shown different brain anatomical variations to this effect. A study group has found lower hippocampal glucocorticoid mRNA expression in those with these positive histories compared to control groups of adults without a history of abuse (Cordero et al., 2022). This discovery was reportedly independent of Brain Neural Circuits It has long been proposed that high suicidality scores and severe early-life exposure to suicide risk alter neuronal connectivity and functioning in the central nervous system. Investigating the pattern of neuronal activation across interconnected structures suggests that some key brain circuits are atypical in youth with higher suicidality risk compared to those with no suicide risk. Over the years, studies have reported differences in the neuronal connectivity and activation in several neuronal regions in youth who had attempted suicide. When compared with control groups, this study population showed unique patterns of altered neuronal activation in different regions of the brain, including the bilateral posterior lobes of the cerebellum, left fusiform gyrus, left inferior frontal gyrus, left hippocampus, bilateral middle frontal gyrus, and bilateral parahippocampal gyrus (Kirshenbaum et al., 2022). Also, the study population of suicide attempters presented with heightened neuronal activation in the right middle frontal gyrus left precuneus, and the right inferior parietal lobe. Further analysis of the possibilities of circuit behavior based on unique experiences of the study population revealed that the nature of neural activation was independent of sex distribution, age, level of education, and past medical history. Regions of the brain directly coupled to impact the stress response also show distinct patterns of circuit behavior in suicide attempters. The hippocampus and dorsolateral prefrontal cortex are of research-specific interest in this regard. Also important in mood regulation and memory formation, the structural integrity of the hippocampus appears to be altered in people with an elevated risk of suicidal ideation and behavior. The anatomical structure of the dorsolateral prefrontal cortex, a region directly
the nature of psychiatric diagnosis and protective factors. Apparently, in some youth, early life exposure to suicide risk factors may induce an epigenetic effect that alters the body’s normal response to stress.
responsible for emotion regulation and conscious judgment, also shows patterned alteration. Further inquiries to investigate how the severity of suicide and the nature of risk factors affect the circuit behavior in these regions are currently underway. Youth who report early-life emotional abuse are expected to show unique patterns of circuit behavior in the dorsolateral prefrontal cortex. Another important circuitry reported to be impacted by suicidal ideation and behavior is the default mode network (DMN), interconnected regions of the brain. Alterations in the DMN may indicate an inability of the central nervous system to coordinate the steps required for creating mental simulations in a different mental process. In youth with a considerable risk of suicide, the circuitry in the DMN is reportedly abnormally connected. Studies have revealed increased connectivity in the cerebellum and in contrast, decreased connectivity in the right posterior cingulate cortex. When compared with control groups of depressed youth with no history of suicide attempts, individuals with abnormally connected DMN also show increased circuitry connectivity in the left lingual gyrus and decreased connectivity in the right precuneus. These observations have provided evidence to infer that MDN alterations may be considered a biomarker for suicidal ideation and behavior in at-risk youth. However, further investigations are needed to understand how different demographic patterns may affect circuitry connections in the DMN and to understand possible correlations between the nature of DMN abnormalities and the stages of transitioning from ideation to attempts.
Mental Disorders There is copious research evidence linking mental disorders to suicidality in youth and positioning it as a biological correlation in many cases. Reports from epidemiological surveys suggest that close to 90% of people who die by suicide have experienced a mental disorder stage in their lifetime. This strong correlation holds irrespective of age, gender, level of education, and region of habitation. As a suicide risk, mental disorders contribute to between 47% and 74% of all reported cases of suicidal ideation and behavior. The most studied mental disorders in this regard include eating disorders, personality disorders, schizophrenia, and addiction. Eating disorders such as anorexia nervosa have a strong link to suicide attempts in youth, especially in poorly managed cases. In schizophrenia, most cases of reported suicide are related to self-inflicted mortal injuries (Kim et al., 2021a). The relationship has received significant research interest over the years. Preliminary reports suggest that about 30%–40% of people who commit suicide had a personality disorder. The struggle to gain community approval and the subsequent depression, and the multiple contradictions of persona as observed in people with personality disorders are considered the primary triggers of suicide in people with personality disorders. There is also a strong link between suicide and anxiety disorders. Although it is difficult to gauge the effects of mood changes and substance abuse disorders on suicidality, available evidence suggests a correlation between suicide attempts and mood disorders in the youth population. In many cases, early-life experiences have a significant impact on the severity of suicidality. CONNECTING SUICIDAL IDEATION AND BEHAVIOR IN YOUTH TO PUBERTY HORMONES between suicidal ideation and attempts and personality disorders such as borderline or antisocial personality disorder
Focusing on suicidality in youth requires a succinct examination of the pubertal neuroendocrine mechanisms as they drive suicidal ideation and behavior (SIB). Adolescent SIB is linked to a pathological response to stress at a stage when the neurobiological mechanisms responsible for stress regulation are just developing. At this point, the effects of life stressors commonly characterized by loss, conflict, rejection, and social withdrawal are most pronounced in the course of suicide. In youth, the timing of these stressors coincides with the development of stress regulatory circuits. Hormonal changes during puberty may alter the development of the brain and its normal endocrine functionalities. The region of the brain reportedly predisposed to alteration as a result of hormonal changes in puberty is also linked to impulse control, emotion, regulation, and social cognition regulation. It appears the contribution of these brain regions to suicide in youth extends
beyond merely modifying biological correlates and risk factors of suicide. For instance, at puberty, these brain regions exhibit sexual dimorphism, including a larger amygdala and hippocampus in boys than in girls, the sex-based difference in the developmental course of frontoparietal networks, and sex- based differences in white matter organization. The argument on the effect of puberty in the development of suicidal ideation and behavior in youth implicates changes in pubertal hormones. Since the social stressors experienced by both sexes are somewhat different, sex-based hormonal changes at puberty may explain the difference in the severity of suicidality, risk, and rate of transition from ideation to attempt in both sexes. In the same vein, this link may further explain the roles of puberty hormones in the modulation of suicidality in youth.
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Book Code: PYMA2024
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