Brain-based predictions of psychiatric illness-linked behaviors across the sexes

Background Individual differences in functional brain connectivity can be used to predict both the presence of psychiatric illness and variability in associated behaviors. However, despite evidence for sex differences in functional network connectivity and in the prevalence, presentation, and trajectory of psychiatric illnesses, the extent to which disorder-relevant aspects of network connectivity are shared or unique across the sexes remains to be determined. Methods In this work, we used predictive modelling approaches to evaluate whether shared or unique functional connectivity correlates underlie the expression of psychiatric illness-linked behaviors in males and females in data from the Adolescent Brain Cognitive Development study (n=5260; 2571 females). Results We demonstrate that functional connectivity profiles predict individual differences in externalizing behaviors in males and females, but only predict internalizing behaviors in females. Furthermore, models trained to predict externalizing behaviors in males generalize to predict internalizing behaviors in females, and models trained to predict internalizing behaviors in females generalize to predict externalizing behaviors in males. Finally, the neurobiological correlates of many behaviors are largely shared within and across sexes: functional connections within and between heteromodal association networks including default, limbic, control, and dorsal attention networks are associated with internalizing and externalizing behaviors as well as attentional deficits. Conclusions Taken together, these findings suggest that shared neurobiological patterns may manifest as distinct behaviors across the sexes. These results highlight the need to consider factors beyond just neurobiology in the diagnosis and treatment of psychiatric illnesses. ### Competing Interest Statement The authors have declared no competing interest.