OBJECTIVE: To investigate the correlation between the theory of mind and the amplitude difference of low-frequency fluctuations in resting-state fMRI. METHODS: This study included 38 depressed adolescents who had attempted suicide (SU group), 53 depressed patients who had not attempted suicide (NSU group), and 20 healthy controls (HC group). All participants used the 17-item Hamilton Depression Scale. The low-frequency fluctuation amplitude (zALFF) values were calculated using resting-state functional magnetic resonance imaging and compared between the groups. The theory of mind story picture task (theory of mind-picture sequencing task, ToM-PST) were used to test the psychological theory level of the three groups. Statistical analysis of the data was performed using SPSS 25.0. One-way ANOVA was used to compare the differences between the three groups. Pearson correlation analysis was used to explore the correlation between zALFF values and psychological theoretical damage in specific brain regions. RESULTS: Significant zALFF values were found between the three groups (GRF correction), with decreased zALFF values in both the SU and NSU groups compared to HC. In the adolescent SU group, the primary belief, primary false belief, and deception scores were significantly higher than those in the NSU group. The primary false belief, reality, and deception detection scores were significantly lower than those in the HC group (all P <
0. 05). Pearson Correlation analysis showed that the zALFF value of the left dorsolateral superior frontal gyrus was significantly negatively correlated with secondary false beliefs, reciprocity, and the total score. (all P <
0.05). CONCLUSION: Juvenile patients with depressive disorder with suicide attempts showed an ability to understand secondary false beliefs, reciprocity, and total scores. This ability showed a significant negative correlation with low-frequency fluctuation amplitude values in the left dorsolateral superior frontal gyri.