Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.

中文翻译：

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对自杀想法和行为进行成像：对 20 年神经影像学研究的全面回顾。

识别导致自杀想法和行为 (STB) 的大脑变化对于制定更有针对性和更有效的预防自杀策略非常重要。在过去十年中，尤其是在过去 5 年中，报告 STB 的结构和功能脑回路相关性的神经影像学研究数量呈指数级增长。在这篇叙述性综述中，我们对迄今为止发表的 STB 神经影像学研究进行了全面回顾，并总结了在阐明 STB 神经生物学基础方面取得的进展，重点是跨研究的趋同发现。我们回顾了不同精神疾病中与 STB 相关的结构、功能和分子改变的神经影像学证据，这些改变特别集中在促进情绪和冲动调节的大脑系统区域，包括腹侧前额叶皮层 (VPFC) 和背侧前额皮质 (DPFC)，岛叶及其内侧颞叶、纹状体和后部连接部位，以及这些大脑区域之间的连接。文献综述表明，内侧和外侧 VPFC 区域及其连接的损伤可能在过度消极和钝化的积极内部状态中发挥重要作用，从而刺激自杀意念，并且 DPFC 和额下回 (IFG) 系统的损伤可能很重要在自杀未遂行为中。VPFC 和 DPFC 系统紊乱的结合可能会导致非常高的风险情况，在这种情况下，自杀意念会通过减少自上而下的行为抑制和/或适应不良、不灵活的决策和计划而转化为致命行动。背侧前扣带皮层和岛叶可能在 VPFC 和 DPFC 系统之间的切换中发挥重要作用，这可能有助于从自杀想法到行为的转变。未来更大样本量的神经影像研究，包括全球努力、纵向设计以及对发育阶段、性和性别的仔细考虑，将有助于更有效地进行有针对性的预防和干预，以减少自杀造成的生命损失。