Understanding the emergence of suicidal thoughts and behaviors in adolescence from a brain and behavioral developmental perspective

Suicide is a leading cause of death in adolescents, and a spectrum of suicidal thoughts and behaviors (STBs) is common among teenagers. Adolescence is a transitional period marked by critical brain changes, coinciding with major changes in how teenagers regulate emotions and impulses, as well as in how they understand themselves and interact with others. We review neuroimaging evidence supporting a developmental conceptualization of suicide risk, focusing on neural changes associated with key developmental tasks of adolescence. Functional and structural imaging studies have implicated medial prefrontal, cingulate, dorsolateral prefrontal, orbitofrontal, and frontolimbic circuitry changes in youth with STBs. There is emerging evidence that psychotherapeutic and neuromodulatory interventions can engage these brain processes and modify behavior in at-risk youth. We argue that harnessing these techniques more specifically by using targeted approaches aimed at enhancing emotion regulation, impulse control, positive identity development, and healthy social functioning is a promising way forward for reducing suicide risk in teens. Continued investigation into neural trajectories of suicidality in adolescence is critical for developing more effective risk assessment and treatment approaches to aid suicidal youth in navigating adolescent development and transitioning successfully to adulthood.