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Proinflammatory gene expression is associated with prospective risk for adolescent suicidal thoughts and behaviors over twelve months

Published online by Cambridge University Press:  08 January 2025

Matthew G. Clayton Open the ORCID record for Matthew G. Clayton [Opens in a new window] ,
Steve W. Cole ,
Matteo Giletta ,
Paul D. Hastings Open the ORCID record for Paul D. Hastings [Opens in a new window] ,
Matthew K. Nock ,
Karen D. Rudolph Open the ORCID record for Karen D. Rudolph [Opens in a new window] ,
George M. Slavich Open the ORCID record for George M. Slavich [Opens in a new window]  and
Mitchell J. Prinstein Open the ORCID record for Mitchell J. Prinstein [Opens in a new window]
Matthew G. Clayton*
Affiliation:
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Steve W. Cole
Affiliation:
Division of Hematology-Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
Matteo Giletta
Affiliation:
Department of Psychology, Ghent University, Ghent, Belgium Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
Paul D. Hastings
Affiliation:
Center for Mind and Brain and Department of Psychology, University of California, Davis, CA, USA
Matthew K. Nock
Affiliation:
Department of Psychology, Harvard University, Boston, MA, USA
Karen D. Rudolph
Affiliation:
Department of Psychology, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA
George M. Slavich
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
Mitchell J. Prinstein
Affiliation:
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
*
Corresponding author: Matthew G. Clayton; Email: mgc12@live.unc.edu
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Abstract

Objective:

Recent theories have implicated inflammatory biology in the development of psychopathology and maladaptive behaviors in adolescence, including suicidal thoughts and behaviors (STB). Examining specific biological markers related to inflammation is thus warranted to better understand risk for STB in adolescents, for whom suicide is a leading cause of death.

Method:

Participants were 211 adolescent females (ages 9–14 years; Mage = 11.8 years, SD = 1.8 years) at increased risk for STB. This study examined the prospective association between basal levels of inflammatory gene expression (average of 15 proinflammatory mRNA transcripts) and subsequent risk for suicidal ideation and suicidal behavior over a 12-month follow-up period.

Results:

Controlling for past levels of STB, greater proinflammatory gene expression was associated with prospective risk for STB in these youth. Similar effects were observed for CD14 mRNA level, a marker of monocyte abundance within the blood sample. Sensitivity analyses controlling for other relevant covariates, including history of trauma, depressive symptoms, and STB prior to data collection, yielded similar patterns of results.

Conclusions:

Upregulated inflammatory signaling in the immune system is prospectively associated with STB among at-risk adolescent females, even after controlling for history of trauma, depressive symptoms, and STB prior to data collection. Additional research is needed to identify the sources of inflammatory up-regulation in adolescents (e.g., stress psychobiology, physiological development, microbial exposures) and strategies for mitigating such effects to reduce STB.

Keywords

adolescencebiomarkerschildhood traumainflammationsuicide

Information

Type
Regular Article
Information
Development and Psychopathology , Volume 37 , Issue 3 , August 2025 , pp. 1676 - 1684
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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References

