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.

Plain language summary

This narrative review explores structural, functional, and genetic aspects of the brain that are associated with the resilience of youth to psychiatric risks. Multiple brain features (eg, greater prefrontal cortex volume and activity, less default mode connectivity) are linked to children and adolescents having fewer psychiatric symptoms or better functioning in the presence of risk factors such as family mood disorder risk or community adversity. These findings have implications for research and for prevention which could be leveraged to develop interventions for youth who are at-risk for developing psychiatric illness.

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.