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Cited by 204Suicide and Self-Harm StudiesNeural and Behavioral Psychology StudiesMental Health via Writing

Neural correlates associated with suicide and nonsuicidal self-injury in youth

Open access
Auerbach, Randy P., Pagliaccio, David, Allison, Grace O., Alqueza, Kira L., Alonso, Maria Fernanda·2021·Biological Psychiatry
DOI 10.1016/j.biopsych.2020.06.002PMC PMC7726029
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Abstract

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.

AI snapshot

Written from the paper’s full text.

TL;DR

This comprehensive review of 47 MRI studies (STB = 27; NSSI = 20) finds no definitive neural marker but modest convergence in structural and functional alterations linked to suicidal thoughts/behaviors and nonsuicidal self-injury in youth. Shared findings include reduced ventral prefrontal/orbitofrontal and anterior cingulate volumes, blunted striatal activation, and altered frontolimbic connectivity, with recommendations for longitudinal, well-characterized samples.

Key findings

  • Across 47 articles, structural MRI suggests reduced ventral prefrontal and orbitofrontal cortex volume among youth reporting STB, and reduced anterior cingulate cortex volume related to both STB and NSSI.
  • Functional alterations include blunted striatal activation in STB and NSSI youth, reduced frontolimbic task-based connectivity in suicide ideators and attempters, reduced positive resting-state connectivity between the default mode network and salience network in attempters, and frontolimbic alterations in self-injurers.
  • The review notes 63% of STB articles and 45% of NSSI articles were published in the previous 3 years; prevalence context includes 12.1% of adolescents thinking about suicide, 4.1% attempting, and 15–20% reporting lifetime NSSI.
  • Suicidal and non-suicidal behaviors are related to top-down and bottom-up neural alterations that may compromise approach, avoidance, and regulatory systems.

Methods

  • PubMed and Google Scholar search through January 15, 2020, using MRI/fMRI/functional connectivity/resting-state terms combined with suicide, suicide attempt, suicidal ideation, suicidal behavior, non-suicidal self-injury, parasuicidal behaviors, and self-harm; inclusion required English-language peer-reviewed articles, participants under age 26, lifetime STB and/or NSSI, and structural, functional, or resting-state MRI.
  • Narrative review of 47 articles (STB = 27; NSSI = 20); most participants reported lifetime major depressive disorder, bipolar disorder, and/or borderline personality disorder; most STB studies compared attempters with psychiatric or healthy comparison groups, few compared attempters with ideators, and the vast majority of research was cross-sectional.
  • No pooled meta-analytic estimate of effects was provided.

Limitations

  • The paper states there are no definitive neural markers of STB or NSSI; heterogeneity in methods, sample overlap (NSSI youth in STB studies and STB youth in NSSI studies), and inconsistent reporting of STB/NSSI histories make it unclear whether effects reflect the targeted behaviors or underlying mental disorders.
  • The paper states small samples are ill-equipped to explore age, sex, and gender effects, longitudinal research is scant, and there is insufficient evidence for discrete neural circuitry underlying sex differences; it recommends larger diverse samples, interview-based assessments, attempter-versus-ideator comparisons, longitudinal ambulatory stress assessments, and multimodal imaging.
  • Evident from the text: the review is narrative rather than meta-analytic, the search ended January 15, 2020, and cross-sectional designs dominate, so conclusions are qualitative convergence rather than pooled effect estimates.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.biopsych.2020.06.002

Cites

146 of 146 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 180 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Suicide ideators and attempters show reduced frontolimbic task-based connectivity.

    “there is reduced frontolimbic task-based connectivity in suicide ideators and attempters.”
    • Also stated in: § Discussion · plain
      “there is reduced frontolimbic connectivity in suicide ideators and attempters (75).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Alarcón, 2019, Amygdala functional connectivity during self-face processing in depressed adolescents with recent suicide attempt, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • Findingcitation

    Youth with NSSI show frontolimbic alterations.

    “self-injurers exhibit frontolimbic alterations.”
    • Also stated in: § Discussion · hedged
      “for NSSI behaviors, growing evidence implicates frontolimbic alterations (96).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Schreiner, 2017, Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity, J Affect Disord source

      Not checked in the free run.

  • Findingcitation

    Structural MRI evidence indicates reduced ventral prefrontal and orbitofrontal cortex volume in youth reporting STB.

    “Structural MRI research suggests reduced volume in the ventral prefrontal and orbitofrontal cortices among youth reporting STB”
    • Also stated in: § Discussion · plain
      “First, reduced VPFC and OFC volume associates with STB (53–55)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [53] Johnston, 2017, Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [54] Fan, 2019, Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders, J Affect Disord source

      Not checked in the free run.

    • cites [55] Huber, 2019, Reduced lateral orbitofrontal cortex volume and suicide behavior in youth with bipolar disorder, Bipolar Disord source

      Not checked in the free run.

  • Findingcitation

    Blunted striatal activation may characterize youth with STB and NSSI.

    “blunted striatal activation may characterize STB and NSSI youth”
    • Also stated in: § Discussion · plain
      “Second, blunted striatal activation characterizes STB (82) and NSSI (92)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [82] Harms, 2019, Adolescent suicide attempts and ideation are linked to brain function during peer interactions, Psychiatry Res Neuroimaging source

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    • cites [92] Sauder, 2016, Neural responses to monetary incentives among self-injuring adolescent girls, Dev Psychopathol source

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  • Findingcitation

    Reduced anterior cingulate cortex volume is associated with STB and NSSI in youth.

