Cerebral Activation During Moral Decisions and Salience Network Coherence in Ideation of Suicide

To look for structural and/or functional deviations of the salience network in depressive patients that might help to identify individuals with ideation of suicide.

In 2 matched groups of patients with major depression and with and without ideation of suicide and in a healthy control group, structural and functional magnetic resonance imaging was performed during resting state and activation by a moral decision paradigm. Data were evaluated using voxel based morphometry, statistical parametric mapping, independent component analysis and network-based statistics (NBS) and related to the Clinical Analysis Questionnaire score of suicidality.

Functional connectivity was reduced significantly (p<0.05, NBS corrected) within the salient network during resting state in patients with suicide ideation. Application of a moral paradigm activated nearly identical areas, and both anterior parts of the insulae correlated negatively to the score of suicidality.

Because the cerebral areas activated during a moral decision paradigm are nearly identical to the salience network seen in our study and because selected areas within this network, mainly the anterior parts of the insula, correlate negatively to suicidality, a special training using moral tasks or possibly also religious reinforcement might help to reduce suicidality in depressive patients.