Investigation Of The Correlation Between Resting FMRI And Impulsivity,Emotional Regulation Of First-episode MDD Adolescents With Non-suicidal Self-injury

Objective:1.To analyze the potential neuroimaging mechanism of first-episode adolescent of major depressive disorder(MDD)with NSSI and to explore the differences of spontaneous brain functional activities in resting state.2.To explore the correlation between abnormal brain activity and clinical characteristics in first-episode adolescent of MDD with NSSI,and to provide scientific basis for effective prevention and treatment of adolescent MDD with NSSI.Methods:1.In December 2019 to May 2021 in sichuan province center for mental health clinic outpatient and hospitalization of 76 cases of diagnostic criteria accord with the DSM-5 patients with the first-episode adolescent depression(MDD group).According to the "Ottawa NSSI Questionnaire",they were divided into two groups:MDD group with NSSI(40 cases)and MDD group without NSSI(36 cases)and 33 healthy controls adolescents(HC group)matched by gender,age and educational background were recruited.2.Clinical Scale Evaluation:Using the Hamilton Anxiety Scale(HAMA),the Hamilton Depression rating Scale-24(HAMD-24),Barratt Impulsiveness Scale(BIS-11),Regulatory Emotional Self efficacy Scale(RES)and Ottawa self-injury inventory(OSI)were assessed,followed by a resting-state fMRI scan.3.Magnetic Resonance Acquisition and Processing:Imaging data were preprocessed by SPM software to exclude fMRI data.Finally,due to large head movements,36 cases were included in the NSSI group,33 cases in the NSSI group and 30 cases in the HC group.The Amplitude of Low Frequency Fluctuation(ALFF)analysis method was used to obtain the different brain regions among the three groups.To remove individual differences and improve specificity,standardized ALFF value(mALFF value)was used for analysis.The mALFF values of different brain regions in the three groups were analyzed in SPSS25.0 to obtain mALFF values of different brain regions in the group with MDD without NSSI.4.Partial correlation analysis:Age,gender,head movement and other possible influencing factors were taken as covariables to conduct correlation analysis between mALFF values of different brain regions in the NSSI group and clinical scale.Results:1.General and Clinical data comparison:there were no significant differences in gender(P=0.613),age(P=0.249),years of education(P=0.583)and Wechsler intelligence(P=0.862)among three groups.In HAMD-24,HAMA,BIS-11 total scores and subscales,cognitive impulsivity(CI)and non-planning impulsiveness(NI)scores,RES total scores and their subscales Perceived self-efficacy in expressing positive affect(POS),despondency/distress(DES)and managiong anger/irritation(ANG)scores had statistical significance(all P<0.01).Postmortem analysis showed that there were no significant differences in HAMD and HAMA scores between the NSSI group and the NSSI group(all P>0.05).BIS-11 total score,CI,RES total score,POS,DES and ANG of MDD with NSSI were higher than that of MDD without NSSI(P all<0.05).2.There were statistically significant differences in mALFF values in the right middle frontal gyrus,left triangular inferior frontal gyrus,right insular inferior frontal gyrus,dorsolateral prefrontal cortex(DPFC)and auxiliary motor area among the three groups(P<0.05,GRF corrected).The post-mortem analysis showed that compared with the group without NSSI,mALFF values in DPFC and auxiliary motor area were decreased in the group with NSSI.Compared with HC group,the mALFF values of right middle frontal gyrus,left trigone inferior frontal gyrus,right insular inferior frontal gyrus,dorsolateral prefrontal cortex and paralmomotor area were lower in NSSI group.Compared with the HC group,mALFF values in the right middle frontal gyrus,left triangular inferior frontal gyrus,right insular inferior frontal gyrus and dorsolateral prefrontal cortex were lower in the non-NSSI group,with statistically significant differences(P<0.05,Bonferroni corrected).3.Partial correlation analysis:mALFF value of dorsolateral prefrontal cortex in NSSI group was positively correlated with BIS-11 total score and unplanned impulsivity,but negatively correlated with RES total score(r=0.345,P=0.040),(r=0.375,P=0.024),(r=-0.356,P=0.033).Conclusion:1.Compared with healthy controls and adolescents with first-episode depression without NSSI,adolescents with first-episode depression with NSSI had worse emotion regulation and higher impulsivity.2.The brain function,such as dorsolateral prefrontal cortex and auxiliary mirror area,of executive control in the basal state for adolescents with first episode of depression and NSSI is abnormal.3.The abnormal activity of dorsolateral prefrontal cortex is correlated with the level of emotion regulation and impulsivity,which may be the neuropathological mechanism of NSSI in adolescent depression.