Neurocognitive Processes Implicated in Adolescent Suicidal Thoughts and Behaviors: Applying an RDoC Framework for Conceptualizing Risk
Purpose of Review
Identifying risk factors for STBs during adolescence is essential for suicide prevention. In this review, we employ the Research Domain Criteria (RDoC) framework to synthesize studies on key neurocognitive processes—cognitive control, reward responsiveness/valuation, and negative urgency—relevant to adolescent STBs.
Within subdomains of cognitive control, studies of inhibition/suppression and updating/maintenance were mixed, while response selection (i.e., decision-making) deficits were consistently associated with suicide attempts. Fewer studies, by comparison, have probed the Positive Valence Systems. Relative to healthy controls, adolescents with prior STBs may show a blunted neural response to rewards and value rewards less, but findings require replication. Finally, negative urgency, which may span subdomains within both cognitive control and the Positive Valence Systems, was associated with recent suicide attempts in the only study to directly test this association.
Few studies have examined neurocognitive functioning in relation to adolescent STBs, despite the relevance of this research to detecting suicide risk. We recommend that future studies incorporate developmental contexts relevant to both neurocognitive processes and STBs.
KeywordsRDoC Suicide Cognitive control Reward responsiveness Negative urgency
The project was supported through funding from the National Institute of Mental Health (NIMH) U01MH116923 (RPA).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or NIMH.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Centers for Disease Control and Prevention (CDC). (2017). Web-based injury statistics query and reporting system (WISQARS). Available from: https://www.cdc.gov/injury/ wisqars/fatal.html.
- 2.Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70:300–10.PubMedCrossRefGoogle Scholar
- 3.Miller AB, Prinstein MJ. Adolescent suicide as a failure of acute stress-response systems. Annu Rev Clin Psychol. 2019;15:425–50. https://doi.org/10.1146/annurev-clinpsy-050718-095625.CrossRefPubMedGoogle Scholar
- 5.•• Glenn CR, Cha CB, Kleiman EM, Nock MK. Understanding suicide risk within the Research Domain Criteria (RDoC) framework: insights, challenges, and future research considerations. Clin Psychol Sci. 2017;5:568–92 This article provides a broad overview of how RDoC domains and constructs can be used to organize research on correlates and risk factors for STBs. The authors provide methodological recommendations to enhance the application of the RDoC to suicide science.PubMedPubMedCentralCrossRefGoogle Scholar
- 11.• Zelazny J, Melhem N, Porta G, Biernesser C, Keilp JG, Mann JJ, et al. Childhood maltreatment, neuropsychological function and suicidal behavior. J Child Psychol Psychiatry. 2019. https://doi.org/10.1111/jcpp.13096This study included 382 offspring of depressed parents (mean age 14.83) who completed a broad neuropsychological assessment that captured several aspects of cognitive control (i.e., inhibition, interference suppression, and updating/maintenance). In this sample, poorer inhibition and interference suppression were associated with suicide attempts, but sustained attention (measured by a continuous performance task) was not.PubMedCrossRefPubMedCentralGoogle Scholar
- 13.Dougherty DM, Mathias CW, Marsh-Richard DM, Prevette KN, Dawes MA, Hatzis ES, et al. Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide. Psychiatry Res. 2009;169:22–7. https://doi.org/10.1016/j.psychres.2008.06.011.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.• Stewart JG, Glenn CR, Esposito EC, Cha CB, Nock MK, Auerbach RP. Cognitive control deficits differentiate adolescent suicide ideators from attempters. J Clin Psychiatry. 2017;78:e614–21. https://doi.org/10.4088/JCP.16m10647This study examined cognitive control using the Suicide Stroop Task in a sample of adolescent suicide ideators and attempters. Relative to ideators, attempters showed control deficits in the context of all emotional stimuli, regardless of valence (i.e., positive, negative, suicide-relevant).PubMedCrossRefPubMedCentralGoogle Scholar