    “there is reduced anterior cingulate cortex volume related to STB and NSSI.”
    • Also stated in: § Discussion · plain
      “there is reduced volume in the ACC for youth reporting STB (59) and NSSI (64, 69).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [59] Goodman, 2011, Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression, J Psychiatr Res source

      Not checked in the free run.

    • cites [64] Ando, 2018, Regional grey matter volume reduction in adolescents engaging in non-suicidal self-injury, Psychiatry Res Neuroimaging source

      Not checked in the free run.

    • cites [69] Whittle, 2009, Anterior cingulate volume in adolescents with first-presentation borderline personality disorder, Psychiatry Res source

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  • May combine two claims. 54
  • Classified as probably not a substantial claim. 12
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The review included 47 articles, 27 on STB and 20 on NSSI.

    “Forty-seven articles were reviewed (STB = 27; NSSI = 20)”
    • Also stated in: § Results · plain
      “Forty-seven articles satisfy inclusion criteria (STB = 27; NSSI = 20; Figure 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A large proportion of STB and NSSI articles were published in the previous three years, 63% and 45% respectively.

    “notably, 63% of STB articles and 45% of NSSI articles were published in the previous 3 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    On a response inhibition task, non-attempters exhibit greater right ACC activation relative to attempters but not healthy controls.

    “non-attempters exhibit greater activation within the right ACC relative to attempters but not healthy controls (78).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Pan, 2011, Dissociable patterns of neural activity during response inhibition in depressed adolescents with and without suicidal behavior, J Am Acad Child Adolesc Psychiatry source

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  • May combine two claims.

    Findingcitation

    Non-attempters show greater left hippocampal activation during low-risk but not high-risk decisions relative to healthy adolescents and suicide attempters during an Iowa Gambling Task, but this does not survive correction.

    “Although non-attempters show greater left hippocampal activation during low-risk (but not high-risk) decisions relative to healthy adolescents and suicide attempters during an Iowa Gambling Task (77), it does not survive post-hoc correction for multiple comparisons.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Pan, 2013, Preserved hippocampal function during learning in the context of risk in adolescent suicide attempt, Psychiatry Res source

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  • Classified as probably not a substantial claim.

    Findingreasoning

    It is unclear whether PFC differences reflect suicide attempts specifically or underlying mental disorders more broadly.

    “It also is unclear whether results reflect attempts specifically or the underlying mental disorders more broadly.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    NSSI samples are usually compared with psychiatric or healthy youth, and some studies examine correlates only among NSSI youth.

    “NSSI samples are typically compared with either psychiatric or healthy youth, with some research testing correlates among NSSI youth only.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Compared to low ideators and controls, high ideators including attempters show reduced insula and putamen activation across conditions, but subsequent analyses indicate increased ACC, superior frontal gyrus, and middle frontal gyrus activation among attempters versus ideators.

    “compared to low ideators and controls, high ideators (including attempters) show reduced activation in the insula and putamen across conditions, but subsequent analyses indicate a pattern of increased activation in the ACC, superior frontal gyrus, and middle frontal gyrus among attempters versus ideators (82).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Harms, 2019, Adolescent suicide attempts and ideation are linked to brain function during peer interactions, Psychiatry Res Neuroimaging source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Compared with healthy controls, self-injurers show reduced insula gray matter volume, but this is not substantiated in BPD youth reporting parasuicidal behaviors.

    “In comparison to healthy controls, self-injurers show reduced insula GMV (62, 64), but this is not substantiated in BPD youth reporting parasuicidal behaviors (65).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [62] Beauchaine, 2019, Self-injuring adolescent girls exhibit insular cortex volumetric abnormalities that are similar to those seen in adults with borderline personality disorder, Dev Psychopathol source

      Not checked in the free run.

    • cites [64] Ando, 2018, Regional grey matter volume reduction in adolescents engaging in non-suicidal self-injury, Psychiatry Res Neuroimaging source

      Not checked in the free run.

    • cites [65] Takahashi, 2009, Insular cortex volume and impulsivity in teenagers with first-presentation borderline personality disorder, Prog Neuropsychopharmacol Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    BD suicide attempters have reduced hippocampal and bilateral cerebellum gray matter volume compared to BD non-attempters.

    “Outside of the PFC, BD suicide attempters have reduced hippocampal (53, 54) and bilateral cerebellum (53) GMV compared to BD non-attempters.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [53] Johnston, 2017, Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [54] Fan, 2019, Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Greater connectivity with rostral ACC during self versus other face trials is found for left amygdala in attempters compared to all groups, but for right amygdala in high ideators relative to low ideators and controls.

    “Greater connectivity with the rostral ACC during self versus other face trials also is found for the left amygdala in attempters (compared to all groups) but right amygdala in high ideators (relative to low ideators and controls) (75).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Alarcón, 2019, Amygdala functional connectivity during self-face processing in depressed adolescents with recent suicide attempt, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Among adolescents with BPD, more lifetime parasuicidal behaviors in the past 6 months associates with smaller left ACC volume, consistent with findings comparing past-year self-injurers and healthy youth.

    “Among adolescents with BPD, a greater number of lifetime parasuicidal behaviors in the past 6 months associates with smaller left ACC volume (69), consistent with findings comparing past-year self-injurers and healthy youth (64).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Whittle, 2009, Anterior cingulate volume in adolescents with first-presentation borderline personality disorder, Psychiatry Res source

      Not checked in the free run.

