Neural Correlates Involved in Behavioral Metrics of Emotion Regulation and Suicidal Thoughts and Behaviors.

Given the well-documented association between emotion regulation (ER) deficits and suicidal thoughts and behaviors (STBs), and the limited understanding of their neural mechanisms, we reviewed studies across five databases that included validated ER tasks and neuroimaging techniques such as functional magnetic resonance imaging and electroencephalography. This systematic review synthesizes evidence from 11 neuroimaging studies to explore the neural correlates of ER deficits in individuals with STBs. Findings revealed that individuals with STBs exhibit heightened activation in the dorsolateral and ventrolateral prefrontal cortex during ER tasks, alongside increased amygdala reactivity to negative stimuli (e.g., sad facial expressions), in implicit ER paradigms. Heterogeneity in prefrontal cortex activation suggests that task- and population-specific neural signatures may influence these patterns. Our review also identifies methodological limitations in the current literature, including a reliance on cross-sectional designs and small sample sizes, which limit generalizability. These limitations highlight the need for longitudinal and multi-modal studies to better understand the dynamic neural patterns associated with ER and STBs. By elucidating the neural underpinnings of ER deficits in STBs, these findings may enable earlier identification of at-risk individuals and the development of personalized, targeted interventions (e.g., transcranial magnetic stimulation).