Alley, J., Gassen, J., Parra, L. A., Kipke, M. D., Goldbach, J. T., Cole, S. W., & Slavich, G. M. (in press). How community connection, homophobia, and racism shape gene expression in sexual minority men with and without HIV. Health Psychology. https://doi.org/10.1037/hea0001410 CrossRefGoogle Scholar
Angelakis, I., Austin, J. L., & Gooding, P. (2020). Association of childhood maltreatment with suicide behaviors among young people: A systematic review and meta-analysis. JAMA Network Open, 3(8), e2012563.CrossRefGoogle ScholarPubMed
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0 CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. 2021 Youth Risk Behavior Survey. Available at: www.cdc.gov/YRBSS. Accessed on September 11, 2023.Google Scholar
Centers for Disease Control and Prevention (2014). Youth risk behavior surveillance—United States, 2014. Morbidity and Mortality Weekly Report: Surveillance Summary, 55(SS-5), 1–108. https://doi.org/10.1038/srep25170 Google Scholar
Centers for Disease Control and Prevention (2019). Compressed mortality file 1999-2016 (Series 20 No. 2U) [data set]. http://wonder.cdc.gov/cmf-icd10.html. Accessed on 2021.Google Scholar
Clayton, M. G., Nelson, B. A., Giletta, M., Hastings, P. D., Nock, M. K., Rudolph, K. D., Slavich, G. M., & Prinstein, M. J. (2023). Interpersonal life stress and inflammatory reactivity as prospective predictors of suicide attempts in adolescent females. Research On Child and Adolescent Psychopathology, 51(7), 977–987. https://doi.org/10.1007/s10802-023-01033-4 CrossRefGoogle ScholarPubMed
Colasanto, M., Madigan, S., & Korczak, D. J. (2020). Depression and inflammation among children and adolescents: A meta-analysis. Journal of Affective Disorders, 277, 940–948. https://doi.org/10.1016/j.jad.2020.09.025 CrossRefGoogle ScholarPubMed
Cole, S. W., Shanahan, M. J., Gaydosh, L., & Harris, K. M. (2020). Population-based RNA profiling in add health finds social disparities in inflammatory and antiviral gene regulation to emerge by young adulthood. Proceedings of the National Academy of Sciences of the United States of America, 117(9), 4601–4608. https://doi.org/10.1073/pnas.1821367117 CrossRefGoogle ScholarPubMed
Cole, S. W., Yan, W., Galic, Z., Arevalo, J., & Zack, J. A. (2005). Expression-based monitoring of transcription factor activity: The TELiS database. Bioinformatics, 21(6), 803–810. https://doi.org/10.1093/bioinformatics/bti038 CrossRefGoogle ScholarPubMed
Colmenero-Navarrete, L., García-Sancho, E., & Salguero, J. M. (2022). Relationship between emotion regulation and suicide ideation and attempt in adults and adolescents: A systematic review. Archives of Suicide Research, 26(4), 1702–1735. https://doi.org/10.1080/13811118.2021.1999872 CrossRefGoogle ScholarPubMed
Costello, E. J., & Angold, A. (1988). Scales to assess child and adolescent depression: Checklists, screens, and nets. Journal of the American Academy of Child & Adolescent Psychiatry, 27(6), 726–737. https://doi.org/10.1097/00004583-198811000-00011 CrossRefGoogle ScholarPubMed
Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46–56. https://doi.org/10.1038/nrn2297 CrossRefGoogle ScholarPubMed
Dantzer, R., O’Connor, J. C., Lawson, M. A., & Kelley, K. W. (2011). Inflammation-associated depression: From serotonin to kynurenine. Psychoneuroendocrinology, 36(3), 426–436. https://doi.org/10.1016/j.psyneuen.2010.09.012 CrossRefGoogle ScholarPubMed
Dobin, A., Davis, C. A., Schlesinger, F., Drenkow, J., Zaleski, C., Jha, S., Batut, P., Chaisson, M., & Gingeras, T. R. (2013). STAR: Ultrafast universal RNA-seq aligner. Bioinformatics (Oxford, England), 29(1), 15–21. https://doi.org/10.1093/bioinformatics/bts635 Google ScholarPubMed
Ducasse, D., Olié, E., Guillaume, S., Artéro, S., & Courtet, P. (2015). A meta-analysis of cytokines in suicidal behavior. Brain, Behavior, and Immunity, 46, 203–211. https://doi.org/10.1016/j.bbi.2015.02.004 CrossRefGoogle ScholarPubMed
Eaton, D. K., Lowry, R., Brener, N. D., Galuska, D. A., & Crosby, A. E. (2005). Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students. Archives of Pediatrics & Adolescent Medicine, 159(6), 513–519. https://doi.org/10.1001/archpedi.159.6.513 CrossRefGoogle ScholarPubMed
