Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty

Abstract

Suicide is the second leading cause of death among adolescents. While clinicians and researchers have begun to recognize the importance of considering multidimensional factors in understanding risk for suicidal thoughts and behaviors (STBs) during this developmental period, the role of puberty has been largely ignored. In this review, we contend that the hormonal events that occur during puberty have significant effects on the organization and development of brain systems implicated in the regulation of social stressors, including amygdala, hippocampus, striatum, medial prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Guided by previous experimental work in adults, we also propose that the influence of pubertal hormones and social stressors on neural systems related to risk for STBs is especially critical to consider in adolescents with a neurobiological sensitivity to hormonal changes. Furthermore, facets of the pubertal transition, such as pubertal timing, warrant deeper investigation and may help us gain a more comprehensive understanding of sex differences in the neurobiological and psychosocial mechanisms underlying adolescent STBs. Ultimately, advancing our understanding of the pubertal processes that contribute to suicide risk will improve early detection and facilitate the development of more effective, sex-specific, psychiatric interventions for adolescents.

Navigating adolescence; pubertal development in autism spectrum conditions and its relation to mental health

“…Possibly, as suggested by Ho and colleagues (Ho et al, 2021), exposure to hormones, in a period of high neural plasticity such as in puberty, leaves an individual more susceptible to the effects of daily life stressors. Future studies should look at pubertal development in relation to daily life stressors to assess whether this can prove detrimental in the development of mental health problems in autistic individuals.…”

“…Moreover, differential pubertal onset has been reported in ASC (Corbett et al, 2020;Ingudomnukul et al, 2007;Knickmeyer et al, 2006;Pohl et al, 2014;Tordjman et al, 1997). This differential pubertal onset has been linked to a myriad of problems, such as depression and suicidal ideation (Copeland et al, 2019;Ho et al, 2021). Therefore, it is of the utmost importance to examine the effect that pubertal timing has in ASC.…”

“…Likewise, a recent review poses that exposure to sex hormones, as occurs in puberty, causes a period of neural plasticity in which the brain is increasingly sensitive to social stressors that amplify emotional dysregulation and impulse control (Ho et al, 2021). In autistic adolescents these social and daily life stressors might be more prevalent (Maïano et al, 2016) and impactful (Corbett, Muscatello, & Baldinger, 2019), and in combination with early pubertal onset that posits a risk in itself, could increase the impact that puberty has on mental health in these individuals.…”

Reward sensitivity and internalizing symptoms during the transition to puberty: An examination of 9-and 10-year-olds in the ABCD Study

“…Given that pubertal development parallels changes within neural circuits subserving reward seeking and reward valuation (Ho et al, 2021) -key circuits linked to risk for adolescent internalizing symptoms (Davey et al, 2008;Forbes, 2011;Luking et al, 2016) -we tested whether self-reported, behavioral, or neural signatures of reward sensitivity moderated the association between early pubertal timing and internalizing symptoms. We hypothesized that, across domains, greater reward sensitivity would attenuate the association between early pubertal timing and internalizing symptoms.…”

“…Similar reward processes may also modulate risk for internalizing symptoms in younger adolescents transitioning to puberty. Notably, hormonal processes initiated early in puberty introduce changes within the aforementioned reward-sensitive circuits (Goddings et al, 2019;Ho et al, 2021;Peper et al, 2013;Piekarski et al, 2017;Wierenga et al, 2018). Pubertal onset may introduce a period in which risk for internalizing symptoms is altered alongside functional changes within these reward processing networks (Nelson et al, 2005;Pfeifer & Allen, 2021).…”