Psychiatry - Research Publications

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    Multi-site benchmark classification of major depressive disorder using machine learning on cortical and subcortical measures.
    Belov, V ; Erwin-Grabner, T ; Aghajani, M ; Aleman, A ; Amod, AR ; Basgoze, Z ; Benedetti, F ; Besteher, B ; Bülow, R ; Ching, CRK ; Connolly, CG ; Cullen, K ; Davey, CG ; Dima, D ; Dols, A ; Evans, JW ; Fu, CHY ; Gonul, AS ; Gotlib, IH ; Grabe, HJ ; Groenewold, N ; Hamilton, JP ; Harrison, BJ ; Ho, TC ; Mwangi, B ; Jaworska, N ; Jahanshad, N ; Klimes-Dougan, B ; Koopowitz, S-M ; Lancaster, T ; Li, M ; Linden, DEJ ; MacMaster, FP ; Mehler, DMA ; Melloni, E ; Mueller, BA ; Ojha, A ; Oudega, ML ; Penninx, BWJH ; Poletti, S ; Pomarol-Clotet, E ; Portella, MJ ; Pozzi, E ; Reneman, L ; Sacchet, MD ; Sämann, PG ; Schrantee, A ; Sim, K ; Soares, JC ; Stein, DJ ; Thomopoulos, SI ; Uyar-Demir, A ; van der Wee, NJA ; van der Werff, SJA ; Völzke, H ; Whittle, S ; Wittfeld, K ; Wright, MJ ; Wu, M-J ; Yang, TT ; Zarate, C ; Veltman, DJ ; Schmaal, L ; Thompson, PM ; Goya-Maldonado, R ; ENIGMA Major Depressive Disorder working group, (Springer Science and Business Media LLC, 2024-01-11)
    Machine learning (ML) techniques have gained popularity in the neuroimaging field due to their potential for classifying neuropsychiatric disorders. However, the diagnostic predictive power of the existing algorithms has been limited by small sample sizes, lack of representativeness, data leakage, and/or overfitting. Here, we overcome these limitations with the largest multi-site sample size to date (N = 5365) to provide a generalizable ML classification benchmark of major depressive disorder (MDD) using shallow linear and non-linear models. Leveraging brain measures from standardized ENIGMA analysis pipelines in FreeSurfer, we were able to classify MDD versus healthy controls (HC) with a balanced accuracy of around 62%. But after harmonizing the data, e.g., using ComBat, the balanced accuracy dropped to approximately 52%. Accuracy results close to random chance levels were also observed in stratified groups according to age of onset, antidepressant use, number of episodes and sex. Future studies incorporating higher dimensional brain imaging/phenotype features, and/or using more advanced machine and deep learning methods may yield more encouraging prospects.
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    Investigating Associations Between Maternal Behavior and the Development of Functional Connectivity During the Transition From Late Childhood to Early Adolescence.
    Pozzi, E ; Rakesh, D ; Gracia-Tabuenca, Z ; Bray, KO ; Richmond, S ; Seal, ML ; Schwartz, O ; Vijayakumar, N ; Yap, MBH ; Whittle, S (Elsevier BV, 2024-04)
    BACKGROUND: Parenting behavior is thought to affect child brain development, with implications for mental health. However, longitudinal studies that use whole-brain approaches are lacking. In this study, we investigated associations between parenting behavior, age-related changes in whole-brain functional connectivity, and psychopathology symptoms in children and adolescents. METHODS: Two hundred forty (126 female) children underwent resting-state functional magnetic resonance imaging at up to two time points, providing a total of 398 scans covering the age range 8 to 13 years. Parenting behavior was self-reported at baseline. Parenting factors (positive parenting, inattentive parenting, and harsh and inconsistent discipline) were identified based on a factor analysis of self-report parenting questionnaires. Longitudinal measures of child internalizing and externalizing symptoms were collected. Network-based R-statistics was used to identify associations between parenting and age-related changes in functional connectivity. RESULTS: Higher maternal inattentive behavior was associated with lower decreases in connectivity over time, particularly between regions of the ventral attention and default mode networks and frontoparietal and default mode networks. However, this association was not significant after strict correction for multiple comparisons. CONCLUSIONS: While results should be considered preliminary, they suggest that inattentive parenting may be associated with a reduction in the normative pattern of increased network specialization that occurs with age. This may reflect a delayed development of functional connectivity.