Eisenlohr-Moul, T. A., Miller, A. B., Giletta, M., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J. (2018). HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: A multilevel diathesis-stress framework. Neuropsychopharmacology, 43(13), 2564–2571. https://doi.org/10.1038/s41386-018-0206-6 CrossRefGoogle ScholarPubMed
Essex, M. J., Thomas Boyce, W., Hertzman, C., Lam, L. L., Armstrong, J. M., Neumann, S. M., & Kobor, M. S. (2013). Epigenetic vestiges of early developmental adversity: Childhood stress exposure and DNA methylation in adolescence. Child Development, 84(1), 58–75. https://doi.org/10.1111/j.1467-8624.2011.01641.x CrossRefGoogle ScholarPubMed
Fikke, L. T., Melinder, A., & Landrø, N. I. (2011). Executive functions are impaired in adolescents engaging in non-suicidal self-injury. Psychological Medicine, 41(3), 601–610. https://doi.org/10.1017/S0033291710001030 CrossRefGoogle ScholarPubMed
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. https://doi.org/10.1037/bul0000084 CrossRefGoogle ScholarPubMed
Georgieva, S., Tomas, J. M., & Navarro-Pérez, J. J. (2021). Systematic review and critical appraisal of Childhood Trauma Questionnaire - Short Form (CTQ-SF). Child Abuse & Neglect, 120, 105223. https://doi.org/10.1016/j.chiabu.2021.105223 CrossRefGoogle ScholarPubMed
Gil, A., Aguilera, C. M., Gil-Campos, M., & Canete, R. (2007). Altered signalling and gene expression associated with the immune system and the inflammatory response in obesity. British Journal of Nutrition, 98(S1), S121–S126.CrossRefGoogle ScholarPubMed
Gili, M., Castellví, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., Cebrià, A. I., Gabilondo, A., Pérez-Ara, M . A., A, M.-M., Lagares, C., Parés-Badell, O., Piqueras, J. A., Rodríguez-Jiménez, T., Rodríguez-Marín, J. A., Soto-Sanz, V., Alonso, J., & Roca, M. (2019). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. Journal of Affective Disorders, 245, 152–162. https://doi.org/10.1016/j.jad.2018.10.115 CrossRefGoogle Scholar
Heidt, T., Sager, H. B., Courties, G., Dutta, P., Iwamoto, Y., Zaltsman, A., von Zur Muhlen, C., Bode, C., Fricchione, G. L., Denninger, J., Lin, C. P., Vinegoni, C., Libby, P., Swirski, F. K., Weissleder, R., & Nahrendorf, M. (2014). Chronic variable stress activates hematopoietic stem cells. Nature Medicine, 20(7), 754–758. https://doi.org/10.1038/nm.3589 CrossRefGoogle ScholarPubMed
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., Ryan, N., & et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988. https://doi.org/10.1097/00004583-199707000-00021 CrossRefGoogle ScholarPubMed
Korhonen, T., Sihvola, E., Latvala, A., Dick, D. M., Pulkkinen, L., Nurnberger, J., & Kaprio, J. (2018). Early-onset tobacco use and suicide-related behavior-A prospective study from adolescence to young adulthood. Addictive Behaviors, 79, 32–38. https://doi.org/10.1016/j.addbeh.2017.12.008 CrossRefGoogle ScholarPubMed
Kuhlman, K. R., Horn, S. R., Chiang, J. J., & Bower, J. E. (2020). Early life adversity exposure and circulating markers of inflammation in children and adolescents: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 86, 30–42. https://doi.org/10.1016/j.bbi.2019.04.028 CrossRefGoogle Scholar
Lindsay, E. K., Marsland, A. L., Cole, S. W., Dutcher, J. M., Greco, C. M., Wright, A. G. C., Brown, K. W., & Creswell, J. D. (2024). Mindfulness-based stress reduction reduces pro-inflammatory gene regulation but not systemic inflammation among older adults: A randomized controlled trial. Psychosomatic Medicine, 86(5), 463–472. https://doi.org/10.1097/PSY.0000000000001264 CrossRefGoogle Scholar
Massing-Schaffer, M., Helms, S. W., Rudolph, K. D., Slavich, G. M., Hastings, P. D., Giletta, M., Nock, M. K., & Prinstein, M. J. (2019). Preliminary associations among relational victimization, targeted rejection, and suicidality in adolescents: A prospective study. Journal of Clinical Child & Adolescent Psychology, 48(2), 288–295. https://doi.org/10.1080/15374416.2018.1469093 CrossRefGoogle ScholarPubMed
