Examining Causal Pathways to Suicidal Ideation and Nonsuicidal Self-Injury in the Adolescent Brain Cognitive Development Study

Introduction: Suicide is the second leading cause of death in adolescents in the United States. There is an urgent need to advance understanding of risk mechanisms in adolescents to guide early interventions. While prior research has implicated cognition, neural connectivity, and psychopathology in relation to adolescent suicidal ideation (SI) and nonsuicidal self-injury (NSSI), there is a relative lack of clarity regarding the causal structure of these factors, particularly in early adolescence. Methods: Causal discovery analysis was applied to neuroimaging, neurocognition, and clinical assessment data from the baseline visit of the Adolescent Brain Cognitive Development Study when the participants were 9–10 years old (N = 8937; 49.6% female) to produce models of causal relationships. Results: In the discovered model, causal pathways from resting state functional connectivity to externalizing and internalizing psychopathology were observed. Greater externalizing psychopathology increased SI and NSSI. Cognitive performance indirectly increased SI and NSSI via its negative relationship with externalizing psychopathology. Finally, more SI increased NSSI. Conclusions: In this developmental window prior to when the risk of suicide accelerates, it is critical to begin to advance our understanding of the processes that may undergird suicide risk (neural, cognitive performance), features of psychopathology and the potential progression of SI and NSSI (both risk factors for suicide). Future research should incorporate other factors related to SI and NSSI to produce a more comprehensive understanding of the mechanisms of risk. This line of research has the potential for a more comprehensive understanding of risk and provides avenues for prevention.