Narrative Review: A Neurobiological Perspective on Resilience in Youth

Abstract

Objective: Children and adolescents are faced with multiple factors that may pose risks for development of psychiatric morbidity. These include both inherited and environmental factors such as a family history of depression or experiencing adversity. However, not all individuals who have such risks develop illness, due to resilience factors that effectively provide protection from risk. The topic of resilience has received much attention in research in recent years. Its importance lies in improving our theoretical understanding of protection from illness and may also pave the way for psychoeducation to families and intervention for youth.

Method: Understanding the neurobiology underlying resilience may reveal brain-based methods to protect mental health. Relevant literature from 2008 to 2023 was searched for neuroimaging studies that demonstrated youth outcomes linked with fewer psychiatric symptoms or better functioning in the face of psychiatric risks.

Results: This narrative review summarizes current evidence pertaining to the neurobiological underpinnings of resilience, including anatomical, functional, and genetic perspectives of the hippocampus, amygdala, prefrontal and cingulate cortices, white matter tracts, and related networks in youth with environmental or inherited psychiatric risks. In addition, a functional and developmental overview of the involved regions is provided for a comprehensive understanding. Avenues for further research are also discussed.

Conclusion: Psychiatric resilience in youth is linked with multiple neurobiological and genetic features. This evidence could be leveraged toward identification and intervention development to protect mental health in the face of risks.

Clinical guidance: • When constructing clinical case formulations, it is important to include both risk and resilience factors, to reflect parallels in the structure and function of the brain.• In psychoeducation with youth and families, consider inclusion of evidence indicating neurobiological strengths to promote better outcomes.• Functional aspects of the brain, including neurobiology underlying resilience needs to be studied and targeted to develop effective prevention and intervention programs.

Keywords: genetics; minors; neuroscience; psychiatry; psychological resilience.

Figure 1

A Conceptual Framework for the Possible Neurobiological Underpinnings of Resilience Note:(Top to bottom) Figure shows the various effects of childhood exposure to adversity. For example, there can be increased amgydgalar reactivity and amygdalar–hippocampal activity, which have been implicated in psychopathology. Thus, the brain-based changes can be seen in those affected with adversity and associated with development of psychopathology. Similarly, it is conceptualized that various pathways and mechanisms may lead to the development of resilience in the developing brain. For example, the first of those can be blocking the effects of the adversity, as seen in the FKBP5 variant chaperone protein that can affect stress responsivity, leading to blocking of neurobiological changes. The second could be that while susceptibility is present, the neurobiological changes are reversed, for example, by reductions in amygdalar reactivity and changes in connectivity with hippocampus, reversing the changes that can be seen with the childhood exposure to adversity. Finally, when viewing in childhood exposure to adversity, a compensatory change can also be increased maturation (inc volume) of the dlPFC, leading to perhaps more top-down regulation and a decrease in internalizing symptoms in resilient girls. dlPFC = dorsolateral prefrontal cortex; FKBP5=FK506 Binding Protein 5, PFC = prefrontal cortex. Created withBioRender.com.

Figure 2

Regions Implicated in Resilience Note:Regions implicated in resilience in youth; the dorsolateral prefrontal cortex as demonstrated on lateral view (above) and cingulate cortex, prefrontal cortex, ventromedial prefrontal cortex, hippocampus and amygdala demonstrated on a sagittal view (below).Created withBioRender.com.

Figure 3

White Matter Tract Characteristics Implicated in Resilience Note:(A) White matter tracts implicated in resilience and the changes as noted within text. (B) Markers of structural maturation in white matter tracts. AD = axial diffusion; FA = functional anisotropy; MD = mean diffusivity; R = right; RD = radial diffusivity. Created withBioRender.com.