4.8 Review

Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies

Journal

MOLECULAR PSYCHIATRY
Volume 25, Issue 2, Pages 408-427

Publisher

NATURE PUBLISHING GROUP
DOI: 10.1038/s41380-019-0587-x

Keywords

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Funding

  1. MQ Brighter Futures Award [MQBFC/2]
  2. National Institute of Mental Health of the National Institutes of Health [R01MH117601, RC1MH088366, R01MH113230, R61MH111929, T32MH014276, T32DA022975]
  3. NHMRC [1140764]
  4. Royal Society Dorothy Hodgkin Fellowship [DH15017]
  5. MRC MRF emerging leaders award
  6. American Foundation for Suicide Prevention
  7. Brain and Behavior Foundation/NARSAD
  8. Robert E. Leet and Clara M. Guthrie Patterson Trust
  9. Department of Veterans Affairs National Center for PTSD
  10. CSRD CDA2
  11. International Bipolar Foundation
  12. For the Love of Travis Foundation
  13. Women's Health Research at Yale
  14. Women's Health Access Matters

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Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

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