Multimodal assessment of persistent threat in adolescents with nonsuicidal self-injury.

Başgöze, Z., Mirza, S., Silamongkol, T., Hill, D., Falke, C., Thai, M., ... Cullen, K. (2021). Multimodal assessment of persistent threat in adolescents with nonsuicidal self-injury.Development and Psychopathology, 33(5), 1774-1792. doi: 10.1017 / S0954579421000754

Commentary

Nonsuicidal self-injury (NSSI) is a common but poorly understood phenomenon in adolescents.

In this study, adolescent females with a continuum of NSSI severityNonsuicidal self-injury (NSSI) is a common but poorly understood phenomenon in adolescents. This study examined the persistent threat domain of adolescent females with sequential severity of NSSI (N= 142).

lifetime frequency of NSSI and across NSSI severity groups (No + mild NSSI, moderate NSSI, severe NSSI), Trier Social Stress Test We examined physiological, self-reported, and observed stress during Amygdala volume; Amygdala response to threat stimuli; Resting-state functional connectivity (RSFC) between the amygdala and medial prefrontal cortex (mPFC). Severe NSSI showed a blunted pattern of cortisol responses, despite the elevated stress reported and observed during TSST. 

Severe NSSI showed a decrease in amygdala-mPFCRSFC. Follow-up analysis suggested that this was more pronounced in those with a history of suicide attempts in both moderate and severe NSSI. Moderate NSSI showed increased activation of the right amygdala in response to threat. 

Multiple regressions showed that upper right but lower left amygdala activation predicted severity of NSSI when examined with low amygdala-mPFC RSFC. The pattern of interrelationships between persistent threat measures differed substantially across NSSI severity groups and even by history of suicide attempts. Limitations of the study include cross-sectional design, missing data, and sampling bias. Our findings underscore the value of a multilevel approach in understanding the complexity of neurobiological mechanisms in adolescent NSSI.

The persistent threat domain was investigated in the following way.We were analyzing physiological, self-reported, and observed stress during the Trier Social Stress Test across NSSI lifetime frequency and NSSI severity groups.

They assessed amygdala volume, amygdala response to threat stimuli, and resting-state functional connectivity (RSFC) between the amygdala and medial prefrontal cortex (mPFC).Severe NSSI showed a blunted pattern of cortisol response despite the elevated stress reported and observed during TSST.

Severe NSSI also showed a decrease in amygdala-mPFCRSFC.

Follow-up analysis suggested that this was more pronounced in those with a history of suicide attempts in both moderate and severe NSSI.

Moderate NSSI showed increased activation of the right amygdala in response to threat, and in multiple regressions, upper right but lower left amygdala activation predicted NSSI severity when examined with low amygdala-mPFC RSFC.

The pattern of interrelationships between persistent threat measures differed substantially across NSSI severity groups and even by history of suicide attempts.

Limitations of this study include the cross-sectional design, missing data, and sampling bias.