Resilience in the face of risk: A systematic review of neuroimaging studies in individuals at risk for mood disorders.

Abstract

Mood disorders including major depressive disorder and bipolar disorder are among the leading causes of disability worldwide, often emerging early in life and following chronic, relapsing courses. The development of these disorders is influenced by a range of familial, environmental, clinical, and genetic risk factors. In recent years, neuroimaging techniques have played a key role in identifying biomarkers of vulnerability among individuals at elevated risk, with the goal of improving early detection and preventive interventions. This systematic review aimed to consolidate neuroimaging findings in populations vulnerable to mood disorders, with a particular focus on resilience as a complementary framework to risk, the latter having historically received far more research attention. Following PRISMA 2020 guidelines, we searched PubMed, Embase, and Scopus, applying an independent duplicate screening process to identify relevant studies based on predefined inclusion and exclusion criteria. A total of 31 studies met the inclusion criteria, spanning structural MRI (sMRI), functional MRI (fMRI), and diffusion MRI (dMRI). Synthesis of these findings highlights neurobiological markers of resilience, including preserved task-related and resting-state fronto-limbic function, enhanced connectivity within neural circuits supporting emotion regulation, and structural integrity in prefrontal regions that may underlie adaptive functioning in individuals at high risk for mood disorders.