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Background <p>Alexithymia is implicated in self-harm behaviors, including nonsuicidal self-injury (NSSI), suicide attempt (SA). However,, the neurobiological mechanisms underlying this association remain poorly understood, especially among clinically referred adolescents with depressive symptoms.</p> Methods <p>A total of 129 adolescents with depressive symptoms were recruited from Shenzhen Mental Health Center. NSSI, SA, alexithymia and its dimensions were measured using validated scales. Resting-state functional connectivity (rs-FC) was measured using functional magnetic resonance imaging (fMRI) within a predefined set of emotion regulation (ER)-related regions of interest (ROIs).</p> Results <p>Of the analytic sample, 37 adolescents met the criteria for NSSI and 59 met the criteria for SA. The externally oriented thinking (EOT) subscale scores were positively associated with SA (adjusted OR = 1.21, 95% CI, 1.03–1.43). Adolescents with SA exhibited heightened connectivity within ER regions compared to controls, including between the left orbitofrontal cortex and right medial orbital superior frontal gyrus (z score = 0.19, <i>P</i> &lt; 0.001), left medial orbitofrontal cortex and left inferior occipital gyrus (z score = 0.16; <i>P</i> &lt; 0.001), left dorsolateral prefrontal cortex and right medial orbital of the superior frontal gyrus (z score = 0.17; <i>P</i> &lt; 0.001), right parahippocampal gyrus and right fusiform gyrus (z score = 0.17; <i>P</i> &lt; 0.001), and between the right ventral hippocampus (vHC) and the right fusiform gyrus (FG) (z = 0.17; <i>P</i> &lt; 0.001). Mediation analysis showed that the association between EOT and SA was fully mediated by right vHC-right FG connectivity (indirect effect β = 0.096, 95% CI, 0.027–0.190). No significant associations between alexithymia or rs-FC within ER regions and NSSI were found.</p> Conclusions <p>In clinically referred adolescents with depressive symptoms, EOT-related alexithymia is associated with SA, and this association appears to be fully mediated by enhanced vHC-FG connectivity. The vHC-FG circuit, which plays a key role in ER, may represent a novel neurobiological target for interventions aimed at preventing self-harm behaviors in this vulnerable population.</p>

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Alexithymia and self-harm in depressed adolescents: the mediating role of resting-state functional connectivity of the ventral hippocampal-fusiform gyrus

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Ying Ma,
  • Yongjie Zhou,
  • Huihang Fu,
  • Xiaoyi Lin,
  • Mengxin Huang,
  • Yi Zhang,
  • Yahan Li,
  • Yu Liu,
  • Weiju Zhou,
  • Ruoling Chen,
  • Yaojing Chen,
  • Jieling Wu,
  • Jie Tang

摘要

Background

Alexithymia is implicated in self-harm behaviors, including nonsuicidal self-injury (NSSI), suicide attempt (SA). However,, the neurobiological mechanisms underlying this association remain poorly understood, especially among clinically referred adolescents with depressive symptoms.

Methods

A total of 129 adolescents with depressive symptoms were recruited from Shenzhen Mental Health Center. NSSI, SA, alexithymia and its dimensions were measured using validated scales. Resting-state functional connectivity (rs-FC) was measured using functional magnetic resonance imaging (fMRI) within a predefined set of emotion regulation (ER)-related regions of interest (ROIs).

Results

Of the analytic sample, 37 adolescents met the criteria for NSSI and 59 met the criteria for SA. The externally oriented thinking (EOT) subscale scores were positively associated with SA (adjusted OR = 1.21, 95% CI, 1.03–1.43). Adolescents with SA exhibited heightened connectivity within ER regions compared to controls, including between the left orbitofrontal cortex and right medial orbital superior frontal gyrus (z score = 0.19, P < 0.001), left medial orbitofrontal cortex and left inferior occipital gyrus (z score = 0.16; P < 0.001), left dorsolateral prefrontal cortex and right medial orbital of the superior frontal gyrus (z score = 0.17; P < 0.001), right parahippocampal gyrus and right fusiform gyrus (z score = 0.17; P < 0.001), and between the right ventral hippocampus (vHC) and the right fusiform gyrus (FG) (z = 0.17; P < 0.001). Mediation analysis showed that the association between EOT and SA was fully mediated by right vHC-right FG connectivity (indirect effect β = 0.096, 95% CI, 0.027–0.190). No significant associations between alexithymia or rs-FC within ER regions and NSSI were found.

Conclusions

In clinically referred adolescents with depressive symptoms, EOT-related alexithymia is associated with SA, and this association appears to be fully mediated by enhanced vHC-FG connectivity. The vHC-FG circuit, which plays a key role in ER, may represent a novel neurobiological target for interventions aimed at preventing self-harm behaviors in this vulnerable population.