Comment on “Perception of social inclusion/exclusion and response inhibition in adolescents with past suicide attempt: a multidomain task-based fMRI study.” by Gifuni et al.

The fMRI study conducted by Gifuni et al. [1] investigates neural responses during social inclusion/exclusion tasks in suicide attempters compared to psychiatric and healthy controls. The authors highlight a significant finding regarding lower activation in the left insula during inclusion vs. control condition (i.e. passive viewing or implicit social exclusion (ISE)), in suicide attempters compared to the control groups. Additionally, they report that higher perception of social exclusion (measured by Need Threat Scale) is correlated with insular activity during inclusion-control contrast. Two critical observations merit consideration in light of these results for further investigation.

Firstly, the decreased insula activation in suicide attempters may be associated with a general processing of negative states rather than a specific impact of social exclusion. Indeed, perception of social exclusion is correlated with insular activity but also with level of depression. Interestingly Caceda et al. [2] found a significant correlation between anterior insula response during inclusion-rest and depression severity.