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    Concurrent Validity and Reliability of Suicide Risk Assessment Instruments: A Meta-Analysis of 20 Instruments Across 27 International Cohorts
    Campos, AI ; Van Velzen, LS ; Veltman, DJ ; Pozzi, E ; Ambrogi, S ; Ballard, ED ; Banaj, N ; Basgoeze, Z ; Bellow, S ; Benedetti, F ; Bollettini, I ; Brosch, K ; Canales-Rodriguez, EJ ; Clarke-Rubright, EK ; Colic, L ; Connolly, CG ; Courtet, P ; Cullen, KR ; Dannlowski, U ; Dauvermann, MR ; Davey, CG ; Deverdun, J ; Dohm, K ; Erwin-Grabner, T ; Goya-Maldonado, R ; Fani, N ; Fortea, L ; Fuentes-Claramonte, P ; Gonul, AS ; Gotlib, IH ; Grotegerd, D ; Harris, MA ; Harrison, BJ ; Haswell, CC ; Hawkins, EL ; Hill, D ; Hirano, Y ; Ho, TC ; Jollant, F ; Jovanovic, T ; Kircher, T ; Klimes-Dougan, B ; le Bars, E ; Lochner, C ; McIntosh, AM ; Meinert, S ; Mekawi, Y ; Melloni, E ; Mitchell, P ; Morey, RA ; Nakagawa, A ; Nenadic, I ; Olie, E ; Pereira, F ; Phillips, RD ; Piras, F ; Poletti, S ; Pomarol-Clotet, E ; Radua, J ; Ressler, KJ ; Roberts, G ; Rodriguez-Cano, E ; Sacchet, MD ; Salvador, R ; Sandu, A-L ; Shimizu, E ; Singh, A ; Spalletta, G ; Steele, JD ; Stein, DJ ; Stein, F ; Stevens, JS ; Teresi, GI ; Uyar-Demir, A ; van der Wee, NJ ; van der Werff, SJ ; van Rooij, SJH ; Vecchio, D ; Verdolini, N ; Vieta, E ; Waiter, GD ; Whalley, H ; Whittle, SL ; Yang, TT ; Zarate Jr, CA ; Thompson, PM ; Jahanshad, N ; van Harmelen, A-L ; Blumberg, HP ; Schmaal, L ; Renteria, ME (AMER PSYCHOLOGICAL ASSOC, 2023-03)
    OBJECTIVE: A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behavior. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. METHOD: Here, we examine this issue through two approaches: (a) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments and (b) by pooling data (N ∼ 6,000 participants) from cohorts from the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Major Depressive Disorder and ENIGMA-Suicidal Thoughts and Behaviour working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behavior. RESULTS: We observed moderate-to-high correlations between measures, consistent with the wide range (κ range: 0.15-0.97; r range: 0.21-0.94) reported in the literature. Two common multi-item instruments, the Columbia Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation were highly correlated with each other (r = 0.83). Sensitivity analyses identified sources of heterogeneity such as the time frame of the instrument and whether it relies on self-report or a clinical interview. Finally, construct-specific analyses suggest that suicide ideation items from common psychiatric questionnaires are most concordant with the suicide ideation construct of multi-item instruments. CONCLUSIONS: Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behavior but share a modest core factor with single suicidal ideation items. Retrospective, multisite collaborations including distinct instruments should be feasible provided they harmonize across instruments or focus on specific constructs of suicidality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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    The Role of Educational Attainment and Brain Morphology in Major Depressive Disorder: Findings From the ENIGMA Major Depressive Disorder Consortium
    Whittle, S ; Rakesh, D ; Schmaal, L ; Veltman, DJ ; Thompson, PM ; Singh, A ; Gonul, AS ; Aleman, A ; Demir, AU ; Krug, A ; Mwangi, B ; Kramer, B ; Baune, BT ; Stein, DJ ; Grotegerd, D ; Pomarol-Clotet, E ; Rodriguez-Cano, E ; Melloni, E ; Benedetti, F ; Stein, F ; Grabe, HJ ; Volzke, H ; Gotlib, IH ; Nenadic, I ; Soares, JC ; Repple, J ; Sim, K ; Brosch, K ; Wittfeld, K ; Berger, K ; Hermesdorf, M ; Portella, MJ ; Sacchet, MD ; Wu, M-J ; Opel, N ; Groenewold, NA ; Gruber, O ; Fuentes-Claramonte, P ; Salvador, R ; Goya-Maldonado, R ; Sarro, S ; Poletti, S ; Meinert, SL ; Kircher, T ; Dannlowski, U ; Pozzi, E (AMER PSYCHOLOGICAL ASSOC, 2022-08)