    • cites [64] Ando, 2018, Regional grey matter volume reduction in adolescents engaging in non-suicidal self-injury, Psychiatry Res Neuroimaging source

      Not checked in the free run.

  • The quote only partly states this claim.

    Findingnone given

    The vast majority of research is cross-sectional.

    “The vast majority of research is cross-sectional.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    MDD suicide attempters show increased OFC gray matter volume in left BA47 relative to MDD non-attempters and BD attempters and non-attempters.

    “MDD suicide attempters exhibit increased OFC GMV (left BA47) relative to MDD non-attempters as well as BD attempters and non-attempters (54).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Fan, 2019, Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    BD suicide attempters show reduced OFC thickness, and reduced OFC volume correlates negatively with suicide ideation severity and attempt lethality.

    “There is evidence of reduced OFC thickness among BD suicide attempters, and reduced OFC volume negatively correlates with suicide ideation severity and attempt lethality (55).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [55] Huber, 2019, Reduced lateral orbitofrontal cortex volume and suicide behavior in youth with bipolar disorder, Bipolar Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    MDD attempters have reduced right superior temporal gyrus gray matter volume relative to healthy adolescents but not relative to MDD non-attempters.

    “MDD attempters have reduced right superior temporal gyrus (STG) GMV relative to healthy adolescents but not compared to MDD non-attempters (60, 61).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [60] McLellan, 2018, History of suicide attempt and right superior temporal gyrus volume in youth with treatment-resistant major depressive disorder, J Affect Disord source

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    • cites [61] Pan, 2015, Right superior temporal gyrus volume in adolescents with a history of suicide attempt, Br J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Because most NSSI participants reported a lifetime suicide attempt, it cannot be determined whether ACC effects are specific to NSSI.

    “most NSSI participants (55.2%) reported a lifetime suicide attempt, and given prior work linking anterior ACC volume to suicidal behaviors (59), we cannot determine whether effects are specific to NSSI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] Goodman, 2011, Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression, J Psychiatr Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Amygdala-seed PPI connectivity is elevated in high ideators and attempters relative to low ideation in DLPFC, dorsomedial PFC, and precuneus; connectivity with inferior parietal lobule is elevated in high ideation compared to low ideation and attempters.

    “Amygdala-seed PPI connectivity is elevated in the high ideators and attempters relative to the low ideation group in the DLPFC, dorsomedial PFC, and precuneus, and by contrast, connectivity with inferior parietal lobule is elevated in the high ideation group compared to low ideation and attempters.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Alarcón, 2019, Amygdala functional connectivity during self-face processing in depressed adolescents with recent suicide attempt, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Other research found no relationship between NSSI and OFC, midline structures, or STG.

    “Other research found no relationship with the OFC (66), midline structures (67), or STG (68).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [66] Chanen, 2008, Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder, Psychiatry Res source

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    • cites [67] Takahashi, 2009, Midline brain structures in teenagers with first-presentation borderline personality disorder, Prog Neuropsychopharmacol Biol Psychiatry source

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    • cites [68] Takahashi, 2010, Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder, Psychiatry Res source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    It is unclear whether cingulate findings are driven by suicide attempts or overall mental disorder severity.

    “Yet, it is not clear if this is driven by suicide attempts or overall mental disorder severity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In an expanded sample of depressed youth, suicide ideation severity associates with greater connectivity between a right precuneus seed and cerebellum and right IFG, and lower connectivity between a left PCC seed and cerebellum and cingulate.

    “within-group analyses show that suicide ideation severity associates with greater connectivity between a right precuneus seed and cerebellum and right IFG, as well as lower connectivity between a left PCC seed and cerebellum and cingulate (101).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [101] Schreiner, 2019, Neural correlates of suicidality in adolescents with major depression: Resting-state functional connectivity of the precuneus and posterior cingulate cortex, Suicide Life Threat Behav source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Medial PFC-amygdala connectivity correlates with change in suicidal ideation but not suicidal behavior following treatment.

    “Medial PFC-amygdala connectivity also correlates with change in suicidal ideation but not suicidal behavior following treatment (109).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [109] Santamarina-Perez, 2019, Fronto-limbic connectivity as a predictor of improvement in nonsuicidal self-injury in adolescents following psychotherapy, J Child Adolesc Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    During a gender-judgement emotional face task, BD attempters exhibit reduced bilateral amygdala connectivity to left VPFC across happy and neutral conditions and to right rostral PFC for neutral faces versus baseline.

    “During a gender-judgement emotional face task, BD attempters exhibit reduced bilateral amygdala connectivity to the left VPFC (across happy and neutral conditions) and to the right rostral PFC for neutral faces versus baseline.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Johnston, 2017, Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    NSSI and healthy youth show divergent amygdala task-connectivity, but it is unclear whether this reflects NSSI or MDD or other comorbid disorders.

    “However, NSSI and healthy youth show divergent amygdala task-connectivity, but it is not clear whether this reflects NSSI or MDD (or other comorbid disorders) (96).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [96] Schreiner, 2017, Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Relative to depressed adolescents, depressed self-injurers show increased activation in medial PFC, ventrolateral PFC, and parahippocampus during exclusion versus inclusion trials, suggesting self-injurers may view social exclusion more negatively.

