Neural Correlates of Suicidality in Adolescents with Major Depression: Resting-State Functional Connectivity of the Precuneus and Posterior Cingulate Cortex

Objective: Major depressive disorder (MDD) is associated with suicidal thoughts and behaviors (“suicidality”). Of the three components of Joiner's interpersonal theory of suicide, two involve negatively valenced, self-related beliefs: perceived burdensomeness and thwarted belongingness. However, the neurocircuitry underlying self-processing and suicidality has not been fully explored. This study examined the association between suicidality and the neurocircuitry of regions relevant to self-referential processing in adolescents with depression. Method: Fifty-eight adolescents underwent assessment and a resting-state fMRI scan. Resting-state functional connectivity (RSFC) analyses included two brain regions implicated in self-referential processing: precuneus and posterior cingulate cortex (PCC). Suicidality was measured using the Index of Depression and Anxiety Symptoms. While controlling for depression severity, we conducted whole-brain correlation analyses between suicidality and left and right precuneus and PCC connectivity maps. Results: Suicidality was positively associated with RSFC between left precuneus and left primary motor and somatosensory cortices, and middle and superior frontal gyri. Suicidality was negatively associated with RSFC between left PCC and left cerebellum, lateral occipital cortex, and temporal–occipital fusiform gyrus. Conclusions: Findings of hyperconnectivity stemming from the precuneus and hypoconnectivity from the PCC may reflect maladaptive self-reflection and mentalization. However, additional investigation is warranted to further clarify these relationships.