The neural correlates of low social integration as a risk factor for suicide

  • Ricardo CácedaEmail author
  • G. Andrew James
  • Zachary N. Stowe
  • Pedro L. Delgado
  • Nolan Kordsmeier
  • Clint D. Kilts
Original Paper


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.


Suicide Depression Social exclusion Pain fMRI Cyberball 



We thank Ms. Laura Rakes for a critical review of this manuscript.


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.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

406_2019_990_MOESM1_ESM.docx (374 kb)
Supplementary material 1 (DOCX 374 KB)


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Authors and Affiliations

  1. 1.Department of PsychiatryStony Brook UniversityStony BrookUSA
  2. 2.Psychiatric Research InstituteUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Department of PsychiatryUniversity of Wisconsin at MadisonMadisonUSA

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