    “Relative to depressed adolescents, depressed self-injurers show increased activation in the medial PFC, ventrolateral PFC, and parahippocampus during exclusion versus inclusion trials; suggesting that self-injurers may view social exclusion more negatively (88) (c.f., (89)).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [88] Groschwitz, 2016, Differential neural processing of social exclusion in adolescents with non-suicidal self-injury: An fMRI study, Psychiatry Res Neuroimaging source

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    • cites [89] Perini, 2019, Brain-based classification of negative social bias in adolescents with nonsuicidal self-injury: Findings from simulated online social interaction, EClinicalMedicine source

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    Findingcitation

    Cullen and colleagues found depression-related differences in amygdala seed-based resting-state functional connectivity, but this was not related to suicide severity.

    “Cullen and colleagues identify depression-related differences in amygdala seed-based resting state functional connectivity (RSFC), but this is not related to suicide severity (100).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Cullen, 2014, Abnormal amygdala resting-state functional connectivity in adolescent depression, JAMA Psychiatry source

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  • May combine two claims.

    Findingcitation

    Healthy controls show anterior insula activation varying with increasing electrical stimuli intensity, but among self-injurers this association is blunted.

    “Healthy controls exhibit anterior insula activation varying with increasing electrical stimuli intensity, but among self-injurers, this association is blunted (99).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Bonenberger, 2015, Differential neural processing of unpleasant haptic sensations in somatic and affective partitions of the insula in non-suicidal self-injury (NSSI), Psychiatry Res source

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  • May combine two claims.

    Findingcitation

    Reductions in NSSI frequency post-treatment associate with greater negative amygdala-ACC, greater amygdala-brainstem/parahippocampal gyrus, reduced positive medial PFC-amygdala/striatum, and more negative medial PFC-intracalcarine cortex RSFC.

    “Reductions in NSSI frequency post-treatment associate with greater negative amygdala-ACC, greater amygdala-brainstem/parahippocampal gyrus, reduced positive medial PFC-amygdala/striatum, and more negative medial PFC-intracalcarine cortex RSFC.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Santamarina-Perez, 2019, Fronto-limbic connectivity as a predictor of improvement in nonsuicidal self-injury in adolescents following psychotherapy, J Child Adolesc Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Relative to healthy adolescents, youth with NSSI history show reduced amygdala-seed connectivity with ACC and a cluster spanning right planum temporale and right insula, and reduced medial PFC connectivity with precentral/postcentral gyri and left insula.

    “relative to healthy adolescents, youth with an NSSI history show reduced amygdala-seed connectivity with the ACC and a cluster spanning right planum temporale and right insula, as well as reduced medial PFC connectivity with the precentral/postcentral gyri and left insula.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [109] Santamarina-Perez, 2019, Fronto-limbic connectivity as a predictor of improvement in nonsuicidal self-injury in adolescents following psychotherapy, J Child Adolesc Psychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Compared to psychiatric controls, attempters show increased connectivity between an ICA-derived DMN component and cerebellum and lingual gyrus, and decreased connectivity with precuneus.

    “Compared to psychiatric controls, attempters show increased connectivity between an ICA-derived DMN component and the cerebellum and lingual gyrus, and decreased connectivity with precuneus.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [102] Zhang, 2016, Association between abnormal default mode network activity and suicidality in depressed adolescents, BMC Psychiatry source

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    • cites [103] Cao, 2020, Altered resting-state functional network connectivity is associated with suicide attempt in young depressed patients, Psychiatry Res source

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  • May combine two claims.

    Findingcitation

    Relative to healthy females, adolescents with NSSI history exhibit reduced left amygdala-seed RSFC with a cluster spanning ACC and SMA, and increased RSFC with angular gyrus and a temporal gyrus cluster.

    “Relative to healthy females, adolescents with an NSSI history exhibit reduced left amygdala-seed RSFC with a cluster spanning ACC and supramarginal gyrus (SMA), as well as increased RSFC with angular gyrus and a temporal gyrus cluster (96).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Schreiner, 2017, Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity, J Affect Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Within the attempter group, suicidal ideation negatively correlates with amygdala-right rostral PFC connectivity, and attempt lethality negatively correlates with amygdala-left VPFC connectivity.

    “Within the attempter group, suicidal ideation negatively correlates with amygdala-right rostral PFC connectivity, and attempt lethality negatively correlates with amygdala-left VPFC connectivity (53).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] Johnston, 2017, Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder, Am J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Among youth at high risk for NSSI based on thoughts but without self-injurious behavior history, there is greater bilateral putamen activation following reward receipt compared to low-risk youth, suggesting hypersensitivity to reward.

    “Among youth at high risk for NSSI (based on thoughts) but without any history of self-injurious behaviors, there is greater bilateral putamen activation following reward receipt compared to youth at low-risk for NSSI, suggesting hypersensitivity to reward (93).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [93] Poon, 2019, Adolescents' reward-related neural activation: Links to thoughts of nonsuicidal self-injury, Suicide Life Threat Behav source

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    Findingcitation

    Young adults with lifetime attempt history but no current mental disorders show greater regional homogeneity in MFG, parietal lobe, and precuneus, and reduced ReHo in cerebellum, fusiform, hippocampus, parahippocampal gyrus, angular gyrus, IFG, and MFG compared to healthy controls.

