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Structural and functional alterations of the suicidal brain: An updated review of neuroimaging studies
Abstract
Brain imaging is a non-invasive and in vivo direct estimation of detailed brain structure, regional brain functioning and estimation of molecular processes in the brain. The main objective of this review was to analyze functional and structural neuroimaging studies of individuals at risk for suicide. We reviewed articles published between 2005 and 2018, indexed in PubMed and Medline, assessing structural and functional alterations of the brain of individuals at high risk for suicide and at low risk for suicide. We reviewed functional and structural neuroimaging studies which included individuals with a history of suicidal ideation or attempt in major depressive disorder (MDD), bipolar disorder (BD), psychosis, and borderline personality disorder (BPD). We selected 45 papers that focused on suicidality in MDD, 17 papers on BD, 11 papers on psychosis, and 5 papers on BPD. The suicidal brain across psychiatric diagnoses seems to heavily involve dysfunction of the fronto-temporal network, primarily involving reductions of gray and white matter volumes in the pre-frontal cortex (PFC), anterior cingulate, and superior temporal gyrus. Nonetheless, there are several ways to define suicidal behaviour and ideation. Therefore, it still remains difficult to combine the evidence from imaging studies that used different definitions of suicidality.
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“Several prior reviews have highlighted brain regions implicated in suicidal (32, 45–49) and non-suicidal behaviors (39, 50).”
From Neural correlates associated with suicide and nonsuicidal self-injury in youth (2021) · cites this paper as [46]
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“However, network alterations in the brain are important factors for patients with depression as well as suicidal ideation and may be linked to the risk of suicide attempts [13].”
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The prospect of suicide biomarkers: from neurobiology to precision prevention
Ren, N., Zheng, S., Zhou, Y., Zhang, X., Wang, M. H., & Bian, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1757838 · Cited by 4
Ishikawa, K., Nemoto, K., Shiratori, Y., Sodeyama, N., Kodama, K., Usuniwa, H., Yamada, N., Yaguchi, C., Hori, T., Arai, T., et al. (2022) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.35 · Cited by 3
“5,6 A previous study using structural magnetic resonance imaging (MRI) suggested that suicide attempters (SAs) with depression showed volume reduction or cortical thinning in frontal regions, such as ventral lateral prefrontal cortex, dorso-lateral prefrontal cortex (DLPFC), and orbitofrontal…”
BackgroundSerum Fatty Acid Latent Classes Are Associated With Suicide in a Large Military Personnel Sample
Ryan, A. T., Postolache, T. T., Taub, D. D., Wilcox, H. C., Ghahramanlou‐Holloway, M., Umhau, J. C., & Deuster, P. A. (2021) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.20m13275 · Cited by 3
Electroretinography and suicidal behaviors: a systematic review
Kaggwa, M. M., Prat, S. S., Davids, A., Robbins, A., Erb, B., Mамак, М., Chaimowitz, G. A., & Olagunju, A. T. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05453-w · Cited by 3
“An extended photopic on-off protocol for ERG has been used to assess retina function in studies analyzing psychiatric conditions [9].”
BackgroundMethodCanal‐Rivero, M., Tordesillas‐Gutiérrez, D., Ruíz-Veguilla, M., de la Foz, V. O., de Lucas, E. M., Romero-García, R., Vázquez-Bourgón, J., Ayesa‐Arriola, R., & Crespo‐Facorro, B. (2025) · Archives of Suicide Research · doi:10.1080/13811118.2025.2454581 · Cited by 2
“The STG plays a key role in social cognition (Bani-Fatemi et al., 2018), and structural abnormalities in this region have been observed in individuals with social functioning deficits (Goldstein et al., 2009).”
Torino, G., Maggioni, E., Lengvenytė, A., Brambilla, P., & Delvecchio, G. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03626-7 · Cited by 2
Xia, L., Wu, N., Wang, D., Zhou, H., & Zhang, X. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03784-8 · Cited by 5
“Reduced grey matter volume (GMV) of the ACC has also been found in patients with psychiatric disorders who have attempted suicide [24].”
Dai, Z., Jia, M., Zhou, H., & Wang, H. (2026) · Translational Psychiatry · doi:10.1038/s41398-025-03800-x · Cited by 2
Hou, X., Zhang, J., Duan, J., Song, Y., Tang, X., Gong, Z., Li, Z., Kang, Z., Huang, Y., He, J., et al. (2026) · NeuroImage · doi:10.1016/j.neuroimage.2026.121706 · Cited by 2
Morphofunctional changes in the neuronal environment in suicide
Кислов, М. А., Trusova, D. S., Николаевич, К. К., Zhiganova, M. S., & Maksimov, A. V. (2023) · Russian Journal of Forensic Medicine · doi:10.17816/fm723 · Cited by 1
Xie, M., Liu, Y., Jing, Y., Gao, Y. H., Liu, Y., Li, J., & Mao, F. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107611 · Cited by 1
Neuroanatomical signatures of suicide attempts in major depressive disorder
Kim, A., Kang, Y., Kang, J. C., & Ham, B. (2026) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2026.112192 · Cited by 1
Hong, X., Cui, X., Chen, C., Zhang, Z., Jin, Y., & Wang, Y. (2026) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2026.112223 · Cited by 1
Pharmacological and Neuromodulatory Treatments for Suicidality: A 2026 Updated Review
Medeiros, G. C., Baruzzi, M. M., Beiram, L., Roncete, G. P., de Figueiredo, L. L., Nery, L. D. D. M., Cacciacarro, M. F., Zanetti, M. V., & Damiano, R. F. (2026) · Psychiatric Annals · doi:10.3928/00485713-20260313-05 · Cited by 1
Park, Y.-M. (2023) · Chronobiology in Medicine · doi:10.33069/cim.2023.0009 · Cited by 1
“a well-known characteristic of depression and suicidal tendencies [23].”
