A Systematic Review of MRI Studies and the “Emotional paiN and social Disconnect (END)” Brain Model of Suicidal Behavior in Youth

Figure 2

Emotional paiN and social Disconnect (END) brain model of suicidal behavior in youth. Emotional/mental pain or subjective distress can be caused by a combination of predisposition and stressful life events and leads to suicidal ideation in adolescents. If, in addition, the adolescent is experiencing social disconnect/distortion and communication difficulties, this can lead to a suicide attempt. According to the END model, the biological driver of suicidal behavior in youth is aberration in two distinct brain circuits: “emotional pain” circuit and “social disconnect” circuit. The emotional pain circuit includes the cerebellum, hippocampus, and amygdala and shows similar aberrations in adolescent ideators as in attempters, but to a smaller degree. The social disconnect circuit includes lateral OFC and temporal gyri, as well as the connections between them (the frontotemporal system), and is unique to adolescent suicide attempters. Abbreviation: OFC = orbitofrontal cortex.