    Brain structural abnormalities and low educational attainment are consistently associated with major depressive disorder (MDD), yet there has been little research investigating the complex interaction of these factors. Brain structural alterations may represent a vulnerability or differential susceptibility marker, and in the context of low educational attainment, predict MDD. We tested this moderation model in a large multisite sample of 1958 adults with MDD and 2921 controls (aged 18 to 86) from the ENIGMA MDD working group. Using generalized linear mixed models and within-sample split-half replication, we tested whether brain structure interacted with educational attainment to predict MDD status. Analyses revealed that cortical thickness in a number of occipital, parietal, and frontal regions significantly interacted with education to predict MDD. For the majority of regions, models suggested a differential susceptibility effect, whereby thicker cortex was more likely to predict MDD in individuals with low educational attainment, but less likely to predict MDD in individuals with high educational attainment. Findings suggest that greater thickness of brain regions subserving visuomotor and social-cognitive functions confers susceptibility to MDD, dependent on level of educational attainment. Longitudinal work, however, is ultimately needed to establish whether cortical thickness represents a preexisting susceptibility marker. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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    Empathy and resting-state functional connectivity in children
    Bray, KO ; Pozzi, E ; Vijayakumar, N ; Richmond, S ; Seal, M ; Pantelis, C ; Anderson, V ; Whittle, S (Elsevier BV, 2022-12-01)
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    Harsh and Inconsistent Parental Discipline Is Associated With Altered Cortical Development in Children
    Whittle, S ; Pozzi, E ; Rakesh, D ; Kim, JM ; Yap, MBH ; Schwartz, OS ; Youssef, G ; Allen, NB ; Vijayakumar, N (ELSEVIER, 2022-10)
    BACKGROUND: A growing body of evidence suggests that parenting behaviors may affect child mental health via altering brain development. There is a scarcity of research, however, that has investigated associations between parenting behavior and brain structure using longitudinal magnetic resonance imaging. This study aimed to investigate associations between parenting behaviors and structural brain development across the transition from childhood to adolescence. METHODS: Participants were 246 children who provided 436 magnetic resonance imaging datasets covering the age range from 8 to 13 years. Parents (94% mothers) completed self-report measures of parenting behavior, and both children and parents reported on child mental health. Factor analysis was used to identify dimensions of parental behavior. Linear mixed-effects models investigated associations between parenting behaviors and age-related change in cortical thickness and surface area and subcortical volume. Mediation models tested whether brain changes mediated associations between parenting behaviors and changes in internalizing/externalizing symptoms. RESULTS: Hypothesized associations between parenting and amygdala, hippocampal, and frontal trajectories were not supported. Rather, higher levels of parent harsh/inconsistent discipline were associated with decreases in surface area in medial parietal and temporal pole regions and reduced cortical thinning in medial parietal regions. Some effects were present in female but not male children. There were no associations between these neurodevelopmental alterations and symptoms. CONCLUSIONS: This study provides insight into the links between parenting behavior and child neurodevelopment. Given the functions of implicated regions, findings may suggest that parental harsh/inconsistent discipline affects the development of neural circuits subserving sensorimotor and social functioning in children.
