Abstract
Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.
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(2014) Centers for disease control and prevention, national center for injury prevention and control. Web-based injury statistics query and reporting system (WISQARS). In: Centers for Disease Control and Prevention
Aweid O, Gallie R, Morrissey D, Crisp T, Maffulli N, Malliaras P, Padhiar N (2014) Medial tibial pain pressure threshold algometry in runners. Knee Surg Sports Traumatol Arthrosc 22:1549–1555
Ballard ED, Ionescu DF, Vande Voort JL, Slonena EE, Franco-Chaves JA, Zarate CA Jr, Grillon C (2014) Increased fear-potentiated startle in major depressive disorder patients with lifetime history of suicide attempt. J Affect Disord 162:34–38
Beck AT (1988) Beck hopelessness scale. In: The Psychological Corporation
Beck AT, Steer RA (1990) Bai, beck anxiety inventory: manual. Psychological Corp.: Harcourt Brace Jovanovich, San Antonio
Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of beck depression inventories -ia and -ii in psychiatric outpatients. J Pers Assess 67:588–597
Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, Sapareto E, Ruggiero J (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151:1132–1136
Buitron V, Hill RM, Pettit JW, Green KL, Hatkevich C, Sharp C (2016) Interpersonal stress and suicidal ideation in adolescence: an indirect association through perceived burdensomeness toward others. J Affect Disord 190:143–149
Cáceda R, Durand D, Cortes E, Prendes S, Moskovciak TN, Harvey PD, Nemeroff CB (2014) Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med 76:445–451
Cáceda R, Kordsmeier N, Golden LE, Gibbs HM, Delgado PL (2017) Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom 86:116–118
Caceda R, Kordsmeier NC, Golden E, Gibbs HM, Delgado PL (2017) Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom 86:116–118
Caceda R, Nemeroff CB, Harvey PD (2014) Towards an understanding of decision making in severe mental illness. Psychosom Med 79:36–42
Cacioppo S, Frum C, Asp E, Weiss RM, Lewis JW, Cacioppo JT (2013) A quantitative meta-analysis of functional imaging studies of social rejection. Sci Rep 3:2027
Calati R, Laglaoui Bakhiyi C, Artero S, Ilgen M, Courtet P (2015) The impact of physical pain on suicidal thoughts and behaviors: meta-analyses. J Psychiatr Res 71:16–32
Calhoun VD, Adali T, Pearlson GD, Pekar JJ (2001) A method for making group inferences from functional mri data using independent component analysis. Hum Brain Mapp 14:140–151
Chan SC, Chan CC, Kwan AS, Ting KH, Chui TY (2012) Orienting attention modulates pain perception: an erp study. PloS One 7:e40215
Cox RW (1996) Afni: software for analysis and visualization of functional magnetic resonance neuroimages. Comput Biomed Res 29:162–173
Craig AD (2009) How do you feel–now? The anterior insula and human awareness. Nat Rev Neurosci 10:59–70
Dalgleish T, Walsh ND, Mobbs D, Schweizer S, van Harmelen AL, Dunn B, Dunn V, Goodyer I, Stretton J (2017) Social pain and social gain in the adolescent brain: a common neural circuitry underlying both positive and negative social evaluation. Sci Rep 7:42010
Duberstein PR, Conwell Y, Caine ED (1993) Interpersonal stressors, substance abuse, and suicide. J Nerv Ment Dis 181:80–85
Ducasse D, Holden RR, Boyer L, Artero S, Calati R, Guillaume S, Courtet P, Olie E (2017) Psychological pain in suicidality: a meta-analysis. J Clin Psychiatry. https://doi.org/10.4088/JCP.16r10732
Eisenberger NI (2012) The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nat Rev Neurosci 13:421–434
Eisenberger NI, Inagaki TK, Rameson LT, Mashal NM, Irwin MR (2009) An fmri study of cytokine-induced depressed mood and social pain: the role of sex differences. NeuroImage 47:881–890
Eisenberger NI, Jarcho JM, Lieberman MD, Naliboff BD (2006) An experimental study of shared sensitivity to physical pain and social rejection. Pain 126:132–138
Eisenberger NI, Lieberman MD, Williams KD (2003) Does rejection hurt? An fmri study of social exclusion. Science 302:290–292
Escriba PV, Ozaita A, Garcia-Sevilla JA (2004) Increased mrna expression of alpha2a-adrenoceptors, serotonin receptors and mu-opioid receptors in the brains of suicide victims. Neuropsychopharmacology 29:1512–1521
First MB, Spitzer RL, Gibbon M, Williams BW (2002) Structured clinical interview for dsm-iv-tr axis i disorders, research version, patient edition. (scid-i/p). New York State Psychiatric Institute, New York
