Comparative meta-analysis of task-related functional brain abnormalities in nonsuicidal self-injury and suicide attempt

Background: Nonsuicidal self-injury (NSSI) and suicide attempt (SA) are two major self-injurious behaviors causing substantial suffering and socioeconomic burden. However, it remains unclear whether NSSI and SA are characterized by common or distinct brain dysregulations. Here, we aimed to identify shared and separable neurofunctional alterations during task engagement between NSSI and SA. Method: A coordinate-based meta-analysis was employed using Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) by capitalizing on task-based functional magnetic resonance imaging (fMRI) studies comparing the brain activation between NSSI/SA individuals and controls. Result: The search identified 10 studies for NSSI (n = 200, mean age: 22.89 years) and 16 studies for SA (n = 343, mean age: 28.65 years). After threshold-free cluster enhancement correction, NSSI individuals exhibited increased right amygdala activation relative to both controls and the SA group, as well as heightened left middle frontal gyrus and reduced left paracentral lobule activation compared to the SA group. No significant activation differences were found between SA and controls, though a less conservative threshold revealed increased left postcentral gyrus activation in the SA group. No shared functional abnormalities were identified between NSSI and SA under either corrected or uncorrected thresholds. Importantly, subgroup analyses revealed that the neurofunctional abnormalities in NSSI were primarily driven by adolescent cohorts, whereas no significant clusters emerged for the SA group across age-stratified analyses. Conclusion: These results suggest that neurofunctional abnormalities are evident in adolescent NSSI, particularly in fronto-limbic regions, with no robust findings in adult NSSI or SA subgroups. This highlights a unique developmental trajectory that necessitates age-tailored risk assessment and interventions for self-injurious behaviors.