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    Virtual Ontogeny of Cortical Growth Preceding Mental Illness
    Patel, Y ; Shin, J ; Abe, C ; Agartz, I ; Alloza, C ; Alnaes, D ; Ambrogi, S ; Antonucci, LA ; Arango, C ; Arolt, V ; Auzias, G ; Ayesa-Arriola, R ; Banaj, N ; Banaschewski, T ; Bandeira, C ; Basgoze, Z ; Cupertino, RB ; Bau, CHD ; Bauer, J ; Baumeister, S ; Bernardoni, F ; Bertolino, A ; del Mar Bonnin, C ; Brandeis, D ; Brem, S ; Bruggemann, J ; Bulow, R ; Bustillo, JR ; Calderoni, S ; Calvo, R ; Canales-Rodriguez, EJ ; Cannon, DM ; Carmona, S ; Carr, VJ ; Catts, SV ; Chenji, S ; Chew, QH ; Coghill, D ; Connolly, CG ; Conzelmann, A ; Craven, AR ; Crespo-Facorro, B ; Cullen, K ; Dahl, A ; Dannlowski, U ; Davey, CG ; Deruelle, C ; Diaz-Caneja, CM ; Dohm, K ; Ehrlich, S ; Epstein, J ; Erwin-Grabner, T ; Eyler, LT ; Fedor, J ; Fitzgerald, J ; Foran, W ; Ford, JM ; Fortea, L ; Fuentes-Claramonte, P ; Fullerton, J ; Furlong, L ; Gallagher, L ; Gao, B ; Gao, S ; Goikolea, JM ; Gotlib, I ; Goya-Maldonado, R ; Grabe, HJ ; Green, M ; Grevet, EH ; Groenewold, NA ; Grotegerd, D ; Gruber, O ; Haavik, J ; Hahn, T ; Harrison, BJ ; Heindel, W ; Henskens, F ; Heslenfeld, DJ ; Hilland, E ; Hoekstra, PJ ; Hohmann, S ; Holz, N ; Howells, FM ; Ipser, JC ; Jahanshad, N ; Jakobi, B ; Jansen, A ; Janssen, J ; Jonassen, R ; Kaiser, A ; Kaleda, V ; Karantonis, J ; King, JA ; Kircher, T ; Kochunov, P ; Koopowitz, S-M ; Landen, M ; Landro, NI ; Lawrie, S ; Lebedeva, I ; Luna, B ; Lundervold, AJ ; MacMaster, FP ; Maglanoc, LA ; Mathalon, DH ; McDonald, C ; McIntosh, A ; Meinert, S ; Michie, PT ; Mitchell, P ; Moreno-Alcazar, A ; Mowry, B ; Muratori, F ; Nabulsi, L ; Nenadic, I ; Tuura, RO ; Oosterlaan, J ; Overs, B ; Pantelis, C ; Parellada, M ; Pariente, JC ; Pauli, P ; Pergola, G ; Piarulli, FM ; Picon, F ; Piras, F ; Pomarol-Clotet, E ; Pretus, C ; Quide, Y ; Radua, J ; Ramos-Quiroga, JA ; Rasser, PE ; Reif, A ; Retico, A ; Roberts, G ; Rossell, S ; Rovaris, DL ; Rubia, K ; Sacchet, M ; Salavert, J ; Salvador, R ; Sarro, S ; Sawa, A ; Schall, U ; Scott, R ; Selvaggi, P ; Silk, T ; Sim, K ; Skoch, A ; Spalletta, G ; Spaniel, F ; Stein, DJ ; Steinstrater, O ; Stolicyn, A ; Takayanagi, Y ; Tamm, L ; Tavares, M ; Teumer, A ; Thiel, K ; Thomopoulos, SI ; Tomecek, D ; Tomyshev, AS ; Tordesillas-Gutierrez, D ; Tosetti, M ; Uhlmann, A ; Van Rheenen, T ; Vazquez-Bourgon, J ; Vernooij, MW ; Vieta, E ; Vilarroya, O ; Weickert, C ; Weickert, T ; Westlye, LT ; Whalley, H ; Willinger, D ; Winter, A ; Wittfeld, K ; Yang, TT ; Yoncheva, Y ; Zijlmans, JL ; Hoogman, M ; Franke, B ; van Rooij, D ; Buitelaar, J ; Ching, CRK ; Andreassen, OA ; Pozzi, E ; Veltman, D ; Schmaal, L ; van Erp, TGM ; Turner, J ; Castellanos, FX ; Pausova, Z ; Thompson, P ; Paus, T (ELSEVIER SCIENCE INC, 2022-08-15)
    BACKGROUND: Morphology of the human cerebral cortex differs across psychiatric disorders, with neurobiology and developmental origins mostly undetermined. Deviations in the tangential growth of the cerebral cortex during pre/perinatal periods may be reflected in individual variations in cortical surface area later in life. METHODS: Interregional profiles of group differences in surface area between cases and controls were generated using T1-weighted magnetic resonance imaging from 27,359 individuals including those with attention-deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, schizophrenia, and high general psychopathology (through the Child Behavior Checklist). Similarity of interregional profiles of group differences in surface area and prenatal cell-specific