Neuroimaging Studies of Nonsuicidal Self-Injury in Youth: A Systematic Review

Abstract

Nonsuicidal self-injury (NSSI) is prevalent and affects mainly the youth population. It is prospectively associated with suicide attempts, making it a target for suicide prevention. Recently, several studies have investigated neural pathways of NSSI using neuroimaging. However, there is a lack of systematized appraisal of these findings. This systematic review aims to identify and summarize the main neuroimaging findings of NSSI in youth. We followed PRISMA statement guidelines and searched MEDLINE, APA PsycInfo, and Google Scholar databases for neuroimaging studies, irrespective of imaging modality, specifically investigating NSSI in samples with a mean age of up to 25 years old. Quality assessment was made using the Newcastle–Ottawa and Joanna Briggs Institute scales. The initial search retrieved 3030 articles; 21 met inclusion criteria, with a total of 938 subjects. Eighteen studies employed functional neuroimaging techniques such as resting-state and task-based fMRI (emotional, interpersonal exposure/social exclusion, pain, reward, and cognitive processing paradigms). Three studies reported on structural MRI. An association of NSSI behavior and altered emotional processing in cortico-limbic neurocircuitry was commonly reported. Additionally, alterations in potential circuits involving pain, reward, interpersonal, self-processing, and executive function control processes were identified. NSSI has complex and diverse neural underpinnings. Future longitudinal studies are needed to understand its developmental aspects better.

Elevated levels of monocyte-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with non-suicidal self-injury

“…It is supposed that elevated monocyte count or MLR is accompanied by an increase in the monocyte-related cytokines (such as IL-6, IL-1β, IL-12, and TNF) and activation of microglia in the brain [ 36 ], which is a biomarker of neuroinflammation. Microglia monitors the functional state of synapses and modulates neuroplasticity by synaptic pruning and phagocytosis, resulting in altered brain structure and function, including regions implicated in impulse control and emotion regulation, such as the medial prefrontal cortex, dorsolateral prefrontal cortex, insula, amygdala, and hippocampus [ 7 , 37 – 39 ]. A previous study found that elevated monocyte count and MLR are associated with an increased risk of suicide in adolescents with major depressive disorder [ 30 ].…”

“…According to the latest statistics, Chun W et al estimated that the prevalence of NSSI in middle school students in China (aged 13–18 years) is 27.4% [ 5 ]. Numerous studies have shown that NSSI is strongly associated with suicide attempts (SA) [ 6 , 7 ] and that NSSI is the strongest predictor of future suicidal behavior [ 8 ]. The risks of both SA and completed suicide are significantly higher in those who have engaged in NSSI.…”

Prefrontal cortex neural activity predicts reduction of non-suicidal self-injury in adolescents with major depressive disorder: An event related potential study

“…Many studies suggest that P3 components are related to response inhibition and executive function ( Zhang et al, 2021 ; Egbert et al, 2022 ; Reed et al, 2022 ), which indicates that subjects with higher response inhibition and executive function at baseline, the NSSI behavior are more likely to reduce significantly after treatment. The results of a systematic review of neuroimaging of NSSI behavior showed that the activation of brain areas related to executive function decreased in NSSI samples ( Brañas et al, 2021 ). The results of a near infrared spectroscopy study suggest that NSSI patients show the deactivation of the dorsolateral prefrontal cortex (DLPFC), which plays a key role in the executive regulation of cognitive and behavioral responses to the environment ( Zahid et al, 2020 ).…”

Elevated levels of Monocyte-lymphocyte Ratio and Platelet-lymphocyte Ratio in adolescents with Non-suicidal Self-injury

“…It is supposed that elevated monocyte count or MLR is accompanied by an increase in the monocyte-related cytokines (such as IL-6, IL-1β, IL-12, and TNF) and activation of microglia in the brain [25], which is a biomarker of neuroin ammation. Microglia monitors the functional state of synapses and modulates neuroplasticity by synaptic pruning and phagocytosis, resulting in altered brain structure and function, including regions implicated in impulse control and emotion regulation, such as the medial prefrontal cortex, dorsolateral prefrontal cortex, insula, amygdala, and hippocampus [7,[26][27][28]. A previous study found that elevated monocyte count and MLR are associated with an increased risk of suicide in adolescents with major depressive disorder [19].…”

“…According to the latest statistics, Chun W et al estimated that the prevalence of NSSI in middle school students in China (aged 13-18 years) is 27.4% [5]. Numerous studies have shown that NSSI is strongly associated with suicide attempts (SAs) [6,7] and that NSSI is the strongest predictor of future suicidal behavior [8]. The risks of both SA and completed suicide are signi cantly higher in those who have engaged in NSSI.…”