A neuroimaging study in adolescents found that the link between impulsivity and future suicidal thoughts depends on how the right anterior insula, a region of the brain involved in processing emotions, responds to loss. Among adolescents whose anterior insula responded to small monetary losses with strong activation, higher impulsivity was associated with higher suicidal ideation one year later. In contrast, in adolescents whose anterior insula did not respond strongly to loss, higher impulsivity was associated with lower levels of suicidal ideation. The paper is Developmental cognitive neuroscience.
If you or someone you know is struggling with suicidal thoughts or mental health issues, call the National Suicide Prevention Lifeline at 988 (or 800-273-8255) or visit: NSPL site.
Suicide is now the second leading cause of death among young people in the United States. Despite continued prevention efforts, statistics show that youth suicide rates have increased in recent years. Suicidal behavior is usually preceded by a period of thoughts about death or suicide, known as suicidal ideation. These thoughts range from general contemplation about the end of life to making concrete plans.
Suicidal thoughts tend to appear when a person feels trapped, hopeless, isolated, or in unbearable emotional pain. They can occur simultaneously with depression, trauma, drug use, or other situations of severe distress. Not all suicidal people want to die permanently; many simply want to stop the pain or escape an unbearable situation.
Lead author Carly J. Reniger and colleagues point out that major theories propose that behavioral traits such as impulsivity function as background vulnerabilities. These characteristics may make suicidal ideation more likely when a person experiences severe psychological distress.
Impulsivity is a general tendency to take actions without considering the consequences. Because of this, distressed and impulsive teens may quickly become suicidal without fully considering other consequences. However, previous studies have not shown a simple link between impulsivity and suicide because impulsivity alone cannot reliably distinguish between those who consider suicide and those who actually attempt suicide.
The authors proposed that the way the brain processes negative outcomes or losses may influence the relationship between impulsivity and suicidal ideation. They conducted a study to examine whether hypersensitivity to financial loss influences this relationship in adolescents.
The final study sample consisted of 63 adolescents who were between 13 and 17 years of age at the start of the study. They were recruited from the Pittsburgh area, and 59% of participants were female. The study initially enrolled 135 participants, but the final sample included only those who completed all required questionnaires and brain scans.
Importantly, two-thirds of the participants were classified as having a high familial risk for mental health problems because they had a parent with a history of lifelong disorders such as major depression or schizophrenia. The remaining one-third of participants had no such family history. Interestingly, the high-risk group showed stronger overall brain activation in the anterior insula when experiencing loss compared to the low-risk group.
At the beginning of the study, participants completed assessments for impulsivity, suicidal ideation, symptoms of depression, and anhedonia, the inability to feel pleasure. They also underwent brain scans using functional magnetic resonance imaging. During this scan, they completed an 8-minute guessing task.
In this task, participants earned $1 for winning a trial and lost 50 cents for losing a trial. Participants believed that their guesses would determine the outcome, but in reality the winners and losers were pre-arranged by the researchers. To ensure fair rewards, everyone received $10 at the end of the game, regardless of performance. One year later, participants again completed the suicidal ideation assessment.
Brain scans revealed distinct clusters of active neurons in the anterior insula when participants experienced a financial loss. The strength of this activation varied among participants, with some showing strong responses in this region during loss and others showing much weaker responses.
Further analysis showed that the association between impulsivity and future suicidal ideation depended on how the right anterior insula responded to the consequences of these losses. Interestingly, in participants with reduced brain activation in response to loss, the association between impulsivity and suicidal ideation was negative. This meant that people with low brain reactivity and high impulsivity were actually less likely to experience suicidal ideation in the future, whereas those with low impulsivity and low brain reactivity faced an increased risk.
Conversely, in teens with high brain activation leading up to the loss, the association between impulsivity and suicidal ideation was positive, meaning that those with high impulsivity were more likely to report increased suicidal ideation. Overall, seven participants had very low brain activity, 10 had very high activity, and 46 had moderate levels of activity. Among the 46 moderate participants, impulsivity was not associated with suicidal ideation.
The authors concluded that the relationship between impulsivity and future suicidal ideation varies based on the brain’s response to negative outcomes. Impulsive adolescents appear to be at higher risk only if they have heightened neural sensitivity to loss, whereas less sensitive adolescents appear to be at lower risk.
These findings may point to specific targets for clinical treatment. Building the ability to tolerate distress and regulate emotional responses to negative experiences may be especially important for impulsive adolescents with highly reactive brains. In contrast, teens with quieter brain responses and less impulsivity may benefit more from treatments that encourage engagement, such as behavioral activation, and methods that stimulate brain networks.
This study contributes to scientific understanding of the neural pathways underlying suicidal ideation. However, it is important to note that the final sample size was relatively small as there were many participants who did not complete all scans and surveys. Furthermore, the monetary losses experienced in this study were very small and may not fully capture how teens would react to more personally relevant or severe losses of life.
The paper, “Anterior insula reactivity to loss moderates the association between trait impulsivity and future suicidal ideation in adolescents,” was published in 2026. The paper’s authors are Carly J. Reniger, Kristen L. Ekstrand, T.H. Stanley Shea, Jennifer S. Silk, Jamie L. Hanson, Melissa Nance, Morgan Lindenmuth, and Gretchen. Haas, Neil Ryan, and Erica E. Forbes.
