Guided by research on the typical stress response during adolescence, Miller & Prinstein [
116] suggest a failure of the biological response to acute interpersonal stress as a potential mechanism for suicidal behaviors. Specifically, interpersonal stress in combination with distal risk factors (e.g., early life adversity) are critical to triggering the biological stress-response system. The biological stress-response system, composed of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, adaptively regulates physiological reactions to stress [
117]. Within existing theories, the atypical biological stress-response may contribute to inadequate coping, a key IMV threat-to-self moderator. When the amount of interpersonal stress exceeds the individual's perceived capacity to cope with the stress and when the individual has been exposed to suicide as a way to escape stress, as is articulated in the 3ST [
100], suicidal behaviors are likely to emerge [
116]. Alternatively, an atypical biological stress-response system may enhance feelings of hopelessness about belongingness with others and perceived burdensomeness when encountering interpersonal stress, thus facilitating more active suicidal thoughts.
Additionally, an atypical biological stress-response system may emerge through neurodevelopmental alterations that arise during pubertal development. Expanding upon the diathesis-stress model, distal genetic and environmental factors directly influence the pubertal transition, which can potentially alter connections between brain regions that are important for ruminative processes and future-oriented thinking.