    “Young adults with a lifetime attempt history but no current mental disorders show greater regional homogeneity (ReHo; measuring local synchrony) in the middle frontal gyrus (MFG), parietal lobe, and precuneus, and reduced ReHo in the cerebellum, fusiform, hippocampus, parahippocampal gyrus, angular gyrus, IFG, and MFG compared to healthy controls (106).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [106] Cao, 2015, Abnormal regional homogeneity in young adult suicide attempters with no diagnosable psychiatric disorder: A resting state functional magnetic imaging study, Psychiatry Res source

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  • May combine two claims.

    Findingown data

    The resting-state MRI literature on adolescent STB and NSSI is smaller than structural and task-based fMRI, and interpretations are challenging due to mixed methods and results.

    “The resting state MRI literature on adolescent STB and NSSI is smaller relative to structural and task-based fMRI, and interpretations are challenging given mixed methods and results (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Across ICA networks, patients with an attempt history show reduced positive RSFC between anterior DMN and salience network, less negative anterior DMN-right fronto-parietal network connectivity, and increased right FPN-SN and DMN-cerebellum connectivity compared to patients without attempt history.

    “Across ICA networks, however, there is reduced positive RSFC between the anterior portion of the DMN and the salience network (SN), less negative anterior DMN-right fronto-parietal network connectivity, as well as increased right FPN-SN and DMN-cerebellum connectivity in patients with versus without an attempt history (102, 103).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [102] Zhang, 2016, Association between abnormal default mode network activity and suicidality in depressed adolescents, BMC Psychiatry source

      Not checked in the free run.

    • cites [103] Cao, 2020, Altered resting-state functional network connectivity is associated with suicide attempt in young depressed patients, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In NSSI youth undergoing an 8-week open-label N-acetylcysteine trial, reductions in NSSI frequency after treatment associate with decreases in left amygdala-right SMA and right nucleus accumbens-left superior medial frontal cortex RSFC, and increases in right amygdala-right inferior frontal cortex RSFC.

    “Reductions in NSSI frequency after treatment associate with decreases in left amygdala-right SMA and right nucleus accumbens-left superior medial frontal cortex RSFC, and increases in right amygdala-right inferior frontal cortex RSFC (108).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [108] Cullen, 2020, Neural correlates of clinical improvement in response to N-acetylcysteine in adolescents with non-suicidal self-injury, Prog Neuropsychopharmacol Biol Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Sex differences in STB and NSSI are well documented, but there is insufficient evidence showing discrete neural circuitry underlying these effects.

    “Although sex differences in STB and NSSI are well documented (4, 5, 7), there is insufficient evidence showing discrete neural circuitry underlying these effects.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] Nock, 2013, Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement, JAMA Psychiatry source

      Not checked in the free run.

    • cites [5] McKean, 2018, Rethinking lethality in youth suicide attempts: First suicide attempt outcomes in youth ages 10 to 24, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [7] Swannell, 2014, Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression, Suicide Life Threat Behav source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingnone given

    Longitudinal research in this area is scarce.

    “Fourth, longitudinal research is scant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Suicidal thinking may be worsened by alterations in DLPFC, IFG, rostral PFC, and dACC because these regions support cognitive control, flexibility, and decision-making.

    “Suicidal thinking may then be exacerbated by dorsolateral prefrontal cortex (DLPFC), inferior frontal gyrus (IFG), rostral prefrontal cortex (PFC), and dorsal anterior cingulate cortex (dACC) alterations, as this directly bears on effective cognitive control, flexibility, and decision-making (35).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Blakemore, 2012, Decision-making in the adolescent brain, Nat Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    When all three systems are compromised, compensatory strategies such as future-oriented thinking and cognitive flexibility are undermined, increasing tendency toward suicidal and non-suicidal behaviors.

    “when each system is compromised, it undermines the capacity to engage in compensatory strategies (e.g., future-oriented thinking, cognitive flexibility) that would otherwise limit the tendency to engage in suicidal and non-suicidal behaviors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Motivations for suicidal versus non-suicidal behaviors may differ, possibly explaining why NSSI often stops in adulthood while STB may persist.

    “the motivation for engaging in suicidal (e.g., intolerance of psychological pain (10); perceived burdensomeness (11)) versus non-suicidal behaviors (e.g., self-punishment (12); social signaling (13)) also may differ, perhaps influencing why NSSI often desists in adulthood (14), whereas STB may persist (15, 16).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Plener, 2015, The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature, Borderline Personal Disord Emot Dysregul source

      Not checked in the free run.

    • cites [15] Séguin, 2014, Developmental model of suicide trajectories, Br J Psychiatry source

      Not checked in the free run.

    • cites [16] Borges, 2008, Risk factors for the incidence and persistence of suicide-related outcomes: A 10-year follow-up study using the National Comorbidity Surveys, J Affect Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the triadic model, approach is guided by ventral striatum, avoidance by amygdala, and regulation by prefrontal cortex.

    “Within the triadic model of motivated behavior, the approach system is guided by the ventral striatum, the avoidance system is largely controlled by the amygdala, and the regulatory system—generally managed by the prefrontal cortex—is believed to balance approach and avoidance behaviors (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Ernst, 2006, Triadic model of the neurobiology of motivated behavior in adolescence, Psychol Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Casey and colleagues have argued that risky youth behavior arises from earlier subcortical maturation relative to immature prefrontal systems.

    “Casey and colleagues have long advanced that risky behaviors in youth stem from earlier maturation of subcortical regions relative to immature prefrontal systems (29).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Casey, 2011, Braking and accelerating of the adolescent brain, J Res Adolesc source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    STB and NSSI have complex etiologies that overlap only partially, implying both shared and distinct vulnerability factors.

