Neural Correlates Associated with Suicide and Non-Suicidal Self-Injury in Youth

• Published in: Biological psychiatry (1969) Vol. 89; no. 2; pp. 119 - 133
• Main Authors: Auerbach, Randy P., Pagliaccio, David, Allison, Grace O., Alqueza, Kira L., Alonso, Maria Fernanda
• Format: Journal Article
• Language: English
• Published: 10-06-2020
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2020.06.002

There is no definitive neural marker of suicidal thoughts and behaviors (STB) or non-suicidal self-injury (NSSI), and relative to adults, research in youth is more limited. This comprehensive review focuses on magnetic resonance imaging (MRI) studies reporting structural and functional neural correlates of STB and NSSI in youth to: (i) elucidate shared and independent neural alternations, (ii) clarify how developmental processes may interact with neural alterations to confer risk, and (iii) provide recommendations based on convergence across studies. Forty-seven articles were reviewed (STB = 27; NSSI = 20), and notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years. Structural MRI research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STB, and there is reduced anterior cingulate cortex volume related to STB and NSSI. With regard to functional alterations, blunted striatal activation may characterize STB and NSSI youth, and there is reduced frontolimbic task-based connectivity in suicide ideators and attempters. Resting state functional connectivity findings highlight reduced positive connectivity between the default mode network and salience network in attempters, and self-injurers exhibit frontolimbic alterations. Together, suicidal and non-suicidal behaviors are related to top-down and bottom-up neural alterations, which may compromise approach, avoidance, and regulatory systems. Future longitudinal research with larger and well-characterized samples, especially those integrating ambulatory stress assessments, will be well-positioned to identify novel targets that may improve early identification and treatment for youth with STB and NSSI.