gene expression was assessed. RESULTS: Across the 11 cortical regions, group differences in cortical area for attention-deficit/hyperactivity disorder, schizophrenia, and Child Behavior Checklist were dominant in multimodal association cortices. The same interregional profiles were also associated with interregional profiles of (prenatal) gene expression specific to proliferative cells, namely radial glia and intermediate progenitor cells (greater expression, larger difference), as well as differentiated cells, namely excitatory neurons and endothelial and mural cells (greater expression, smaller difference). Finally, these cell types were implicated in known pre/perinatal risk factors for psychosis. Genes coexpressed with radial glia were enriched with genes implicated in congenital abnormalities, birth weight, hypoxia, and starvation. Genes coexpressed with endothelial and mural genes were enriched with genes associated with maternal hypertension and preterm birth. CONCLUSIONS: Our findings support a neurodevelopmental model of vulnerability to mental illness whereby prenatal risk factors acting through cell-specific processes lead to deviations from typical brain development during pregnancy.
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    Maternal warmth is associated with network segregation across late childhood: A longitudinal neuroimaging study
    Richmond, S ; Beare, R ; Johnson, KA ; Bray, K ; Pozzi, E ; Allen, NB ; Seal, ML ; Whittle, S (FRONTIERS MEDIA SA, 2022-09-13)
    The negative impact of adverse experiences in childhood on neurodevelopment is well documented. Less attention however has been given to the impact of variations in "normative" parenting behaviors. The influence of these parenting behaviors is likely to be marked during periods of rapid brain reorganization, such as late childhood. The aim of the current study was to investigate associations between normative parenting behaviors and the development of structural brain networks across late childhood. Data were collected from a longitudinal sample of 114 mother-child dyads (54% female children, M age 8.41 years, SD = 0.32 years), recruited from low socioeconomic areas of Melbourne, Australia. At the first assessment parenting behaviors were coded from two lab-based interaction tasks and structural magnetic resonance imaging (MRI) scans of the children were performed. At the second assessment, approximately 18 months later (M age 9.97 years, SD = 0.37 years) MRI scans were repeated. Cortical thickness (CT) was extracted from T1-weighted images using FreeSurfer. Structural covariance (SC) networks were constructed from partial correlations of CT estimates between brain regions and estimates of network efficiency and modularity were obtained for each time point. The change in these network measures, from Time 1 to Time 2, was also calculated. At Time 2, less positive maternal affective behavior was associated with higher modularity (more segregated networks), while negative maternal affective behavior was not related. No support was found for an association between local or global efficacy and maternal affective behaviors at Time 2. Similarly, no support was demonstrated for associations between maternal affective behaviors and change in network efficiency and modularity, from Time 1 to Time 2. These results indicate that normative variations in parenting may influence the development of structural brain networks in late childhood and extend current knowledge about environmental influences on structural connectivity in a developmental context.
