Emotional face recognition in adolescent suicide attempters and adolescents engaging in non-suicidal self-injury

Abstract

Little is known about the bio-behavioral mechanisms underlying and differentiating suicide attempts from non-suicidal self-injury (NSSI) in adolescents. Adolescents who attempt suicide or engage in NSSI often report significant interpersonal and social difficulties. Emotional face recognition ability is a fundamental skill required for successful social interactions, and deficits in this ability may provide insight into the unique brain-behavior interactions underlying suicide attempts versus NSSI in adolescents. Therefore, we examined emotional face recognition ability among three mutually exclusive groups: (1) inpatient adolescents who attempted suicide (SA, n = 30); (2) inpatient adolescents engaged in NSSI (NSSI, n = 30); and (3) typically developing controls (TDC, n = 30) without psychiatric illness. Participants included adolescents aged 13-17 years, matched on age, gender and full-scale IQ. Emotional face recognition was evaluated using the diagnostic assessment of nonverbal accuracy (DANVA-2). Compared to TDC youth, adolescents with NSSI made more errors on child fearful and adult sad face recognition while controlling for psychopathology and medication status (ps < 0.05). No differences were found on emotional face recognition between NSSI and SA groups. Secondary analyses showed that compared to inpatients without major depression, those with major depression made fewer errors on adult sad face recognition even when controlling for group status (p < 0.05). Further, compared to inpatients without generalized anxiety, those with generalized anxiety made fewer recognition errors on adult happy faces even when controlling for group status (p < 0.05). Adolescent inpatients engaged in NSSI showed greater deficits in emotional face recognition than TDC, but not inpatient adolescents who attempted suicide. Further results suggest the importance of psychopathology in emotional face recognition. Replication of these preliminary results and examination of the role of context-dependent emotional processing are needed moving forward.

Using an ideal observer analysis to investigate the visual perceptual efficiency of individuals with a history of non-suicidal self-injury when identifying emotional expressions

“…This trend was also observed at the lowest intensity of fear at 50%, which came out slightly above the conservatively adjusted pvalue to accommodate for the multiple comparisons. These results appear in line with the observations made by Seymour et al, [52] who found that inpatient adolescents engaged in NSSI made more emotional face recognition errors for child fearful faces compared to typically developing controls. Among other reasons, theoretical models of NSSI postulate that engaging in NSSI may be used by individuals as a means for social communication to gain attention or influence other's behavior [63][64].…”

“…However, this study also used sad and neutral mood induction to evoke specific mood states before presenting the stimuli, which was not the case for the current research or the Ziebell et al, [30] study. Seymour et al [52], who also used static images for their experiment, found that adolescents engaging in NSSI made more errors on child fearful and adult sad face recognition compared to the typically developing controls.…”

Delta Event-Related Oscillations Are Related to a History of Extreme Binge Drinking in Adolescence and Lifetime Suicide Risk

“…An increased tendency to interpret neutral facial expressions as sad has been reported in adult patients with “affective temperaments” in one study [ 137 ], and more errors in the recognition of facial expressions of “disgust” in another study [ 138 ]. Youth with a history of engaging in non-suicidal self-injury and those with past suicide attempts were found to make more errors in sad face recognition [ 139 ], and children with suicidal ideation were found to misclassify angry emotions as sad [ 140 ]. The percent of correct identifications of the three facial expressions were compared between participants with a history of suicidal thoughts and those without in the present study.…”

The neurobiology of self-face recognition in depressed adolescents with low or high suicidality.

“…Given that biased self-schemas and self-referential processing biases are prevalent among depressed and suicidal youth, atypical processing of self-faces may be characteristic of youth at risk for suicide. Prior research has established that attention, perception, and identification biases for affective facial stimuli are robust among youth with emotional disorders and symptoms, including suicidality (Hankin, et al, 2010; Joormann, Gilbert, & Gotlib, 2010; Seymour et al, 2015), although these studies have not focused on self-faces specifically. Emotional facial stimuli are frequently used in these information processing studies, because processing of facial emotional expressions are rapid and automatic (Vuilleumier & Schwartz, 2001), and are believed to function external to awareness (Gotlib & Neubauer, 2000).…”