    “their etiologies are complex and only partially overlap, suggesting both shared and unique vulnerability factors that potentiate STB and NSSI (2, 3).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] Beauchaine, 2019, Nonsuicidal self-injury and suicidal behaviors in girls: The case for targeted prevention in preadolescence, Clin Psychol Sci source

      Not checked in the free run.

    • cites [3] Crowell, 2014, Developmental approaches to understanding suicidal and self-injurious behaviors

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NSSI is often a precursor to suicidal behaviors in females, while many males who attempt suicide report little or no NSSI history.

    “NSSI is often a precursor to suicidal behaviors in females, but many males attempting suicide report little or no NSSI history (8, 9).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Klonsky, 2013, The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples, J Abnorm Psychol source

      Not checked in the free run.

    • cites [9] Prinstein, 2008, Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization, J Consult Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior reviews have identified brain regions implicated in suicidal and non-suicidal behaviors.

    “Several prior reviews have highlighted brain regions implicated in suicidal (32, 45–49) and non-suicidal behaviors (39, 50).”
    Quote in the paperNot a substantial claim0 of 8 sources checked
    • cites [32] Schmaal, 2020, Imaging suicidal thoughts and behaviors: A comprehensive review of 2 decades of neuroimaging studies, Mol Psychiatry source

      Not checked in the free run.

    • cites [45] Balcioglu, 2018, Neural substrates of suicide and suicidal behaviour: From a neuroimaging perspective, Psychiatry Clin Psychopharmacol source

      Not checked in the free run.

    • cites [46] Bani-Fatemi, 2018, Structural and functional alterations of the suicidal brain: An updated review of neuroimaging studies, Psychiatry Res Neuroimaging source

      Not checked in the free run.

    • cites [47] Dominguez-Baleon, 2018, Neuroimaging studies of suicidal behavior and non-suicidal self-injury in psychiatric patients: A systematic review, Front Psychiatry source

      Not checked in the free run.

    • cites [48] Jollant, 2011, The suicidal mind and brain: A review of neuropsychological and neuroimaging studies, World J Biol Psychiatry source

      Not checked in the free run.

    • cites [49] van Heeringen, 2014, Is there a neuroanatomical basis of the vulnerability to suicidal behavior? A coordinate-based meta-analysis of structural and functional MRI studies, Front Hum Neurosci source

      Not checked in the free run.

    • cites [39] Groschwitz, 2012, The neurobiology of non-suicidal self-injury (NSSI): A review, Suicidol Online

      Not checked in the free run.

    • cites [50] Schreiner, 2015, Conceptualizing the neurobiology of non-suicidal self-injury from the perspective of the Research Domain Criteria Project, Neurosci Biobehav Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Childhood and adolescence involve a progressive shift toward autonomy from parents and greater reliance on peers.

    “Childhood and adolescence reflect a unique developmental period whereby there is a progressive shift towards autonomy from parents and greater reliance on peers (40).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Prinstein, 2016, Peer relations and developmental psychopathology

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Impulsive decision-making and experiencing social rejection are known correlates of suicidal behaviors.

    “Impulsive decision-making and experiencing social rejection are known correlates of suicidal behaviors (21, 76).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Stewart, 2019, Life stress and suicide in adolescents, J Abnorm Child Psychol source

      Not checked in the free run.

    • cites [76] Auerbach, 2017, Impulsivity and suicidality in adolescent inpatients, J Abnorm Child Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Distorted self-referential thinking is a hallmark of adolescent MDD and these biases potentiate suicidal thinking.

    “Distorted self-referential thinking is a hallmark of adolescent MDD (72), and these biases potentiate suicidal thinking (73).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [72] Auerbach, 2015, Self-referential processing in depressed adolescents: A high-density event-related potential study, J Abnorm Psychol source

      Not checked in the free run.

    • cites [73] Burke, 2016, Cognitive risk and protective factors for suicidal ideation: A two year longitudinal study in adolescence, J Abnorm Child Psychol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Alterations in anticipatory and consummatory reward processing may underlie NSSI risk, and divergent associations between mental disorders and reward responsiveness may influence this effect.

    “Although alterations in anticipatory and consummatory reward processing may underlie risk for NSSI, divergent associations between mental disorders and reward responsiveness (e.g., MDD (91) vs. ADHD (94)) may influence this effect.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [91] Auerbach, 2014, Adolescent depression: Stress and reward dysfunction, Harv Rev Psychiatry source

      Not checked in the free run.

    • cites [94] von Rhein, 2015, Increased neural responses to reward in adolescents and young adults with attention-deficit/hyperactivity disorder and their unaffected siblings, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    NSSI research reveals ACC structural alterations and disruptions in amygdala and ACC connectivity, which contribute to hyperarousal and reduced impulse control, central features of NSSI.

    “By contrast, NSSI research reveals ACC structural alterations (64, 69) as well as disruptions in amygdala and ACC connectivity (96), which contributes to hyperarousal and reduced impulse control—central features of NSSI (110, 111).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [64] Ando, 2018, Regional grey matter volume reduction in adolescents engaging in non-suicidal self-injury, Psychiatry Res Neuroimaging source

      Not checked in the free run.

    • cites [69] Whittle, 2009, Anterior cingulate volume in adolescents with first-presentation borderline personality disorder, Psychiatry Res source

      Not checked in the free run.

