The neural correlates of low social integration as a risk factor for suicide
Open accessAbstract
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.
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Brain areas linking suicidality with psychological pain include the insula, anterior cingulate cortex, and orbitofrontal cortex.
“Brain activity studies during social exclusion procedures point to the insula, anterior cingulate cortex [28], and the orbitofrontal cortex [29] as the brain areas linking suicidality with psychological pain.”
From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [28]
The Discussion (page unavailable) reports that anterior insula activity correlated with psychological pain in patients studied across a suicide-risk spectrum. It reports that dorsal anterior cingulate activity during social exclusion correlated with physical pain, not psychological pain. The orbitofrontal cortex is attached to a different citation in the citing sentence and is not assessed here. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe anterior insular response has been associated with psychological pain during social inclusion.
“The anterior insular response has been associated with psychological pain during social inclusion”
From “Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas (2020) · cites this paper as [34]
Low social integration is related to suicidality.
“the consensus that low social integration is related to suicidality.34”
From “Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas (2020) · cites this paper as [34]
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Sorted by citations
Lengvenyte, A., Strumila, R., Courtet, P., Kim, S. Y. H., & Olié, E. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720931237 · Cited by 13 · see citing works
Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol
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- Authors
- Cáceda, R., James, G. A., Stowe, Z. N., Delgado, P. L., Kordsmeier, N., & Kilts, C. D.
- Affiliations
- Stony Brook University (US)
- University of Arkansas for Medical Sciences (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Cáceda, Ricardo
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2019-03-23
- Volume
- 270
- Issue
- 5
- Pages
- 619-631
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- PMC
- PMC6756996
- OpenAlex
- W2941234534
- Cited by
- 25
- References
- 79
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 4
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of General Medical Sciences (P30 GM110702)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- suicide risk, social exclusion, social inclusion, Cyberball game, anterior insula, dorsal anterior cingulate cortex, psychological suffering, bodily pain, depression severity, suicidal ideation, suicide attempts, functional connectivity, pain matrix
- MeSH terms
- Social Inclusion, Adolescent, Adult, Brain Mapping, Cerebral Cortex, Depressive Disorder, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Risk Factors, Severity of Illness Index, Social Isolation, Suicide, Attempted, Young Adult, Suicidal Ideation, Connectome
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