- 17.Kaufman EA, Crowell SE, Coleman J, Puzia ME, Gray DD, Strayer DL. Electroencephalographic and cardiovascular markers of vulnerability within families of suicidal adolescents: a pilot study. Biol Psychol. 2018;136:46–56. https://doi.org/10.1016/j.biopsycho.2018.05.007.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Stewart JG, Kim JC, Esposito EC, Gold J, Nock MK, Auerbach RP. Predicting suicide attempts in depressed adolescents: clarifying the role of disinhibition and childhood sexual abuse. J Affect Disorders. 2015;187:27–34. https://doi.org/10.1016/j.jad.2015.08.034.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.• Tsypes A, Owens M, Gibb BE. Blunted neural reward responsiveness in children with recent suicidal ideation. Clin Psychol Sci. 2019. https://doi.org/10.1177/2167702619856341This study examined reward responsiveness among children 7–11 years old with (n= 23) and without (n= 46) recent suicide ideation (SI). The authors found that the Reward Positivity was smaller among children with recent SI relative to controls, suggesting that SI may be associated with blunted reward responsiveness.CrossRefGoogle Scholar
- 31.Linehan MM. Cognitive behavioral treatment of borderline personality disorder. New Yor: Guilford Press; 1993.Google Scholar
- 32.Williams M. Suicide and attempted suicide: understanding the cry of pain. London: Penguin Books Ltd; 2001.Google Scholar
- 34.Keilp JG, Gorlyn M, Russell M, Oquendo MA, Burke AK, Harkavy-Friedman J, et al. Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt. Psychol Med. 2013;43:39–551. https://doi.org/10.1017/S0033291712001419.PubMedPubMedCentralCrossRefGoogle Scholar
- 40.Pan LA, Hassel S, Segreti AM, Nau SA, Brent DA, Phillips ML. Differential patterns of activity and functional connectivity in emotion processing neural circuitry to angry and happy faces in adolescents with and without suicide attempt. Psychol Med. 2013;43:2129–42. https://doi.org/10.1017/S0033291712002966.CrossRefPubMedGoogle Scholar
- 41.Johnston JAY, Wang F, Liu J, Blond BN, Wallace A, Liu J, et al. Multimodal neuroimaging of frontolimbic structure and function associated with suicide attempts in adolescents and young adults with bipolar disorder. Am J Psychiatry. 2017;174:667–75. https://doi.org/10.1176/appi.ajp.2016.15050652.PubMedCrossRefGoogle Scholar
- 44.Carlson JM, Foti D, Mujica-Parodi LR, Harmon-Jones E, Hajcak G. Ventral striatal and medial prefrontal BOLD activation is correlated with reward-related electrocortical activity: a combined ERP and fMRI study. Neuroimage. 2011;57:1608–16. https://doi.org/10.1016/j.neuroimage.2011.05.037.CrossRefPubMedGoogle Scholar
- 46.Foti D, Weinberg A, Dien J, Hajcak G. Event-related potential activity in the basal ganglia differentiates rewards from nonrewards: temporospatial principal components analysis and source localization of the feedback negativity. Hum Brain Mapp. 2011;32:2207–16. https://doi.org/10.1002/hbm.21182.CrossRefPubMedGoogle Scholar
- 56.• Millner AJ, Lee MD, Hoyt K, Buckholtz JW, Auerbach RP, Nock MK. Are suicide attempters more impulsive than suicide ideators? Gen Hospital Psychiatry. 2018. https://doi.org/10.1016/j.genhosppsych.2018.08.002This study examined trait negative urgency among recent (past 2 weeks) suicide attempters, suicide ideators, and healthy controls. The authors found that negative urgency, but not other forms of impulsivity, differentiated attempters from ideators and controls.
- 62.• Auerbach RP, Stewart JG, Johnson SL. Impulsivity and suicidality in adolescent inpatients. J Abnorm Child Psychol. 2017;45:91–103 This is the only study to date that has directly examined relations between negative urgency and STBs among adolescents. In a sample of adolescent inpatients, negative urgency was associated with more frequent recent suicide attempts, but not suicidal ideation or plans.PubMedPubMedCentralCrossRefGoogle Scholar
- 76.•• Dahl RE, Allen NB, Wilbrecht L, Suleiman AB. Importance of investing in adolescence from a developmental science perspective. Nature. 2018;554:441–50 This review summarizes many of the neuro-maturational changes that occur in adolescence. The authors describe ways in which these changes impact cognition, motivation, and learning.PubMedCrossRefGoogle Scholar
- 79.Kaufman EA, Crowell SE, Lenzenweger MF. The development of borderline personality and self-inflicted injury. In: Beauchaine TP, Hinshaw SP, editors. Child and Adolescent Psychopathology. Hoboken, NJ: John Wiley & Sons. Inc. 2017;2017:642–79.Google Scholar
- 80.• Nelson EE, Jarcho JM, Guyer AE. Social re-orientation and brain development: an expanded and updated view. Dev Cogn Neurosci. 2016;17:118–27 This review describes a framework for understanding social processes at different stages of development (including adolescence). The authors illustrate how transactions between changes in brain function and broader social contexts at each developmental stage impact social behaviors.PubMedCrossRefPubMedCentralGoogle Scholar