Genovese CR, Lazar NA, Nichols T (2002) Thresholding of statistical maps in functional neuroimaging using the false discovery rate. Neuroimage 15:870–878
Giamberardino MA, Tana C, Costantini R (2014) Pain thresholds in women with chronic pelvic pain. Curr Opin Obstet Gynecol 26:253–259
Haggard-Grann U, Hallqvist J, Langstrom N, Moller J (2006) Short-term effects of psychiatric symptoms and interpersonal stressors on criminal violence—a case-crossover study. Soc Psychiatry Psychiatr Epidemiol 41:532–540
Holden RR, Mehta K, Cunningham EJ, McLeod LD (2001) Development and preliminary validation of a scale of psychche. Can J Behav Sci 33:224–232
Hoyert DL, Xu J (2012) Deaths: preliminary data for 2011. Natl Vital Stat Rep 61:1–51
Hurd YL, Herman MM, Hyde TM, Bigelow LB, Weinberger DR, Kleinman JE (1997) Prodynorphin mrna expression is increased in the patch vs matrix compartment of the caudate nucleus in suicide subjects. Mol Psychiatry 2:495–500
Jakab A, Molnar PP, Bogner P, Beres M, Berenyi EL (2012) Connectivity-based parcellation reveals interhemispheric differences in the insula. Brain Topogr 25:264–271
James GA, Hazaroglu O, Bush KA (2016) A human brain atlas derived via n-cut parcellation of resting-state and task-based fmri data. Magn Reson Imaging 34:209–218
Jenkinson M, Beckmann CF, Behrens TE, Woolrich MW, Smith SM (2012) Fsl. Neuroimage 62:782–790
Jollant F, Guillaume S, Jaussent I, Castelnau D, Malafosse A, Courtet P (2007) Impaired decision-making in suicide attempters may increase the risk of problems in affective relationships. J Affect Disord 99:59–62
Jollant F, Lawrence NS, Giampietro V, Brammer MJ, Fullana MA, Drapier D, Courtet P, Phillips ML (2008) Orbitofrontal cortex response to angry faces in men with histories of suicide attempts. Am J Psychiatry 165:740–748
Jollant F, Near J, Turecki G, Richard-Devantoy S (2017) Spectroscopy markers of suicidal risk and mental pain in depressed patients. Prog Neuro-Psychoph 73:64–71
Klonsky ED, May AM (2015) The three-step theory (3st): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Therapy 8:114–129
Koenig J, Thayer JF, Kaess M (2016) A meta-analysis on pain sensitivity in self-injury. Psychol Med. https://doi.org/10.1017/S0033291716000301 (FirstView:1–16)
Kross E, Berman MG, Mischel W, Smith EE, Wager TD (2011) Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci USA 108:6270–6275
Linehan MM (1993) Cognitive-behavioral treatment of borderline personality disorder. Guilford Press, New York
Meerwijk EL, Ford JM, Weiss SJ (2013) Suicidal crises because of diminishing tolerance to psychological pain. Brain Imaging Behav 7:245–247
Mufson EJ, Mesulam MM, Pandya DN (1981) Insular interconnections with the amygdala in the rhesus monkey. Neuroscience 6:1231–1248
Niculescu AB, Levey DF, Phalen PL, Le-Niculescu H, Dainton HD, Jain N, Belanger E, James A, George S, Weber H, Graham DL, Schweitzer R, Ladd TB, Learman R, Niculescu EM, Vanipenta NP, Khan FN, Mullen J, Shankar G, Cook S, Humbert C, Ballew A, Yard M, Gelbart T, Shekhar A, Schork NJ, Kurian SM, Sandusky GE, Salomon DR (2015) Understanding and predicting suicidality using a combined genomic and clinical risk assessment approach. Mol Psychiatry 20:1266–1285
O’Connor RC, Kirtley OJ (2018) The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond B Biol Sci. https://doi.org/10.1098/rstb.2017.0268
Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F (2010) Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord 120:226–230
Olie E, Jollant F, Deverdun J, de Champfleur NM, Cyprien F, Le Bars E, Mura T, Bonafe A, Courtet P (2017) The experience of social exclusion in women with a history of suicidal acts: a neuroimaging study. Sci Rep 7:89
Orbach I (2003) Mental pain and suicide. Isr J Psychiatry Relat Sci 40:191–201
Orbach I, Mikulincer M, King R, Cohen D, Stein D (1997) Thresholds and tolerance of physical pain in suicidal and nonsuicidal adolescents. J Consult Clin Psychol 65:646–652
Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E (2003) Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav 33:219–230
Orbach I, Palgi Y, Stein D, Har-Even D, Lotem-Peleg M, Asherov J, Elizur A (1996) Tolerance for physical pain in suicidal subjects. Death Stud 20:327–341
Orbach I, Stein D, Palgi Y, Asherov J, Har-Even D, Elizur A (1996) Perception of physical pain in accident and suicide attempt patients: self-preservation vs self-destruction. J Psychiatr Res 30:307–320