McHugh, C. M., Lee, R. S. C., Hermens, D. F., Corderoy, A., Large, M., & Hickie, I. B. (2019). Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. Journal of Psychiatric Research, 116, 51–60. https://doi.org/10.1016/j.jpsychires.2019.05.012 CrossRefGoogle ScholarPubMed
Miller, A. B., & Prinstein, M. J. (2019). Adolescent suicide as a failure of acute stress-response systems. Annual Review of Clinical Psychology, 15(1), 425–450. https://doi.org/10.1146/annurev-clinpsy-050718-095625 CrossRefGoogle ScholarPubMed
Miller, A. H. (2020). Beyond depression: The expanding role of inflammation in psychiatric disorders. World Psychiatry, 19(1), 108–109. https://doi.org/10.1002/wps.20723 CrossRefGoogle Scholar
Murphy, M. L. M., Slavich, G. M., Rohleder, N., & Miller, G. E. (2013). Targeted rejection triggers differential pro- and anti-inflammatory gene expression in adolescents as a function of social status. Clinical Psychological Science, 1(1), 30–40. https://doi.org/10.1177/2167702612455743 CrossRefGoogle ScholarPubMed
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309 CrossRefGoogle Scholar
Nusslock, R., & Miller, G. E. (2016). Early-life adversity and physical and emotional health across the lifespan: A neuroimmune network hypothesis. Biological Psychiatry, 80(1), 23–32. https://doi.org/10.1016/j.biopsych.2015.05.017 CrossRefGoogle ScholarPubMed
Onat, M., İnal Emiroğlu, N., Baykara, B., Özerdem, A. C., Özyurt, G., Öztürk, Y., Şahin, C., Ildız, A. C., Kaptancık Bilgiç, B., Hıdıroğlu Ongun, C., & Pekcanlar Akay, A. (2019). Executive functions and impulsivity in suicide attempter adolescents with major depressive disorder. Psychiatry and Clinical Psychopharmacology, 29(3), 332–339. https://doi.org/10.1080/24750573.2018.1541647 CrossRefGoogle Scholar
Petersen, A. C., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: Reliability, validity, and initial norms. Journal of Youth and Adolescence, 17(2), 117–133. https://doi.org/10.1007/BF01537962 CrossRefGoogle ScholarPubMed
Phillips, M. L., Ladouceur, C. D., & Drevets, W. C. (2008). A neural model of voluntary and automatic emotion regulation: Implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Molecular Psychiatry, 13(9), 833–857. https://doi.org/10.1038/mp.2008.65 CrossRefGoogle ScholarPubMed
Powell, N. D., Sloan, E. K., Bailey, M. T., Arevalo, J. M., Miller, G. E., Chen, E., Kobor, M. S., Reader, B. F., Sheridan, J. F., & Cole, S. W. (2013). Social stress up-regulates inflammatory gene expression in the leukocyte transcriptome via β-adrenergic induction of myelopoiesis. Proceedings of the National Academy of Sciences of the United States of America, 110(41), 16574–16579. https://doi.org/10.1073/pnas.1310655110 CrossRefGoogle ScholarPubMed
Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76(1), 92–103. https://doi.org/10.1037/0022-006X.76.1.92 CrossRefGoogle ScholarPubMed
Reid, B. M., Doom, J. R., Argote, R. B., Correa-Burrows, P., Lozoff, B., Blanco, E., & Gahagan, S. (2020). Pathways to inflammation in adolescence through early adversity, childhood depressive symptoms, and body mass index: A prospective longitudinal study of Chilean infants. Brain, Behavior, and Immunity, 86, 4–13. https://doi.org/10.1016/j.bbi.2019.06.003 CrossRefGoogle ScholarPubMed
Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls and boys. Psychological Bulletin, 132(1), 98–131. https://doi.org/10.1037/0033-2909.132.1.98 CrossRefGoogle Scholar
Rudolph, K. D., & Flynn, M. (2007). Childhood adversity and youth depression: Influence of gender and pubertal status. Development and Psychopathology, 19(2), 497–521. https://doi.org/10.1017/S0954579407070241 CrossRefGoogle ScholarPubMed
Schilling, E. A., Aseltine, R. H. Jr, James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44(4), 335–341. https://doi.org/10.1016/j.jadohealth.2008.08.006 CrossRefGoogle ScholarPubMed
Serafini, G., Parisi, V. M., Aguglia, A., Amerio, A., Sampogna, G., Fiorillo, A., Pompili, M., & Amore, M. (2020). A specific inflammatory profile underlying suicide risk? Systematic review of the main literature findings. International Journal of Environmental Research and Public Health, 17(7), 2393. https://doi.org/10.3390/ijerph17072393 CrossRefGoogle ScholarPubMed
