Topological alterations in suicide attempters: exploring the role of the pain network

Psychological pain showed stronger predictive power for suicide attempts (SAs) than depression, even in patients with major depressive disorder (MDD). This study aimed to elucidate the compositional architecture of the pain network and quantify the explanatory power of this network versus the reward network in modeling suicide risk mechanisms. Resting-state functional magnetic resonance imaging data from MDD patients with SA, MDD patients without SA, and healthy controls (HCs) were analyzed using graph theoretical analysis. Partial least squares regression was used to assess suicide-related neural alterations in relation to depression and psychological pain. Compared with HCs, MDD patients exhibited reduced nodal centrality in both the reward and pain networks. Within MDD, individuals with SA exhibited changes primarily in the pain network, including a decrease in the betweenness centrality of the right anterior insula. Suicide-related alterations overlapped more with pain avoidance than with depression. Centrality in the right opercular inferior frontal gyrus, left medial superior temporal gyrus, and right anterior insula was associated with pain arousal, feelings, and avoidance, broadening the current understanding of the pain network. These findings extended the conceptualization of the pain network and highlight its pivotal role in suicide risk.