Pompili M, Innamorati M, Szanto K, Di Vittorio C, Conwell Y, Lester D, Tatarelli R, Girardi P, Amore M (2011) Life events as precipitants of suicide attempts among first-time suicide attempters, repeaters, and non-attempters. Psychiatry Res 186:300–305
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ (2011) The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 168:1266–1277
Power JD, Schlaggar BL, Petersen SE (2015) Recent progress and outstanding issues in motion correction in resting state fmri. Neuroimage 105:536–551
Ray KL, McKay DR, Fox PM, Riedel MC, Uecker AM, Beckmann CF, Smith SM, Fox PT, Laird AR (2013) Ica model order selection of task co-activation networks. Front Neurosci 7:237
Reisch T, Seifritz E, Esposito F, Wiest R, Valach L, Michel K (2010) An fmri study on mental pain and suicidal behavior. J Affect Disord. https://doi.org/10.1016/j.jad.2010.03.005
Rosen DH (1976) Suicide survivors: psychotherapeutic implications of egocide. Suicide Life Threat Behav 6:209–215
Seeley WW, Menon V, Schatzberg AF, Keller J, Glover GH, Kenna H, Reiss AL, Greicius MD (2007) Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci 27:2349–2356
Shneidman ES (1993) Suicide as psychache. J Nerv Ment Dis 181:145–147
Smith PN, Cukrowicz KC, Poindexter EK, Hobson V, Cohen LM (2010) The acquired capability for suicide: a comparison of suicide attempters, suicide ideators, and non-suicidal controls. Depress Anxiety 27:871–877
Strigo IA, Matthews SC, Simmons AN (2013) Decreased frontal regulation during pain anticipation in unmedicated subjects with major depressive disorder. Transl Psychiatry 3:e239
Tsai AC, Lucas M, Kawachi I (2015) Association between social integration and suicide among women in the united states. JAMA Psychiatry 72:987–993
Tsai AC, Lucas M, Sania A, Kim D, Kawachi I (2014) Social integration and suicide mortality among men: 24-year cohort study of us health professionals. Ann Intern Med 161:85–85+
Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr (2010) The interpersonal theory of suicide. Psychol Rev 117:575–600
Wager TD, Atlas LY, Lindquist MA, Roy M, Woo CW, Kross E (2013) An fmri-based neurologic signature of physical pain. N Engl J Med 368:1388–1397
Wager TD, Keller MC, Lacey SC, Jonides J (2005) Increased sensitivity in neuroimaging analyses using robust regression. Neuroimage 26:99–113
Wasserman D, Tran Thi Thanh H, Pham Thi Minh D, Goldstein M, Nordenskiold A, Wasserman C (2008) Suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural vietnamese community. World Psychiatry 7:47–53
Williams KD, Cheung CK, Choi W (2000) Cyberostracism: effects of being ignored over the internet. J Pers Soc Psychol 79:748–762
Woo CW, Koban L, Kross E, Lindquist MA, Banich MT, Ruzic L, Andrews-Hanna JR, Wager TD (2014) Separate neural representations for physical pain and social rejection. Nat Commun 5:5380
Yager J (2015) Addressing patients’ psychic pain. Am J Psychiatry 172:939–943
Yovell Y, Bar G, Mashiah M, Baruch Y, Briskman I, Asherov J, Lotan A, Rigbi A, Panksepp J (2015) Ultra-low-dose buprenorphine as a time-limited treatment for severe suicidal ideation: a randomized controlled trial. Am J Psychiatry 173(5):491–498. https://doi.org/10.1176/appi.ajp.2015.15040535
Zaroff CM, Wong HL, Ku L, Van Schalkwyk G (2014) Interpersonal stress, not depression or hopelessness, predicts suicidality in university students in macao. Australas Psychiatry 22:127–131
Zoller C, Maroof P, Weik U, Deinzer R (2010) No effect of social exclusion on salivary cortisol secretion in women in a randomized controlled study. Psychoneuroendocrinology 35:1294–1298
Acknowledgements
We thank Ms. Laura Rakes for a critical review of this manuscript.
Funding
This work was partially funded by the Clinician Scientist Program and the Medical Research Endowment Award of the University Arkansas for Medical Sciences and by the National Institute of Health Clinical and Translational Science Award program (UL1TR000039), (National Institute of General Medical Sciences P30 GM110702). No funding source had any role in study design, in the collection, analysis and interpretation of data, in the decision to submit the article for publication.
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Cáceda, R., James, G.A., Stowe, Z.N. et al. The neural correlates of low social integration as a risk factor for suicide. Eur Arch Psychiatry Clin Neurosci 270, 619–631 (2020). https://doi.org/10.1007/s00406-019-00990-6
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DOI: https://doi.org/10.1007/s00406-019-00990-6