Slavich, G. M. (2020). Social safety theory: A biologically based evolutionary perspective on life stress, health, and behavior. Annual Review of Clinical Psychology, 16(1), 265–295. https://doi.org/10.1146/annurev-clinpsy-032816-045159 CrossRefGoogle ScholarPubMed
Slavich, G. M. (2022). Social safety theory: Understanding social stress, disease risk, resilience, and behavior during the COVID-19 pandemic and beyond. Current Opinion in Psychology, 45, 101299. https://doi.org/10.1016/j.copsyc.2022.101299 CrossRefGoogle ScholarPubMed
Slavich, G. M., & Auerbach, R. P. (2018). Stress and its sequelae: Depression, suicide, inflammation, and physical illness. In Butcher, J. N., & Hooley, J. M. (Ed.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders (pp. 375–402). American Psychological Association, https://doi.org/10.1037/0000064-016 CrossRefGoogle Scholar
Slavich, G. M., & Cole, S. W. (2013). The emerging field of human social genomics. Clinical Psychological Science, 1(3), 331–348. https://doi.org/10.1177/2167702613478594 CrossRefGoogle ScholarPubMed
Slavich, G. M., Giletta, M., Helms, S. W., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J. (2020). Interpersonal life stress, inflammation, and depression in adolescence: Testing social signal transduction theory of depression. Depression and Anxiety, 37, 179–193. https://doi.org/10.1002/da.22987 CrossRefGoogle ScholarPubMed
Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychological Bulletin, 140(3), 774–815. https://doi.org/10.1037/a0035302 CrossRefGoogle ScholarPubMed
Slavich, G. M., Mengelkoch, S., & Cole, S. W. (2023a). Human social genomics: Concepts, mechanisms, and implications for health. Lifestyle Medicine, 4, e75. https://doi.org/10.1002/lim2.75 CrossRefGoogle ScholarPubMed
Slavich, G. M., Roos, L. G., Mengelkoch, S., Webb, C. A., Shattuck, E. C., Moriarity, D. P., & Alley, J. C. (2023b). Social safety theory: Conceptual foundation, underlying mechanisms, and future directions. Health Psychology Review, 17(1), 5–59. https://doi.org/10.1080/17437199.2023.2171900 CrossRefGoogle ScholarPubMed
Slavich, G. M., Thornton, T., Torres, L. D., Monroe, S. M., & Gotlib, I. H. (2009). Targeted rejection predicts hastened onset of major depression. Journal of Social and Clinical Psychology, 28(2), 223–243. https://doi.org/10.1521/jscp.2009.28.2.223 CrossRefGoogle ScholarPubMed
Slavish, D. C., Graham-Engeland, J. E., Smyth, J. M., & Engeland, C. G. (2015). Salivary markers of inflammation in response to acute stress. Brain, Behavior, and Immunity, 44, 253–269. https://doi.org/10.1016/j.bbi.2014.08.008 CrossRefGoogle Scholar
Stroud, L. R., Papandonatos, G. D., D’Angelo, C. M., Brush, B., & Lloyd-Richardson, E. E. (2017). Sex differences in biological response to peer rejection and performance challenge across development: A pilot study. Physiology & Behavior, 169, 224–233. https://doi.org/10.1016/j.physbeh.2016.12.005 CrossRefGoogle ScholarPubMed
Thabrew, H., Stasiak, K., Bavin, L. M., Frampton, C., & Merry, S. (2018). Validation of the mood and feelings questionnaire (MFQ) and short mood and feelings questionnaire (SMFQ) in New Zealand help-seeking adolescents. International Journal of Methods in Psychiatric Research, 27(3), e1610–268. https://doi.org/10.1016/S0165-1781(98)00073-0 CrossRefGoogle ScholarPubMed
Toomey, R. B., Syvertsen, A. K., & Shramko, M. (2018). Transgender adolescent suicide behavior. Pediatrics, 142(4), e20174218. https://doi.org/10.1542/peds.2017-4218 CrossRefGoogle ScholarPubMed
Vargas-Medrano, J., Diaz-Pacheco, V., Castaneda, C., Miranda-Arango, M., Longhurst, M. O., Martin, S. L., Ghumman, U., Mangadu, T., Chheda, S., Thompson, P. M., & Gadad, B. S. (2020). Psychological and neurobiological aspects of suicide in adolescents: Current outlooks. Brain, Behavior, & Immunity-Health, 7, 100124. https://doi.org/10.1016/j.bbih.2020.100124 CrossRefGoogle ScholarPubMed
Zeller, M. H., Reiter-Purtill, J., Jenkins, T. M., & Ratcliff, M. B. (2013). Adolescent suicidal behavior across the excess weight status spectrum. Obesity, 21(5), 1039–1045. https://doi.org/10.1002/oby.20084 CrossRefGoogle ScholarPubMed