BackgroundCognitive dysfunction: An important feature of major depressive disorder
Duan, D.-X., Li, X., Yang, L., Wang, W., & Zhu, H. (2023) · Neurons and Neurological Disorders · doi:10.58489/2836-8851/011 · Cited by 1
Feedback Processing as it Relates to Suicidal Ideation and Behavior Using a Time-Frequency ApproachPreprint
Pavuluri, A., Ellis, J., Vivino, A. A., Butler, D., Arenson, M. B., Joiner, T. E., Schmidt, N. B., & Bernat, E. M. (2023) · medRxiv · doi:10.1101/2023.12.06.23299613 · Cited by 1
Candidate Genes for Suicide Risk in Head and Neck Squamous Cell Carcinoma Patients
Thavarajah, R., Mohandoss, A. A., Joshua, E., Rao, U., & Ranganathan, K. (2019) · Journal of Orofacial Sciences · doi:10.4103/jofs.jofs_2_19
van Velzen, L. S. (2019) · Bipolar Disorders · doi:10.1111/bdi.12832
Suicidal behaviors in bipolar disorder
Serafini, G., Cipriani, N., & Amore, M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-819182-8.00029-6
Estudio post-mortem de las alteraciones en la expresión de RNA en el cerebro de pacientes suicidasPreprint
Cabrera‐Mendoza, B. (2020) · Thesis Commons (OSF Preprints) · doi:10.31237/osf.io/cmvjb
Wen, X., Qu, D., Wu, G., Liu, D., Wang, Y. Y., Cui, Z., Zhang, X., & Chen, R. (2022) · medRxiv · doi:10.1101/2022.05.24.22275547
Vandeloo, K. L., Burhunduli, P., Sylvain Bouix, A., Owsia, K., Cho, K. I. K., Zhuo, F., Geel, A. V., Pasternak, O., Blier, P., & Phillips, J. L. (2022) · Research Square · doi:10.21203/rs.3.rs-1712962/v1
Psychological theories and models of suicide and suicidal behavior
Volarov, M. (2022) · TIMS Acta · doi:10.5937/timsact16-37398
Rakús, T., Hubčíková, K., Bruncvik, L., Petrášová, Z., & Brunovský, M. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1002215
“According to a recent review article (3), dysfunction of the frontotemporal networks with a volume reduction in the gray and white matter in the prefrontal cortex, the anterior cingulate, and the upper anterior temporal gyrus of the brain of individuals with suicidal ideation across psychiatric diagnoses (major depres…”
BackgroundMalyam, V., Sannappa, A. C., Gopalakrishnan, V. V., Roy, S., & Parameshwaraiah, S. T. (2024) · The Journal of Medical Sciences · doi:10.5005/jp-journals-10045-00315
Sen, M., Karamustafalıoğlu, N., Çelikkıran, P., Ansen, G., Şakul, B. U., Namlı, M. N., & Yeşilkaya, Ü. H. (2025) · Psychiatric Quarterly · doi:10.1007/s11126-025-10124-y
“Abnormalities in the brain’s gray matter have been implicated in the manifestation of such behavioral trajectories associated with suicidality [7, 9, 10].”
Metadata
- Authors
- Bani-Fatemi, A., Tasmim, S., Graff-Guerrero, A., Gerretsen, P., Strauss, J., Kolla, N., Spalletta, G., & De Luca, V.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- University of Toronto (CA)
- Baylor College of Medicine (US)
- Venue
- Psychiatry Research Neuroimaging
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 278
- Pages
- 77-91
- ISSN
- 0925-4927 (ISSN-L)
- OpenAlex
- W2803650243
- Cited by
- 112
- References
- 87
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 7 · 2023: 22 · 2022: 15 · 2021: 15 · 2020: 15 · 2019: 10 · 2018: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatry Research Neuroimaging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- suicide, suicidal ideation, suicide attempts, brain structure, brain function, major depressive disorder, bipolar disorder, psychosis, borderline personality disorder, fronto-temporal network, prefrontal cortex, anterior cingulate cortex, superior temporal gyrus, gray matter volume, white matter volume
- MeSH terms
- Bipolar Disorder, Borderline Personality Disorder, Brain, Major Depressive Disorder, Humans, Magnetic Resonance Imaging, Suicidal Ideation, Neuroimaging, White Matter
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