    • cites [96] Schreiner, 2017, Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity, J Affect Disord source

      Not checked in the free run.

    • cites [110] Nock, 2008, Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers, J Consult Clin Psychol source

      Not checked in the free run.

    • cites [111] Hamza, 2015, Impulsivity and nonsuicidal self-injury: A review and meta-analysis, Clin Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Youth STB research is characterized by alterations within prefrontal and limbic systems, where a compromised regulatory system may potentiate suicidal thinking, and perturbations in top-down and bottom-up connections may lead to suicidal behaviors.

    “Consistent with Schmaal and colleagues (32), youth STB research is characterized by alterations within prefrontal (53–55) and limbic (62, 75, 102, 103) systems whereby a compromised regulatory system may potentiate suicidal thinking, and perturbations in top-down and bottom-up connections may lead to suicidal behaviors.”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [32] Schmaal, 2020, Imaging suicidal thoughts and behaviors: A comprehensive review of 2 decades of neuroimaging studies, Mol Psychiatry source

      Not checked in the free run.

    • cites [53] Johnston, 2017, Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder, Am J Psychiatry source

      Not checked in the free run.

    • cites [54] Fan, 2019, Gray and white matter differences in adolescents and young adults with prior suicide attempts across bipolar and major depressive disorders, J Affect Disord source

      Not checked in the free run.

    • cites [55] Huber, 2019, Reduced lateral orbitofrontal cortex volume and suicide behavior in youth with bipolar disorder, Bipolar Disord source

      Not checked in the free run.

    • cites [62] Beauchaine, 2019, Self-injuring adolescent girls exhibit insular cortex volumetric abnormalities that are similar to those seen in adults with borderline personality disorder, Dev Psychopathol source

      Not checked in the free run.

    • cites [75] Alarcón, 2019, Amygdala functional connectivity during self-face processing in depressed adolescents with recent suicide attempt, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [102] Zhang, 2016, Association between abnormal default mode network activity and suicidality in depressed adolescents, BMC Psychiatry source

      Not checked in the free run.

    • cites [103] Cao, 2020, Altered resting-state functional network connectivity is associated with suicide attempt in young depressed patients, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Environmental, parental, and youth factors may compound effects on neuromaturation and potentially increase STB and NSSI vulnerability.

    “This may be compounded by environment (e.g., poverty (118)), parent (e.g., mental disorders (119)), and youth (e.g., stress (120); psychiatric symptoms (121)) factors—each affecting neuromaturation—and potentially, increasing STB and NSSI vulnerability.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [118] Luby, 2013, The effects of poverty on childhood brain development: The mediating effect of caregiving and stressful life events, JAMA Pediatr source

      Not checked in the free run.

    • cites [119] Spadoni, 2013, Family history of alcohol use disorders and neuromaturation: A functional connectivity study with adolescents, Am J Drug Alcohol Abuse source

      Not checked in the free run.

    • cites [120] Carrion, 2007, Stress predicts brain changes in children: A pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Repeated and chronic stress may tax limbic systems that modulate arousal and approach behaviors, disrupt bottom-up and top-down connections, and potentially facilitate transition from ideation to behavior.

    “Repeated and chronic stress may tax limbic systems that modulate arousal and approach behaviors, disrupt bottom-up and top-down connections, and potentially, facilitate the transition from ideation to behavior (32, 127).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [32] Schmaal, 2020, Imaging suicidal thoughts and behaviors: A comprehensive review of 2 decades of neuroimaging studies, Mol Psychiatry source

      Not checked in the free run.

    • cites [127] Oliveira, 2013, Chronic stress disrupts neural coherence between cortico-limbic structures, Front Neural Circuits source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The neurobiology of MDD may be similar across sexes, but the antecedent trigger may differ.

    “The neurobiology of MDD may be similar (91), but the antecedent trigger may differ.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Auerbach, 2014, Adolescent depression: Stress and reward dysfunction, Harv Rev Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Earlier mental disorder onset shapes brain development and relates to self-injurious behaviors.

    “Earlier mental disorder onset shapes brain development (e.g., (123)) and relates to self-injurious behaviors (1).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [123] Castellanos, 1996, Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder, Arch Gen Psychiatry source

      Not checked in the free run.

    • cites [1] Glenn, 2017, Examining the course of suicidal and nonsuicidal self-injurious thoughts and behaviors in outpatient and inpatient adolescents, J Abnorm Child Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Timing of puberty is important, with early onset for girls and late onset for boys possibly increasing risk for internalizing disorders.

    “For example, the timing of puberty is important, as early onset for girls versus late onset for boys may increase risk for internalizing disorders (122).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [122] Negriff, 2011, Pubertal timing, depression, and externalizing problems: A framework, review, and examination of gender differences, J Res Adolesc source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Comparing samples with suicidal thoughts and behaviors or nonsuicidal self-injury to healthy individuals makes it difficult to attribute neural alterations to self-injurious behaviors rather than mental disorders.

    “comparing STB or NSSI samples with healthy individuals makes it challenging to attribute neural alterations to self-injurious behaviors versus mental disorders.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    The population with suicidal thoughts and behaviors or nonsuicidal self-injury is inherently heterogeneous in frequency, method, underlying disorders, and medication use.

    “Larger, diverse samples are key given the inherent heterogeneity (e.g., frequency, method, underlying disorders, medication use)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Small samples cannot adequately examine age, sex, and gender effects.

