Alterations of structural-functional coupling in bipolar disorder patients with suicidal ideation correlated with chronotype

Nov 15, 2025Journal of affective disorders

Changes in brain structure-function links in bipolar disorder patients with suicidal thoughts related to sleep-wake patterns

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Abstract

BD-SI patients exhibited a significant evening chronotype shift with pronounced alterations in structural-functional connectivity.

Altered functional connectivity networks were identified among BD-SI, BD-nSI, and healthy controls, involving key brain regions.
BD-SI patients showed reduced structural-functional connectivity coupling in the triangular part of the right inferior frontal gyrus compared to BD-nSI and healthy controls.
Both BD patient groups displayed decreased connectivity in the right olfactory cortex relative to healthy controls.
Increased coupling in the right amygdala was observed in BD-SI patients compared to BD-nSI, though its link to evening chronotype was not statistically significant.

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BACKGROUND: Bipolar disorder (BD) carries high suicidality risk. While suicidal ideation (SI) correlates with evening chronotype, their joint neuroimaging mechanisms remain unclear. Unimodal MRI lacks sensitivity to detect coupled structural-functional abnormalities. We hypothesized BD patients with SI (BD-SI) would exhibit altered structural connectivity-functional connectivity (SC-FC) coupling versus BD patients without SI (BD-nSI) and healthy controls (HC), potentially correlating with chronotype.

METHODS: We recruited 138 BD-SI, 46 BD-nSI, and 280 HC. Resting-state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) data were acquired, and chronotype was assessed by Morningness-Eveningness Questionnaire (MEQ). Structural/functional connectivity and SC-FC coupling were compared across groups. Associations between SI, chronotype, and altered SC-FC coupling were examined in BD-SI group.

RESULTS: We found an altered functional connectivity (FC) network between 3 groups, involving the caudate nucleus, putamen, supplementary motor area, postcentral gyrus, inferior temporal gyrus and fusiform gyrus as important nodes. BD-SI patients demonstrated the most pronounced evening chronotype shift in MEQ total scores. BD-SI patients showed reduced SC-FC coupling in the triangular part of right inferior frontal gyrus (IFGtriang.R) compared to BD-nSI and HC, while both BD subgroups exhibited decreased coupling in the right olfactory cortex (OLF.R) relative to HC. The right amygdala (AMYG.R) displayed increased coupling in BD-SI versus BD-nSI, however, its nominal association with evening chronotype in BD-SI patients did not survive multiple comparisons correction.

CONCLUSION: Our study reveals changes in SC-FC coupling and a significant eveningness chronotype in BD-SI patients. This conjunction of physiological and clinical features warrants further investigation into chronotherapeutic strategies.

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Alterations of structural-functional coupling in bipolar disorder patients with suicidal ideation correlated with chronotype

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