Neural correlates of rumination in psychiatric disorders: A systematic review of fMRI evidence

Clinical Snapshot

Key Findings

• P Value: Not applicable for systematic review

• Effect Size: Not quantified - narrative synthesis only

• Primary Outcome: Neural correlates of rumination across psychiatric disorders

• Nnt Or Sensitivity: Neural signatures persisted in remitted patients, suggesting trait vulnerability markers

• Confidence Interval: Not reported

Clinical Application

Limited immediate clinical application due to research-grade fMRI requirements and methodological heterogeneity Relevant for Australian psychiatrists and psychologists treating mood disorders; may inform future neuroimaging research priorities but not ready for routine clinical use Patients with psychiatric disorders, particularly major depressive disorder, showing ruminative thinking patterns

Abstract

BACKGROUND: Rumination is a transdiagnostic, persistent factor across many psychiatric conditions. Mapping its neural mechanisms may help differentiate ruminative profiles. OBJECTIVE: To systematically review fMRI studies that evaluated rumination in psychiatric populations METHODS: We searched four databases (PubMed, EMBASE, Web of Science, Scopus) and included studies that integrated rumination measures with fMRI data. RESULTS: Thirty-two articles met criteria; most were non-randomized (n = 31, 97%) and focused on depression (n = 24, 75%). Across disorders, clinical groups showed higher rumination than healthy controls, including in euthymic participants. In major depressive disorder, neural alterations implicated the default mode network, limbic and striatal regions, dorsolateral prefrontal cortex, and anterior cingulate cortex consistent with maladaptive ongoing processing. Neural signatures often persisted in remitted patients, suggesting possible trait markers of vulnerability. Intervention studies (n = 7) support using neuroimaging to track ruminative profiles and to inform more personalized interventions. CONCLUSION: This review highlights the importance of examining rumination, here measured via trait questionnaires, state-induction paradigms, cognitive tasks, or resting-state fMRI, using more consistent conceptual and methodological approaches. Although rumination is transdiagnostic, implicated brain regions and networks may show disorder-specific patterns. Given heterogeneity in the literature, future work should prioritize controlled and interventional studies to clarify neural mechanisms and guide circuit-based, targeted treatments. PROSPERO REGISTRATION: #CRD532512.

References

1. 1.Carneiro, A. M., da Silva, V. A., Razza, L. B., Vanderhasselt, M. A., Brunoni, A. R., & da Silva, P. H. R. (2026). Neural correlates of rumination in psychiatric disorders: A systematic review of fMRI evidence. Behavioural Brain Research, 116181. https://doi.org/10.1016/j.bbr.2026.116181