Research Spotlight: David Pagliaccio, BRAINS Study

This new research project, led by Dr. David Pagliaccio, aims to combine novel brain imaging techniques with smartphone assessment to understand factors that contribute to depression and suicidal thoughts and behaviors in adolescents. This work is supported by the National Institute of Mental Health (R01 MH126181-01) and the Tommy Fuss Fund.

Suicide is a major public health crisis and, currently, is the second leading cause of death among 10-24-year-olds. Suicidal thoughts and behaviors increase drastically during adolescence and are particularly common among depressed adolescents. However, definitive markers to identify depressed adolescents who are most at-risk for suicidal behaviors have not been revealed. Research that combines information about brain biology with real-world social experiences can help improve prediction of youth suicide and reduce needless loss of life. In particular, we are building on academic theories of suicidal thoughts and behaviors that suggest that risk is highest among those who have pre-existing risk factors and then experience acute stress, particularly social rejection or interpersonal losses. In reviewing prior work, we found suggestions of potential brain-based risk factors for suicidal thoughts and behaviors, yet data are limited, particularly for high-risk adolescents. We aim to bridge this gap by targeting studying three brain measures in combination with in-depth assessment of stress experience.

First, prior research has found reduction in dopamine, an essential neurotransmitter in the brain, in adult suicide and depression. Dopamine plays a critical role in many functions, including the experience of rewarding events. We hypothesize that dopaminergic reductions will be prominent in adolescents with suicidal thoughts and behaviors, particularly among those with a prior attempt history. As dopamine is difficult to directly measure in youth, we are using a new magnetic resonance imaging (MRI) method that assesses one of dopamine’s byproducts—called neuromelanin—as a non-invasive proxy for dopamine in key brain regions. This will be the first study to test dopaminergic function as a potential prospective risk factor for adolescent STB. Second, individuals who attempt suicide tend to experience more interpersonal stress than those who experience suicidal ideation, but who do not act on it. Thus, the proposed project will clarify whether differences in the neural circuitry of social processing increase risk for suicidal behaviors. Third, negative urgency, the tendency to act impulsively following negative emotions, is implicated in adolescent suicidal behaviors. We hypothesize that teens with a history of attempts will exhibit differences in the neural circuitry of response inhibition, probed during emotional conditions.

Teens experiencing suicidal thoughts and behaviors will be recruited from our pediatric emergency department. Teens will be followed prospectively for the subsequent year, where the 3-months following hospital discharge tend to be a high-risk period for relapse of symptoms. Interpersonal stress will be characterized over follow-up via prospective smartphone assessment and in-depth retrospective interviews. Passive sensor smartphone techniques will also be used to assess physical activity and other measures to unobtrusively capture participant behavior outside of the lab. Collectively, these novel multimodal MRI, smartphone, and stress measures hold great promise to elucidate the pathway to adolescent suicidal behaviors, a key NIMH research priority.