New imaging study finds evidence that emotion regulation is not always the most effective strategy to mitigate suicidal ideation

Senior investigator J. John Mann, MD, Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute; and Department of Psychiatry and Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons, says, "Suicide rates in the United States have increased about 37% since the year 2000. To reverse this trend, we need to understand how suicide risk emerges in daily life, and specifically the biopsychosocial factors that may influence the ebb and flow of suicide risk."

Retrospective reports show that the most immediate trigger of suicidal acts is a stressful life event, but researchers say it is very difficult to prospectively study how stress impacts the emergence of acute suicidality.

Co-first author Sarah Herzog, PhD, Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, explains, "Ecological momentary assessment allows us to observe how individuals suffering from depression react to stressful events in their daily lives, for example, with intensified suicidal thoughts and worsened mood. Our study took this a step further by linking a laboratory-based biological marker of risk in a depressed sample to naturalistic responses to real-world daily stressors. This multimodal method prmoises to improve prediction of suicide risk in those vulnerable to suicide and perhaps aiding effective intervention of potentially life-threatening reactions to stress."

A group of 82 participants with major depressive disorder was assessed using two innovative methods. First, a functional MRI (fMRI)-based neural signature for cognitive reappraisal, an emotion regulation strategy, quantified the degree to which individuals engaged emotion regulation while recalling personal negative memories. Next, researchers used ecological momentary assessment (EMA), which involves prospective, repeated measurement of participants' thoughts and emotions in naturalistic settings. EMA provides a window into how individuals react to daily life stressors with changes in mood symptoms and suicidal thoughts. The researchers then used the fMRI-based neural signature of emotion regulation expressed during the autobiographical memory task to predict participants' responses to daily life stressors during the EMA period.

The study found that depressed individuals who spontaneously engaged a neural signature of emotion regulation when presented with personal negative memories also experienced greater increases in suicidal thoughts during day-to-day stressful events over the course of a week. When participants were directed to use reappraisal, they showed more adaptive responses to stress.

Editor-in-Chief of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging Cameron S. Carter, MD, University of California Irvine, comments, "Flexibility in emotion regulation is generally understood to be a marker of psychological health. However, in the current study researchers found that reflexively engaging emotion regulation in the face of unexpected stressors may not be helpful or effective in all circumstances. These findings, which leverage functional imaging combined with real-world in the moment assessments, are important to further our understanding of how to effectively deal with stress in daily life."

Co-first author Noam Schneck, PhD, Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, points out, "The use of neural decoding allows us to identify mental processes that were previously elusive to capture, such as spontaneous emotion regulation. In future work, the decoder approach can be employed to better understand how emotion regulation is engaged spontaneously to modulate hour-to-hour, day-to-day experience, thereby influencing suicide risk in a fluctuating manner."

Senior author of the current study Barbara H. Stanley, MD, Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute; and Department of Psychiatry and Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons, who passed away in 2023, was instrumental in designing this study. Recognizing her valuable contributions to this work, Dr. Mann remarks, "It was Dr. Stanley's idea that we employ ecological momentary assessment in the same depressed patients who completed the fMRI negative autobiographical memories task. It was that combination of research procedures that led to these remarkable findings."