Narrative review highlights distinct biological processes in pediatric suicidal behavior compared to adults

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Frontiers in Medicine Published May 28, 2026 Medically reviewed May 28, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note that adult biomarker data cannot be directly extrapolated to youth for suicidal behavior.

This narrative review addresses biological signatures of suicidal ideation, suicide attempt, and death by suicide specifically within pediatric and adolescent populations. The authors compare these findings against adult data to determine if youth and adults share a single continuum of severity or possess distinct biological markers. The review concludes that biological signatures are partially distinct rather than lying on a single continuum of severity.

The analysis indicates that cortisol regulation and stress-related DNA methylation differ in direction between pediatric and adult cohorts. Furthermore, the biological processes underlying pediatric suicidal behavior are developmentally distinct and cannot be inferred from adult findings. These qualitative conclusions highlight the complexity of translating adult biomarker data to youth.

The authors note that pediatric-specific evidence remains limited and the extent to which adult findings can be extrapolated to youth is unclear. Advancing the field will require longitudinal, multimodal pediatric studies that disaggregate suicidal phenotypes, span the pubertal transition, and apply age-stratified reference ranges. This approach supports biologically informed stratification and mechanism-targeted intervention while acknowledging that adult biomarker data cannot be directly extrapolated to youth.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundSuicide is the second leading cause of death among children and adolescents, with rates of pediatric suicidal behavior rising substantially over the past two decades. The neurobiology of suicide has been extensively studied in adults, yet pediatric-specific evidence remains limited and the extent to which adult findings can be extrapolated to youth is unclear. This review synthesizes current evidence on the neurobiological correlates of suicidal ideation, suicide attempt, and death by suicide in pediatric and adolescent populations across neurological, genetic, epigenetic, inflammatory, metabolic, and endocrine domains.MethodsA literature search was conducted in PubMed, Embase, PsycINFO, and Google Scholar for peer-reviewed, English-language human studies. Priority was given to pediatric and adolescent samples, with adult data included where pediatric evidence was lacking. Studies were grouped by biological domain and by suicidal phenotype.ResultsSuicidal ideation, suicide attempt, and death by suicide showed partially distinct biological signatures rather than lying on a single continuum of severity. Different markers, most notably cortisol regulation and stress-related DNA methylation, differed in direction between pediatric and adult cohorts, indicating that adult biomarker data cannot be directly extrapolated to youth. Findings converged on a developmental cascade in which genetic liability and early-life adversity influence the hypothalamic-pituitary-adrenal axis, with downstream effects on epigenetic regulation, neuroinflammation, neurochemistry, and frontolimbic circuitry.ConclusionsPediatric suicidal behavior reflects developmentally distinct biological processes that cannot be inferred from adult findings. Advancing the field will require longitudinal, multimodal pediatric studies that disaggregate suicidal phenotypes, span the pubertal transition, and apply age-stratified reference ranges, supporting biologically informed stratification and mechanism-targeted intervention.