Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Behav Neurol. 2023 Sep 23;2023:7254574. doi: 10.1155/2023/7254574. eCollection 2023.
Risk of suicidal ideation and suicidal behaviors greatly increases during adolescence, and rates have risen dramatically over the past two decades. However, few risk factors or biomarkers predictive of suicidal ideation or attempted suicide have been identified in adolescents. Neuroimaging correlates hold potential for early identification of adolescents at increased risk of suicidality and risk stratification for those at high risk of suicide attempt.
In this systematic review, we evaluated neural regions and networks associated with suicidal ideation and suicide attempt in adolescents derived from magnetic resonance imaging (MRI) studies. A total of 28 articles were included in this review.
After descriptively synthesizing the literature, we propose the Emotional paiN and social Disconnect (END) model of adolescent suicidality and present two key neural circuits: (1) the emotional/mental pain circuit and (2) the social disconnect/distortion circuit. In the END model, the emotional pain circuit-consisting of the cerebellum, amygdala, and hippocampus-shows similar aberrations in adolescents with suicidal ideation as in those with a history of a suicide attempt (but to a smaller degree). The social disconnect circuit is unique to adolescent suicide attempters and includes the lateral orbitofrontal cortex (OFC), the temporal gyri, and the connections between them.
Our proposed END brain model of suicidal behavior in youth, if confirmed by future prospective studies, can have implications for clinical goals of early detection, risk stratification, and intervention development. Treatments that target emotional pain and social disconnect may be ideal interventions for reducing suicidality in adolescents.
自杀意念和自杀行为的风险在青少年时期大大增加，而且在过去的二十年中，这一比率急剧上升。然而，很少有预测自杀意念或自杀未遂的风险因素或生物标志物在青少年中被发现。神经影像学的相关性具有潜在的可能性，可以早期识别自杀风险增加的青少年，并对那些自杀未遂风险高的青少年进行风险分层。
在这项系统综述中，我们评估了从磁共振成像（MRI）研究中得出的与青少年自杀意念和自杀尝试相关的神经区域和网络。本综述共纳入了 28 篇文章。
在描述性地综合文献后，我们提出了青少年自杀的情绪痛苦和社交脱节（END）模型，并提出了两个关键的神经回路：（1）情绪/心理痛苦回路，（2）社交脱节/扭曲回路。在 END 模型中，情绪疼痛回路-包括小脑、杏仁核和海马体-在有自杀意念的青少年中表现出与有自杀未遂史的青少年相似的异常（但程度较小）。社交脱节回路是青少年自杀未遂者所特有的，包括外侧眶额皮层（OFC）、颞叶回及其之间的连接。
如果未来的前瞻性研究证实了我们提出的青少年自杀行为的 END 大脑模型，它可能对早期发现、风险分层和干预措施发展的临床目标产生影响。针对情绪痛苦和社交脱节的治疗可能是减少青少年自杀风险的理想干预措施。
