Triple Network Dysconnectivity and Sleep Disturbance in Young People With Suicidal Ideation: Reply to Ferruzzi et al

See letter by Ferruzzi et al and article by Huang et al

To the Editor: Taiwan’s suicide mortality among 15-to 24-year-olds has approximately doubled over the past decade (5.1 per 100,000 in 2014 vs 10.9 in 2023),¹ coinciding with an earlier upswing (2013–2016) in youth-reported insomnia and in suicidal ideation, plans, and attempts.² In our recently published study,³ youth suicidality was related to aberrant functional connectivity (FC) across the canonical triple network, namely, default mode (DMN), salience (SN), and frontoparietal (FPN), indicating network-level dysconnectivity as a key correlate. Ferruzzi et al advanced a synthesis that integrates suicidality-related triple-network dysconnectivity with insomnia and circadian dysregulation, in line with evidence that sleep and circadian disturbances increase suicide risk.⁴ Following this concept that sleep disturbance disrupts triple network integrity,⁵ we examined associations between our study-identified FC features and the Montgomery-Asberg Depression Rating Scale (MADRS) sleep item (Item 4: reduced sleep). Sleep disturbance severity (MADRS Item 4) was positively associated with left posterior parietal cortex (PPC, a hub of FPN)–right gyrus rectus (DMN) connectivity (r =0.195, P=.005) but inversely associated with left amygdala (SN)–right cerebellar Crus II connectivity (r =−0.174, P =.013). In our published paper, relative to youth without current suicidal ideation, those with current ideation showed increased PPC–gyrus rectus FC and diminished amygdala–cerebellar Crus II FC.³ The additional analyses corroborate the integrative model advanced by Ferruzzi et al, linking triple-network dysconnectivity (DMN, SN, FPN) to sleep–circadian disturbance in youth suicidality. Because our data were cross-sectional, causal relationships between sleep–circadian disturbance and suicidality cannot be inferred. Determining whether youth suicide risk can be reduced by targeting triple-network dysfunction (eg, repetitive transcranial magnetic stimulation, low-dose ketamine infusion)^6,7 or by treating insomnia and circadian dysregulation⁸ will require longitudinal cohorts and randomized trials that assess suicidal outcomes.

Article Information

Published Online: March 16, 2026. https://doi.org/10.4088/JCP.26lr16326a
© 2026 Physicians Postgraduate Press, Inc.
J Clin Psychiatry 2026;87(2):26lr16326a
To Cite: Cheng LK, Huang WS, Chen MH. Triple network dysconnectivity and sleep disturbance in young people with suicidal ideation: reply to Ferruzzi et al. J Clin Psychiatry. 2026;87(2):26lr16326a.
Author Affiliations: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan (Cheng, Huang, Chen); Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (Huang, Chen); Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan (Cheng, Chen); Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan (Huang).
Corresponding Author: Mu-Hong Chen, MD, PhD, Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou district, Taipei, 112, Taiwan ([email protected]).
Author Contributions: Drafted the letter: (Cheng and Chen); analyzed the neuroimaging data: (Cheng); performed the literature reviews: (all authors); reviewed the final manuscript and agreed to its publication: (all authors).
Relevant Financial Relationships: The authors report no conflicts of interest.
Funding/Support: The study discussed in this letter was supported by grants from Taipei Veterans General Hospital (V113C-039, V113C-011, V113C-010, V114C-089, V114C-064, V114C-217); Yen Tjing Ling Medical Foundation (CI-113-32, CI-113-30, CI-114-35); Ministry of Science and Technology, Taiwan (MOST111-2314-B-075 -014 -MY2, MOST 111-2314-B-075 -013, NSTC113-2314-B-075-042, NSTC 114-2628-B-A49 -008 -MY3, NSTC114-2314-B-075-022, NSTC114-2314-B-075-023); Taipei, Taichung, Kaohsiung Veterans General Hospital, Tri-Service General Hospital, Academia Sinica Joint Research Program (VTA112-V1-6-1, VTA114-V1-4-1); Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST112-G1-8-1, VGHUST114-G1-9-1); and Cheng Hsin General Hospital (CY11402-1, CY11402-2). The funding sources had no role in any process of the study.
Acknowledgments: The authors thank Mr I-Fan Hu, MA (Courtauld Institute of Art, University of London; National Taiwan University), for his friendship and support. Mr Hu declares no conflicts of interest.
Ethical Considerations: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Taipei Veterans General Hospital. All participants and parents of adolescent subjects gave written informed consent.