Psychological Medicine

Original Articles

Differential patterns of activity and functional connectivity in emotion processing neural circuitry to angry and happy faces in adolescents with and without suicide attempt

L. A. Pana1 c1, S. Hassela2, A. M. Segretia1, S. A. Naua1, D. A. Brenta1 and M. L. Phillipsa1a3

a1 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

a2 Department of Psychiatry and Hotchkiss Brain Institute, University of Calgary, School of Medicine, Calgary, AB, Canada

a3 Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK


Background Neural substrates of emotion dysregulation in adolescent suicide attempters remain unexamined.

Method We used functional magnetic resonance imaging to measure neural activity to neutral, mild or intense (i.e. 0%, 50% or 100% intensity) emotion face morphs in two separate emotion-processing runs (angry and happy) in three adolescent groups: (1) history of suicide attempt and depression (ATT, n = 14); (2) history of depression alone (NAT, n = 15); and (3) healthy controls (HC, n = 15). Post-hoc analyses were conducted on interactions from 3 group × 3 condition (intensities) whole-brain analyses (p < 0.05, corrected) for each emotion run.

Results To 50% intensity angry faces, ATT showed significantly greater activity than NAT in anterior cingulate gyral–dorsolateral prefrontal cortical attentional control circuitry, primary sensory and temporal cortices; and significantly greater activity than HC in the primary sensory cortex, while NAT had significantly lower activity than HC in the anterior cingulate gyrus and ventromedial prefrontal cortex. To neutral faces during the angry emotion-processing run, ATT had significantly lower activity than NAT in the fusiform gyrus. ATT also showed significantly lower activity than HC to 100% intensity happy faces in the primary sensory cortex, and to neutral faces in the happy run in the anterior cingulate and left medial frontal gyri (all p < 0.006,corrected). Psychophysiological interaction analyses revealed significantly reduced anterior cingulate gyral–insula functional connectivity to 50% intensity angry faces in ATT v. NAT or HC.

Conclusions Elevated activity in attention control circuitry, and reduced anterior cingulate gyral–insula functional connectivity, to 50% intensity angry faces in ATT than other groups suggest that ATT may show inefficient recruitment of attentional control neural circuitry when regulating attention to mild intensity angry faces, which may represent a potential biological marker for suicide risk.

(Received June 21 2012)

(Revised November 28 2012)

(Accepted November 29 2012)

(Online publication January 09 2013)

Key words

  • Adolescents;
  • anterior cingulate;
  • depression;
  • emotion processing;
  • insula;
  • suicide


c1 Address for correspondence: L. A. Pan, M.D., Assistant Professor of Psychiatry, Child and Adolescent Psychiatry, Loeffler Building, 121 Meyran Avenue, Room 304, Pittsburgh, PA 15213, USA. (Email: