Preventing suicide by young people requires integrative strategies

In reply: We are delighted that our recent editorial1 received positive and inspiring feedback from Malhi and colleagues.2 Indeed, reducing disease burdens associated with suicidal thoughts or behaviour requires not only integrative intervention and prevention programs but also evidence‐based approaches informed by in‐depth knowledge of mechanisms.

We also agree that mental illnesses remain a major point of intervention for suicidality.

Pathological mechanisms linked to such illnesses are also likely to play a pivotal role, foreshadowing novel therapeutic targets. Accumulating evidence illuminates neuropsychological mechanisms underlying aberrant cognitions that correlate with suicidal ideation or behaviour. For example, emotional dysregulation could lead to biased emotional appraisal and impulsive behaviour, including self‐injurious or suicidal attempts.3 Suicidal imagery may be crucial,4 as may defeat, entrapment and volitional motivational moderators.5 Moreover, since most suicidal behaviours among youths occur in response to discrete stressful precipitants, it has been hypothesised that suicides among youths are consequences of dysregulated acute stress responses.6 A deeper understanding of mechanisms underlying suicidality allows investigation of modifiable risk factors associated with stressful precipitants. Early childhood traumatic experiences, negative peer relationships, and other lifetime stressful events can be studied in the context of neuropsychological responses associated with suicidality.

A better understanding of the mechanisms associated with these aberrant cognitions, emotional dysregulation and stressful events that coexist with mental disorders can clarify clinical presentations and prevention and intervention strategies. This includes the identification of early signs of suicidal ideation or behaviour and early intervention to avert the cascade.

To conclude, we resonate with Malhi and colleagues that mechanism‐informed knowledge can inform clinical practice, paving the way for targeted prevention and intervention strategies for suicide. More rigorous research on biological and neuropsychological mechanisms is needed to complement that regarding sociocultural factors and to guide the translation of mechanism‐based research findings into clinical practice for suicide prevention and intervention.