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Abnormal connectivity of anterior-insular subdivisions and relationship with somatic symptom in depressive patients

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Abstract

Depressive patients frequently present with somatic complaints such as pain and fatigue. The anterior insula (AI) is a crucial region for somatic processing, but reported contributions of AI dysfunction to somatic symptoms have varied across studies. We speculated that functional heterogeneity among AI subdivisions may contribute to this inconsistency. To reveal the correlation between each subdivision and somatic symptoms, we investigated resting-state functional connectivity (RSFC) based on seeds within distinct AI subdivisions in 45 depressive patients and 35 matched healthy controls (HCs). Depressive and somatic symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15), respectively. The contributions of AI subregion-specific pathways to depression were further validated by examining changes in symptom severity and RSFC following electroconvulsive therapy (ECT). At baseline, depressive patients exhibited weaker RSFC between ventral AI (vAI) and right orbitofrontal cortex (rOFC) than HCs. Moreover, vAI–rOFC RSFC strength was negatively correlated with PHQ-15 and HDRS scores, indicating that weaker RSFC predicted greater symptom severity. ECT reduced depressive and somatic symptoms, and symptom mitigation was correlated with enhanced vAI–rOFC RSFC. The findings suggest that reduced vAI–rOFC RSFC underlies the somatic symptoms of depression and that enhancing vAI–rOFC RSFC can contribute to amelioration of somatic symptoms.

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Acknowledgements

We thank the Anhui Mental Health Center and the University of Science and Technology of China for their support.

Funding

This study was funded by the Natural Science Foundation of China (31,970,979, 91,432,301, 31,571,149, 81,171,273, and 91,232,717 to K.W., 81,671,354, 91,732,303 to Y.T., 81,601,187 to Q.W.) and the Science Fund for Distinguished Young Scholars of Anhui Province (1808085J23 to Y.T.).

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Author notes

  1. Ting Zhang,Tongjian Bai and Wen Xie equally contributed to this work.

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China

    Ting Zhang, Tongjian Bai, Qiang Wei, Huaming Lv, Yanghua Tian & Kai Wang

  2. Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China

    Ting Zhang, Tongjian Bai, Qiang Wei, Huaming Lv, Yanghua Tian & Kai Wang

  3. Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China

    Ting Zhang, Tongjian Bai, Qiang Wei, Huaming Lv, Yanghua Tian & Kai Wang

  4. Anhui Mental Health Center, Hefei, Anhui Province, China

    Wen Xie, Anzhen Wang & Jianjun Guan

  5. National Clinical Research Center for Mental Disorders, Hefei, China

    Yanghua Tian

  6. Department of Medical Psychology, Anhui Medical University, Anhui Province, Hefei, China

    Yanghua Tian & Kai Wang

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  1. Ting Zhang
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  2. Tongjian Bai
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  3. Wen Xie
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  8. Yanghua Tian
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  9. Kai Wang
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Contributions

Ting Zhang, Tongjian Bai and Kai Wang designed the study. Ting Zhang and Huaming Lv acquired behavior and imaging data. Wen Xie, Anzhen Wang and Jianjun Guan conducted ECT sessions. Qiang Wei, Ting Zhang and Yanghua Tian analyzed imaging data. Ting Zhang, Tongjian Bai and Kai Wang wrote this article, which all authors have reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

Corresponding authors

Correspondence to Yanghua Tian or Kai Wang.

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We have obtained the ethical approval of Anhui Medical University Ethics Committee. All subjects involved in this investigation provided written informed consent.

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Zhang, T., Bai, T., Xie, W. et al. Abnormal connectivity of anterior-insular subdivisions and relationship with somatic symptom in depressive patients. Brain Imaging and Behavior 15, 1760–1768 (2021). https://doi.org/10.1007/s11682-020-00371-x

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