    “small samples are ill-equipped to explore age, sex, and gender effects (2, 3; Table S1–S3 for sample sex characteristics).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] Beauchaine, 2019, Nonsuicidal self-injury and suicidal behaviors in girls: The case for targeted prevention in preadolescence, Clin Psychol Sci source

      Not checked in the free run.

    • cites [3] Crowell, 2014, Developmental approaches to understanding suicidal and self-injurious behaviors

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    MDD females report more interpersonal stress whereas males experience more achievement-related stressors.

    “For example, MDD females report a higher frequency of interpersonal stress (128) whereas males experience more achievement-related stressors (129).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [128] Rudolph, 2002, Gender differences in emotional responses to interpersonal stress during adolescence, J Adolesc Health source

      Not checked in the free run.

    • cites [129] Rudolph, 1999, Age and gender as determinants of stress exposure, generation, and reactions in youngsters: A transactional perspective, Child Dev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Adolescent interpersonal stress may initially compromise cortical regions involved in cognitive flexibility and future-oriented thinking, which over time may potentiate suicidal and non-suicidal thinking.

    “Additionally, adolescent interpersonal stress (e.g., loss (21, 25), peer victimization (22, 24))—may initially act on cortical regions by compromising cognitive flexibility and future oriented thinking (124), which over time, may potentiate suicidal and non-suicidal thinking (125, 126).”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [21] Stewart, 2019, Life stress and suicide in adolescents, J Abnorm Child Psychol source

      Not checked in the free run.

    • cites [25] Prinstein, 2009, Interpersonal models of nonsuicidal self-injury

      Not checked in the free run.

    • cites [22] Stewart, 2018, Peer victimization and suicidal thoughts and behaviors in depressed adolescents, J Abnorm Child Psychol source

      Not checked in the free run.

    • cites [24] Vergara, 2019, Non-suicidal self-injury and suicide in depressed adolescents: Impact of peer victimization and bullying, J Affect Disord source

      Not checked in the free run.

    • cites [124] Arnsten, 2009, Stress signalling pathways that impair prefrontal cortex structure and function, Nat Rev Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Trauma and maltreatment during developmentally sensitive periods affect cortical and subcortical development, directly affecting top-down and bottom-up processes implicated in STB and NSSI.

    “Trauma and maltreatment occurring during developmentally sensitive periods impact cortical and subcortical development (116), directly affecting top-down (e.g., ACC) and bottom-up (e.g., striatum) processes implicated in STB and NSSI (117).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [116] Andersen, 2008, Stress, sensitive periods and maturational events in adolescent depression, Trends Neurosci source

      Not checked in the free run.

    • cites [117] Cohen, 2006, Early life stress and morphometry of the adult anterior cingulate cortex and caudate nuclei, Biol Psychiatry source

      Not checked in the free run.

63 of 63

  • The paper relies on this without support.

    No definitive neural marker of STB or NSSI currently exists.

    “There is no definitive neural marker of suicidal thoughts and behaviors (STB) or non-suicidal self-injury (NSSI)”
    “Presently, there are no definitive neural markers of STB or NSSI.”

  • The authors state this as an assumption.

    Neural alterations act as biological diatheses that may be necessary but not sufficient to predispose to self-injurious behaviors.

    “Neural alterations are biological diatheses that may be a necessary but not sufficient predisposition to engage in self-injurious behaviors.”

  • The paper relies on this without support.

    Research on neural correlates in youth is more limited than in adults.

    “relative to adults, research in youth is more limited.”

  • The paper relies on this without support.

    Childhood and adolescence constitute a distinct developmental phase for studying neural diatheses and stressors, separable from adults.

    “Childhood and adolescence represent a unique developmental phase to unpack neural diatheses and stressors that may be separable from adults.”

  • The paper relies on this without support.

    Interviews ensure that definitions of a suicide attempt or an NSSI episode are shared.

    “interviews ensure shared definitions of what constitutes a suicide attempt or an NSSI episode.”

  • The paper relies on this without support.

    A substantial proportion of youth with suicidal or nonsuicidal thoughts will later engage in self-injurious behaviors.

    “A substantial number of participants characterized by suicidal and non-suicidal thoughts will engage in self-injurious behaviors over time.”
6 of 6

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Authors
Auerbach, R. P., Pagliaccio, D., Allison, G. O., Alqueza, K. L., & Alonso, M. F.
Affiliations
  • Columbia University Irving Medical Center (US)
  • New York State Psychiatric Institute (US)
Corresponding author
Auerbach, Randy P.
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2021-01
Volume
89
Issue
2
Pages
119-133
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/j.biopsych.2020.06.002
PMC
PMC7726029
OpenAlex
W3034490900
Semantic Scholar
1382e2af99e28b68fc23446bd061a13ab10c73a9
Cited by
204
References
146
Citations by year
2026: 43 · 2025: 47 · 2024: 30 · 2023: 22 · 2022: 32 · 2021: 26 · 2020: 4
FWCI
1.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health via Writing
Keywords
suicide, non-suicidal self-injury, youth, neural correlates, suicidal ideation, suicide attempts, ventral prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex, striatal activation, default mode network, salience network, brain development, suicide risk
MeSH terms
Adolescent, Adult, Gyrus Cinguli, Humans, Suicide, Suicide, Attempted, Self-Injurious Behavior, Suicidal Ideation

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

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