Neurocognitive characteristics of short-term risk for suicidal behavior in adolescents

摘要 自杀是青少年死亡的第二大原因。事实上，全国自杀率已经 在过去15年中增长了24%，儿童和青少年自杀就诊人数在#年翻了一番 在过去的10年里。尽管已有大量研究致力于确定自杀的风险因素 在行为方面，到目前为止的研究重点是长期风险，平均随访间隔为10年。 事实上，目前还没有关于青少年这种行为的短期风险的研究。解决这一差距 自杀研究很重要，因为长期风险因素不能很好地预测短期风险。因此， 澄清与自杀行为的短期风险相关的过程对于增进我们的知识是很重要的 从谁面临风险到他们面临的风险最大的时间。神经认知功能已被确认为有 特别是作为短期风险指标的潜力。尽管神经认知功能的核心组件有 与自杀有关，青少年自杀企图的短期纵向研究值得注意的是 缺乏。此外，尽管传统的统计方法已经被用来对这些神经认知进行建模 过程，计算精神病学中涉及认知过程模型的最新发展可能会更多 实事求是地反映这些过程。此外，计算精神病学允许同时 以一种产生复杂预测模型的方式考虑多个变量 大大优于传统统计方法得出的结果。我们的长期目标是改进 检测短期风险，并确定临床干预的潜在可修改目标。为此， 目前应用的目标是评估短期风险的候选神经认知标记物 青少年精神病患者的自杀企图和自杀事件(即一个月以上的随访) 计算精神病学的新进展补充了传统的统计方法。 重要的是，缺乏研究自杀行为短期风险的主要原因是 青少年的问题是，这种行为的低基准率对可行性构成了重大挑战。大型 需要从高危或临床严重人群中提取样本以克服这一障碍。我们是 通过利用我们当前研究中的现有数据，我们处于独特的地位来应对这一挑战。我们会一起打球 我们目前的数据收集了200名新患者的数据，最终样本为414人。这个应用程序是创新的 通过：(I)是对一个月以上企图自杀的风险因素进行的第一次统计研究； 全面的神经认知电池，包括一般神经认知和特定于自我伤害的神经认知 以及(Iii)应用新的计算精神病学方法来模拟 短期风险。这项申请解决了NIMH/National的抱负目标1的研究目标 预防自杀行动联盟的优先预防自杀研究议程：确定 神经精神病学特征和认知功能障碍与自杀风险相关。

Abstract Suicide is the second leading cause of death among adolescents. In fact, the national suicide rate has increased 24% over the last 15 years, and hospital visits for child and adolescent suicidality have doubled in the last 10 years. Although considerable research has been devoted to identifying risk factors for suicidal behavior, the research to date has focused on long-term risk, with average follow-up intervals of 10 years. Indeed, there are currently no studies of short-term risk for this behavior in adolescents. Addressing this gap in suicide research is important because long-term risk factors are poor predictors of short-term risk. Therefore, clarifying processes relevant to short-term risk for suicidal behavior is important for advancing our knowledge from who is at risk to when they are most at risk. Neurocognitive function has been identified as having particular potential as indicators of short-term risk. Although core components of neurocognitive function have been associated with suicidality, short-term longitudinal studies of adolescent suicide attempts, are notably lacking. Additionally, although traditional statistical methods have been used to model these neurocognitive processes, recent developments in computational psychiatry involving cognitive process models may more realistically reflect these processes. Furthermore, computational psychiatry allows for simultaneous consideration of multiple variables in a manner that produces a complex prediction model that is often substantially superior to those derived from traditional statistical approaches. Our long-term goal is to improve detection of short-term risk and to identify potential modifiable targets for clinical intervention. Toward this end, the objective of the current application is to evaluate candidate neurocognitive markers of short-term risk for suicide attempts and suicidal events (i.e., over one-month follow-up) in a sample of adolescent psychiatric inpatients, supplementing traditional statistical methods with novel advances in computational psychiatry. Importantly, the primary reason for the absence of studies investigating short-term risk for suicidal behavior in adolescents is that the low base rate for this behavior poses a significant challenge for feasibility. Large samples drawn from high-risk or clinically severe populations are required to overcome this obstacle. We are uniquely positioned to address this challenge by leveraging existing data from our current studies. We will pool our current data with data collected on 200 new patients for a final sample of 414. This application is innovative by: (i) being the first statistically powered study of risk factors for suicide attempts over one month; (ii) featuring a comprehensive neurocognitive battery that includes general and self-harm-specific neurocognitive processes; and (iii) applying novel computational psychiatry approaches to modelling neurocognitive indices of short-term risk. This application addresses the research objectives of Aspirational Goal 1 in the NIMH/National Action Alliance for Suicide Prevention's Prioritized Research Agenda for Suicide Prevention: identifying neuropsychiatric profiles and cognitive dysfunction associated with suicide risk.