The experience of social exclusion in women with a history of suicidal acts: a neuroimaging study

Abstract

Suicidal behaviors result from a complex interaction between social stressors and individual vulnerability. However, little is known of the specific neural network supporting the sensitivity to social stressors in patients at risk of suicidal acts. Using functional Magnetic Resonance Imaging, we investigated brain processing of social rejection in suicide attempters. Thirty-six euthymic women with a history of depression and suicidal behavior were compared to 41 euthymic women with a history of depression but no suicidal attempt, and 28 healthy controls. The Cyberball Game was used as a validated social exclusion paradigm. Relative to healthy controls, both patient groups reported higher levels of social distress related to the task, without significant differences according to suicidal status. Compared to patients without any history of suicide attempt and healthy controls, suicide attempters showed decreased contrast in the left insula and supramarginal gyrus during the exclusion vs. inclusion condition, after controlling for number of depressive episodes, medication, mood disorder type or social phobia. Our study highlights impaired brain response to social exclusion in euthymic female suicide attempters in regions previously implicated in pain tolerance and social cognition. These findings suggest sustained brain dysfunctions related to social perception in suicide attempters.

Figure 1

Main effect of conditions in healthy controls (voxel p-FWE corrected < 0.05, k ≥ 10) Brodmann Areas 13/45.

Figure 2

Comparison of brain activation between the three groups for the explicit exclusion (ESE) vs. inclusion (INC) conditions contrast. Significant group x condition differences in supramarginal gyrus at −39 −36 18 (red) and insula −39 −16 13 (blue) (voxel p-FWE corrected < 0.05, k ≥ 10).

Figure 3

Betas values of brain activation (arbitrary units) during contrasts of interest ES vs. INC and ISE vs. INC in the three groups in (a) left supramarginal gyrus (−39 −36 18) and (b) left posterior insula (−39 −16 13). Footnotes: SA: Suicide attempters; PC: Psychiatric controls; HC: Healthy controls; ESE: explicit social exclusion; ISE: implicit social exclusion; INC: inclusion.