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Link to original content: https://pubmed.ncbi.nlm.nih.gov/30386264/
Neuroimaging Studies of Suicidal Behavior and Non-suicidal Self-Injury in Psychiatric Patients: A Systematic Review - PubMed Skip to main page content
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. 2018 Oct 16:9:500.
doi: 10.3389/fpsyt.2018.00500. eCollection 2018.

Neuroimaging Studies of Suicidal Behavior and Non-suicidal Self-Injury in Psychiatric Patients: A Systematic Review

Affiliations

Neuroimaging Studies of Suicidal Behavior and Non-suicidal Self-Injury in Psychiatric Patients: A Systematic Review

Carmen Domínguez-Baleón et al. Front Psychiatry. .

Abstract

Background: With around 800,000 people taking their own lives every year, suicide is a growing health concern. Understanding the factors that underlie suicidality and identifying specific variables associated with increased risk is paramount for increasing our understanding of suicide etiology. Neuroimaging methods that enable the investigation of structural and functional brain markers in vivo are a promising tool in suicide research. Although a number of studies in clinical samples have been published to date, evidence about neuroimaging correlates for suicidality remains controversial. Objective: Patients with mental disorders have an increased risk for both suicidal behavior and non-suicidal self-injury. This manuscript aims to present an up-to-date overview of the literature on potential neuroimaging markers associated with SB and NSSI in clinical samples. We sought to identify consistently reported structural changes associated with suicidal symptoms within and across psychiatric disorders. Methods: A systematic literature search across four databases was performed to identify all English-language neuroimaging articles involving patients with at least one psychiatric diagnosis and at least one variable assessing SB or NSSI. We evaluated and screened evidence in these articles against a set of inclusion/exclusion criteria and categorized them by disease, adhering to the PRISMA guidelines. Results: Thirty-three original scientific articles investigating neuroimaging correlates of SB in psychiatric samples were found, but no single article focusing on NSSI alone. Associations between suicidality and regions in frontal and temporal cortex were reported by 15 and 9 studies across four disorders, respectively. Furthermore, differences in hippocampus were reported by four studies across three disorders. However, we found a significant lack of replicability (consistency in size and direction) of results across studies. Conclusions: Our systematic review revealed a lack of neuroimaging studies focusing on NSSI in clinical samples. We highlight several potential sources of bias in published studies, and conclude that future studies should implement more rigorous study designs to minimize bias risk. Despite several studies reporting associations between SB and anatomical differences in the frontal cortex, there was a lack of consistency across them. We conclude that better-powered samples, standardized neuroimaging and analytical protocols are needed to continue advancing knowledge in this field.

Keywords: bipolar disorder; depression; neuroimaging; psychiatric patients; schizophrenia; self-harm; suicide attempt.

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Figures

Figure 1
Figure 1
General overview of the methodology. Flow diagram depicting database sources and the steps performed for this systematic review.
Figure 2
Figure 2
Database source of articles included in this systematic review. Venn diagram illustrating the overlap between studies obtained from different databases.
Figure 3
Figure 3
Risk of bias assessment. Stacked bars representing the percentage of literature papers identified at a high, medium, low, or unknown risk of bias for specific possible sources of bias. AffD, affective disorder; MRI, magnetic resonance imaging; HC, healthy controls.

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