Multimodal neuroimaging and suicidality in a US population-based sample of school-aged children

ImportanceSuicide deaths and suicidality are considered a public health emergency, yet their brain underpinnings remain elusive. ObjectiveTo examine individual, environmental, and clinical characteristics, as well as multimodal brain imaging correlates of suicidality in a US population-based sample of school-aged children. DesignCross-sectional analysis of the first wave of data from the Adolescent Brain Cognitive Development study SettingMulticenter population-based study ParticipantsChildren aged 9-10 years from unreferred, community samples with suicidality data available (n=7,994). Following quality control, we examined structural magnetic resonance imaging (sMRI) (n=6,238), resting state functional MRI (rs-fMRI) (n=4,134), and task-based fMRI (range n=4,075 to 4,608). ExposureLifetime suicidality, defined as suicidal ideation, plans and attempts reported by children or/and caregivers. Main Outcomes and MeasuresMultimodal neuroimaging analyses examined differences with Welchs t-test and Equivalence Tests, with observed effect sizes (ES, Cohens d) and their 90% confidence interval (CI) < |0.15|. Predictive values were examined using the area under precision-recall curves (AUPRC). Measures included, cortical volume and thickness, large-scale network connectivity and task-based MRI of reward processing, inhibitory control and working memory. ResultsAmong the 7,994 unrelated children (3,757 females [47.0%]), those will lifetime suicidality based on children (n=684 [8.6%]; 276 females [40.4%]), caregiver (n=654 [8.2%]; 233 females [35.6%]) or concordant reports (n=198 [2.5%]; 67 females [33.8%]), presented higher levels of social adversity and psychopathology on themselves and their caregivers compared to never-suicidal children (n=6,854 [85.7%]; 3,315 females [48.3%]). A wide range of brain areas was associated with suicidality, but only one test (0.06%) survived statistical correction: children with caregiver-reported suicidality had a thinner left bank of the superior temporal sulcus compared to never-suicidal children (ES=-0.17, 95%CI -0.26, -0.08, pFDR=0.019). Based on the prespecified bounds of |0.15|, [~]48% of the group mean differences for child-reported suicidality comparisons and a [~]22% for parent-reported suicidality comparisons were considered equivalent. All observed ES were relatively small (d[&le;]|0.20|) and with low predictive value (AUPRC[&le;]0.10). Conclusion and RelevanceUsing commonly-applied neuroimaging measures, we were unable to find a discrete brain signature related to suicidality in youth. There is a great need for improved approaches to the neurobiology of suicide.