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Alterations of insular dynamic functional connectivity and psychological characteristics in unmedicated bipolar depression patients with a recent suicide attempt

Published online by Cambridge University Press:  08 March 2022

Lai Shunkai*
Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Pan Chen
Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
Shuming Zhong
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Guanmao Chen
Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
Yiliang Zhang
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Hui Zhao
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Jiali He
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Ting Su
Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
Shuya Yan
School of Management, Jinan University, Guangzhou, China
Yange Luo
School of Management, Jinan University, Guangzhou, China
Hanglin Ran
School of Management, Jinan University, Guangzhou, China
Yanbin Jia
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
Ying Wang
Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
Authors for correspondence: Yanbin Jia, E-mail:; Ying Wang, E-mail:



Mounting evidence showed that insula contributed to the neurobiological mechanism of suicidal behaviors in bipolar disorder (BD). However, no studies have analyzed the dynamic functional connectivity (dFC) of insular Mubregions and its association with personality traits in BD with suicidal behaviors. Therefore, we investigated the alterations of dFC variability in insular subregions and personality characteristics in BD patients with a recent suicide attempt (SA).


Thirty unmedicated BD patients with SA, 38 patients without SA (NSA) and 35 demographically matched healthy controls (HCs) were included. The sliding-window analysis was used to evaluate whole-brain dFC for each insular subregion seed. We assessed between-group differences of psychological characteristics on the Minnesota Multiphasic Personality Inventory-2. Finally, a multivariate regression model was adopted to predict the severity of suicidality.


Compared to NSA and HCs, the SA group exhibited decreased dFC variability values between the left dorsal anterior insula and the left anterior cerebellum. These dFC variability values could also be utilized to predict the severity of suicidality (r = 0.456, p = 0.031), while static functional connectivity values were not appropriate for this prediction. Besides, the SA group scored significantly higher on the schizophrenia clinical scales (p < 0.001) compared with the NSA group.


Our findings indicated that the dysfunction of insula–cerebellum connectivity may underlie the neural basis of SA in BD patients, and highlighted the dFC variability values could be considered a neuromarker for predictive models of the severity of suicidality. Moreover, the psychiatric features may increase the vulnerability of suicidal behavior.

Original Article
Copyright © The Author(s), 2022. Published by Cambridge University Press

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Lai Shunkai, Pan Chen and Shuming Zhong contributed equally to this work, and are the first co-authors.


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Alterations of insular dynamic functional connectivity and psychological characteristics in unmedicated bipolar depression patients with a recent suicide attempt
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