Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2025; 15(6): 105555
Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.105555
Neural correlates of rumination in remitted depressive episodes: Brain network connectivity and topology analyses
Kang-Ning Li, Shi-Xiong Tang, You-Fu Tao, Hai-Ruo He, Mo-Han Ma, Qian-Qian Zhang, Mei Huang, Wen-Tao Chen, Hui Liang, Ao-Qian Deng, Si-Rui Gao, Fan-Yu Meng, Yi-Lin Peng, Yu-Meng Ju, Wen-Wen Ou, Su Shu, Yan Zhang
Kang-Ning Li, Hai-Ruo He, Mo-Han Ma, Qian-Qian Zhang, Mei Huang, Wen-Tao Chen, Hui Liang, Ao-Qian Deng, Si-Rui Gao, Fan-Yu Meng, Yi-Lin Peng, Yu-Meng Ju, Wen-Wen Ou, Su Shu, Yan Zhang, Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Shi-Xiong Tang, Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
You-Fu Tao, Xiangya Medical School, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Co-first authors: Kang-Ning Li and Shi-Xiong Tang.
Co-corresponding authors: Wen-Wen Ou and Su Shu.
Author contributions: Li KN and Tang SX collected the clinical data and fMRI data, performed data analysis, conducted figure plotting, searched comprehensive literature, and prepared each version of the manuscript. They made equally significant contributions to this project and thus qualified as the co-first authors of the paper. He HR and Tao YF contributed to manuscript editing, including textual revisions and reference validation, and prepared submission. Huang M and Ju YM were responsible for patient screening, enrollment, collection of clinical data. Ma MH, Zhang QQ, Chen WT, Liang H, Gao SR, Meng FY, Peng YL screened patients, acquired clinical data and fMRI data. Deng AQ conducted data quality control and preprocessing for fMRI data. Ou WW and Shu S have played important and indispensable roles in the experimental design, data interpretation and manuscript preparation as the co-corresponding authors. Shu S conceptualized, designed, and supervised the whole process of the project. He performed data analysis, revised and submitted each version of the manuscript. Ou WW was responsible for conceptualization, comprehensive literature search, data interpretation, and preparation of the current version of the manuscript. This collaboration between Shu S and Ou WW is crucial for the publication of this manuscript. Zhang Y and Ju YM applied for and obtained the funds for this research project.
Supported by the National Key Research and Development Program of China, No. 2021ZD0202000; the National Natural Science Foundation of China, No. 82101612 and No. 82471570; the Natural Science Foundation of Hunan Province, China, No. 2022JJ40692; and the Science and Technology Innovation Program of Hunan Province, No. 2021RC2040 and No. 2024RC3056.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Second Xiangya Hospital (No. 2021-022) and registered on ClinicalTrials.gov (NCT05585047).
Informed consent statement: All involved persons gave their informed written consent prior to study inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items—and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author upon reasonable request at shusujy@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su Shu, PhD, Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Furong District, Changsha 410011, Hunan Province, China. shusujy@163.com
Received: February 6, 2025
Revised: March 11, 2025
Accepted: April 21, 2025
Published online: June 19, 2025
Processing time: 113 Days and 2.6 Hours
Abstract
BACKGROUND

Rumination is a critical psychological factor contributing to the relapse of major depressive episodes (MDEs) and a core residual symptom in remitted MDEs. Investigating its neural correlations is essential for developing strategies to prevent MDE relapse. Despite its clinical importance, the brain network mechanisms underlying rumination in remitted MDE patients have yet to be fully elucidated.

AIM

To investigate the brain network mechanism underlying rumination in patients with remitted MDEs using functional magnetic resonance imaging (fMRI).

METHODS

We conducted an fMRI-based rumination-distraction task to induce rumination and distraction states in 51 patients with remitted MDEs. Functional connectivity (FC) was analyzed using the network-based statistic (NBS) approach, and eight topological metrics were calculated to compare the network topological properties between the two states. Correlation analyses were further performed to identify the relationships between individual rumination levels and the significantly altered brain network metrics.

RESULTS

The NBS analysis revealed that the altered FCs between the rumination and distraction states were located primarily in the frontoparietal, default mode, and cerebellar networks. No significant correlation was detected between these altered FCs and individual rumination levels. Among the eight topological metrics, the clustering coefficient, shortest path length, and local efficiency were significantly lower during rumination and positively correlated with individual rumination levels. In contrast, global efficiency was greater in the rumination state than in the distraction state and was negatively correlated with individual rumination levels.

CONCLUSION

Our work revealed the altered FC and topological properties during rumination in remitted MDE patients, offering valuable insights into the neural mechanisms of rumination from a brain network perspective.

Keywords: Neural mechanism; Network topology; Functional connectivity; Rumination; Major depressive episode

Core Tip: Rumination is a key risk factor for relapse in major depressive episode (MDE) patients, yet its neural mechanisms in remitted MDEs remain unclear. Using a rumination induction neuroimaging task, we analyzed brain network alterations during rumination. The alterations in functional connectivity between the rumination and distraction states occurred mainly in the frontoparietal, default mode, and cerebellar networks. Topology analysis revealed that the whole-brain network was more functionally integrated and less segregated during rumination. These altered network topological characteristics were associated with individual rumination levels, providing insights into the neural basis of rumination in remitted MDE patients.