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    ENIGMA HALFpipe: Interactive, reproducible, and efficient analysis for resting-state and task-based fMRI data
    Waller, L ; Erk, S ; Pozzi, E ; Toenders, YJ ; Haswell, CC ; Buettner, M ; Thompson, PM ; Schmaal, L ; Morey, RA ; Walter, H ; Veer, IM (WILEY, 2022-06-15)
    The reproducibility crisis in neuroimaging has led to an increased demand for standardized data processing workflows. Within the ENIGMA consortium, we developed HALFpipe (Harmonized Analysis of Functional MRI pipeline), an open-source, containerized, user-friendly tool that facilitates reproducible analysis of task-based and resting-state fMRI data through uniform application of preprocessing, quality assessment, single-subject feature extraction, and group-level statistics. It provides state-of-the-art preprocessing using fMRIPrep without the requirement for input data in Brain Imaging Data Structure (BIDS) format. HALFpipe extends the functionality of fMRIPrep with additional preprocessing steps, which include spatial smoothing, grand mean scaling, temporal filtering, and confound regression. HALFpipe generates an interactive quality assessment (QA) webpage to rate the quality of key preprocessing outputs and raw data in general. HALFpipe features myriad post-processing functions at the individual subject level, including calculation of task-based activation, seed-based connectivity, network-template (or dual) regression, atlas-based functional connectivity matrices, regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF), offering support to evaluate a combinatorial number of features or preprocessing settings in one run. Finally, flexible factorial models can be defined for mixed-effects regression analysis at the group level, including multiple comparison correction. Here, we introduce the theoretical framework in which HALFpipe was developed, and present an overview of the main functions of the pipeline. HALFpipe offers the scientific community a major advance toward addressing the reproducibility crisis in neuroimaging, providing a workflow that encompasses preprocessing, post-processing, and QA of fMRI data, while broadening core principles of data analysis for producing reproducible results. Instructions and code can be found at https://github.com/HALFpipe/HALFpipe.
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    Brain Correlates of Suicide Attempt in 18,925 Participants Across 18 International Cohorts
    Campos, A ; Thompson, PM ; Veltman, DJ ; Pozzi, E ; van Veltzen, LS ; Jahanshad, N ; Adams, MJ ; Baune, BT ; Berger, K ; Brosch, K ; Bulow, R ; Connolly, CG ; Dannlowski, U ; Davey, CG ; de Zubicaray, G ; Dima, D ; Erwin-Grabner, T ; Evans, JW ; Fu, CHY ; Gotlib, IH ; Goya-Maldonado, R ; Grabe, HJ ; Grotegerd, D ; Harris, MA ; Harrison, BJ ; Hatton, SN ; Hermesdorf, M ; Hickie, IB ; Ho, TC ; Kircher, T ; Krug, A ; Lagopoulos, J ; Lemke, H ; McMahon, K ; MacMaster, FP ; Martin, NG ; McIntosh, AM ; Medland, SE ; Meinert, S ; Meller, T ; Nenadic, I ; Opel, N ; Redlich, R ; Reneman, L ; Repple, J ; Sacchet, MD ; Schmitt, S ; Schrantee, A ; Sim, K ; Singh, A ; Stein, F ; Strike, LT ; van Der Wee, NJA ; van Der Werff, SJA ; Volzke, H ; Waltemate, L ; Whalley, HC ; Wittfeld, K ; Wright, MJ ; Yang, TT ; Zarate, CA ; Schmaal, L ; Renteria, ME (ELSEVIER SCIENCE INC, 2021-08-15)
    BACKGROUND: Neuroimaging studies of suicidal behavior have so far been conducted in small samples, prone to biases and false-positive associations, yielding inconsistent results. The ENIGMA-MDD Working Group aims to address the issues of poor replicability and comparability by coordinating harmonized analyses across neuroimaging studies of major depressive disorder and related phenotypes, including suicidal behavior. METHODS: Here, we pooled data from 18 international cohorts with neuroimaging and clinical measurements in 18,925 participants (12,477 healthy control subjects and 6448 people with depression, of whom 694 had attempted suicide). We compared regional cortical thickness and surface area and measures of subcortical, lateral ventricular, and intracranial volumes between suicide attempters, clinical control subjects (nonattempters with depression), and healthy control subjects. RESULTS: We identified 25 regions of interest with statistically significant (false discovery rate < .05) differences between groups. Post hoc examinations identified neuroimaging markers associated with suicide attempt including smaller volumes of the left and right thalamus and the right pallidum and lower surface area of the left inferior parietal lobe. CONCLUSIONS: This study addresses the lack of replicability and consistency in several previously published neuroimaging studies of suicide attempt and further demonstrates the need for well-powered samples and collaborative efforts. Our results highlight the potential involvement of the thalamus, a structure viewed historically as a passive gateway in the brain, and the pallidum, a region linked to reward response and positive affect. Future functional and connectivity studies of suicidal behaviors may focus on understanding how these regions relate to the neurobiological mechanisms of suicide attempt risk.