subgenual cingulate, posterior insula, ventral striatal, and lateral orbitofrontal activation. Anxiety negatively correlated with pain rating activation in the bilateral insula, caudate, thalamus, and medial temporal lobe. Consummatory anhedonia correlated with dorsomedial prefrontal activation during pain anticipation, while anticipatory anhedonia negatively correlated with lateral occipital activation during pain experience. Though preliminary, findings indicated distinct phases of neural pain response were associated with adolescent suicidality, particularly in ventral cingulate and dopaminergic circuitry, and with depression symptomatology.